Laparoscopic Surgery Group Research Articles

Canagliflozin and irbesartan ameliorate renal fibrosis via the TGF-β1/Smad signaling pathway in Dahl salt-sensitive rats.

This study assessed the antifibrotic effects of canagliflozin, with or without irbesartan, on renal injury in Dahl salt-sensitive (SS) rats fed a high-salt (HS) diet. After the preconditioning stage, Dahl SS rats (n = 47) were divided into five experimental groups as follows: low-salt (LS, n = 7), HS (n = 10), HS with canagliflozin (n = 10), HS with irbesartan (n = 10), and HS with canagliflozin and irbesartan (n = 10). The HS diet increased systolic blood pressure (SBP), renal fibrosis, fibrotic protein expression, and transforming growth factor-β1 (TGF-β1)/Smad2/3 pathway protein expression compared with the findings in the LS group. Irbesartan reduced SBP and slowed the loss of renal function. Canagliflozin significantly reduced body weight and renal fibrosis and suppressed the TGF-β1/Smad2/3 pathway. The combined therapy exerted better renoprotective effects on all outcome parameters. These results indicate that canagliflozin and irbesartan exert different effects on renal injury in SS hypertensive rats, and the combined regimen could have stronger effects than either monotherapy.

The physical, mechanical and fire performance of bamboo scrimber processed with thermal-treated bamboo bundles

Thermal treatment is gaining increasing attention for bamboo modification in practical production due to its advantages of simplicity, effectiveness and environmental friendliness, particularly in the production of bamboo scrimber. The objective of this study is to investigate the effects of two typical thermal modification methods on the physical, mechanical and fire performance of bamboo scrimber, as well as the related physicochemical properties of bamboo bundles for production purpose. The results indicated that the two types of bamboo scrimber processed distinct advantages in terms of physical and mechanical performances. Specifically, the one processed with bamboo bundles treated by superheated steam at a temperature of 200 ℃ (referred to as the “HL group”), exhibited exceptional dimensional stability and fire resistance, while exhibiting slightly lower mechanical properties. Notably, the HL group exhibited a significantly more pronounced hue compared to the LS group, which was treated with saturated vapor at a temperature of 140 ℃. Both demonstrated exceptional water resistance, with the HL group surpassing that of the LS group in either 24-hour room temperature or a combination of boiling-drying cycling treatments. The MORs of the LS group were determined to be 152.3 MPa and 108.5 MPa under dry and wet conditions, respectively, exhibiting significantly higher values than those observed in the HL group. Conversely, the variation of MOEs was found to be opposite. Both MORs and MOEs of the two groups exhibited a significant decrease in wet condition compared to those in dry condition, with reductions linearly correlated to water absorption of the samples. The failure mode of the LS group demonstrated elastoplastic failure characterized by a “Z-shaped”, while the HL group exhibited with a relatively flat cross-section. Furthermore, the HL group demonstrated superior fire performance in comparison to the LS group, and as evidenced by a significantly denser char residue surface with fewer and wider cracks than that of the LS group. The variations of chemical components and microstructures in bamboo can be attributed to variances in the extent of degradation of hemicellulose, lignin, and even cellulose during the thermal modification processes. The water resistance, dimensional stability and fire performance of bamboo scrimber can be significantly improved through thermal treatment, while resulting in a decrease in MOR, particularly for the HL group. The HL and LS groups of bamboo scrimber both exhibited excellent performances, making them suitable for application as structural engineering materials. The work we conducted offers experimental and theoretical support for improve the pre-treatment procedures of bamboo in the manufacturing of bamboo scrimber for structural utilizations.

Zinc protoporphyrin IX generation by Leuconostoc strains isolated from bulged pasteurized vacuum sliced hams

The colour of meat typically fades as it decays. However, it has been observed that certain vacuum-packaged spoiled hams can maintain a pink colour even when the packaging is bulged. A large amount of Zinc protoporphyrin IX (ZnPP) was found in these hams, compared to fresh red hams or spoiled and grey hams. Combined with high-throughput sequencing and cultural isolation, the potential cultures of Leuconostoc mesenteroides S-13 (LM), Leuconostoc citreum OCLC11 (LC), and Leuconostoc mesenteroides subsp. IMAU:80679 (LS) were selected based on their ability to produce ZnPP. Subsequently, these cultures were introduced into a fermented sausage model to assess their effect on colour conversion. The analysis of absorption and fluorescent spectra showed that Nitrite sausages contained nitrosyl heme pigment, while bacteria-inoculated sausages were predominantly composed of ZnPP. In addition, the a* value of the LS sausage was close to the Nitrite group at the end of fermentation, significantly higher than control, indicating the effect of bacterial metabolism on the redness. Meanwhile, the Ferrochelatase (FECH) activity of LM, LC and LS groups were 140 ± 13, 113 ± 16 and 201 ± 20 U/g sausage, respectively, providing a potential method on compensating for nitrite/nitrate substitution based on the presence of ZnPP in meat products.

Efficacy of lumbosacral and sacrococcygeal epidural ropivacaine in dogs undergoing surgery for perineal hernia.

Epidural anesthesia is commonly administered as part of balanced anesthesia for perioperative analgesia. The main goal of this randomized clinical trial was to compare the efficacy of two epidural approaches in dogs undergoing surgery for a perineal hernia. A secondary aim was to compare motor blockade. Intact ASA 1 and 2 male dogs, weighing ≤25 kg with no previous surgery for perineal hernia were enrolled. After premedication with IM acepromazine 0.02 mg/kg and butorphanol 0.3 mg/kg, general anesthesia was induced with propofol and maintained with sevoflurane in oxygen. Dogs were randomly allocated to receive either a lumbosacral (LS, n = 30) or a sacrococcygeal (SC, n = 26) epidural injection with ropivacaine 1% (0.2 mL/kg) under computed tomography guidance. Successful analgesia was defined as no need of intraoperative rescue analgesia (fentanyl 3 μg/kg IV). Clinical failure was defined as the need of more than two boluses of fentanyl/h each dog received meloxicam 0.2 mg/kg IV at the end of the surgery. The Glasgow Composite Pain Scale short form (GCPS-SF), tactile sensitivity, pressure pain thresholds and motor blockade were assessed at 4, 6, 8, and 24 h after the epidural injection. Methadone (0.2 mg/kg, IV) was administered if the GCPS-SF was ≥6/24 points. Differences between groups were analyzed with the Mann-Whitney U test, Student's t-test or Fisher's Exact test, as appropriate. Success rate was assessed for non-inferiority between groups. The non-inferiority margin was set at -10%. Epidural analgesia was successful in 24 dogs in group LS and 17 dogs in group SC (p = 0.243), resulting in success rates of 80 and 65% in LS and SC groups, respectively. The non-inferiority of group SC versus group LS was confirmed. Clinical failure was recorded in two dogs in group LS and one dog in group SC. No significant differences between groups were detected in the GCPS-SF score, tactile sensitivity, pressure pain thresholds, need of post-operative methadone, or motor blockade. Both epidural techniques are valuable analgesic options for perineal hernia repair in dogs.

Comparison of Double-Port Laparoscopic-Assisted Extracorporeal Suture Technique and Open Surgical Repair in Morgagni Hernia

Background: We aimed to compare the results of open surgery and double-port laparoscopic-assisted extracorporeal suturing repair for the treatment of morgagni hernia (MH). Methods: Twenty-two patients with MH who were operated on in our clinic between January 2012 and January 2023 were included in the study. Patients were divided into two groups according to the surgical technique as open surgery (OS) (n=14) or laparoscopic surgery (LS) (n=8). Retrospective comparisons were made between the groups' demographic information, surgical method used, defect size, operation time, hospital stay length, cost, postoperative problems, and recurrence. Results: There were no statistically significant differences between the groups in terms of gender, defect size, and costs (p>0.05). The mean age of the patients in the LS group (101 ± 68.3 months) was significantly higher than that of the OS group (23 ± 18.2 months) (p=0.005). It was determined that the operation time of the LS group (33.8 ± 3.6) was significantly shorter than that of the OS group (50.8 ± 6.5) (p<0.01). Moreover, the LS group’s length of hospitalization (1.6 ± 0.9) was significantly lower than the OS group’s (2.8 ± 0.7) (p=0.027). Conclusion: Double-port laparoscopic-assisted extracorporeal suturing repair technique is a reliable technique that can be preferred over open surgical repairs due to its shorter operative time and hospital stay, ease of application, better cosmetic results, and no cost difference.

Transfer of acquired practical skills from dry lab into live surgery using the avatera robotic system: An experimental study

ObjectiveTo evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. Material and methodsAn in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10−14 h dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. ResultsAll procedures were completed successfully by all groups except the pyeloplasty by group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. ConclusionsAlthough further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study.

1282 Comparing Overall Survival and Oncological Recurrence in Laparoscopic and Open Hepatectomy for Colorectal Cancer Metastases: A Systematic Review

Abstract Aim The use of laparoscopic surgery (LS) for liver resection has risen exponentially and is competing, in popularity, with open surgery (OPS). The aim of this study is to compare the oncological recurrence and overall survival of LS and OPS approaches for colorectal cancer liver metastases resection. Method A literature search was conducted, in-line with the PRISMA guidelines, via Ovid and PubMed to collect manuscripts dated between 01/01/2010-01/03/2021. The outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and negative resection margins (R0). A modified quality assessment was achieved using the Newcastle-Ottawa Score (NOS) and the ROBINS-I Tool, and the data was analysed using Stata 16.0. Results Overall, 10 studies were selected of which included a total of 1924 patients. The results show the 1-, 3- and 5-years RFS and OS for LS and OPS were comparable, therefore not significant. Whereas the R0 differences were small yet significant - the LS group had an 89.9% R0 (95% CI: 87% to 92.8%) and for OPS was 85.4% (95% CI: 81% to 88.9%), Z – score of 1.6550, p = 0.0490 (p < 0.05). Even though the results are not significant for RFS and OS, LS is preferable for patients in improving the quality of life in the long-term. Conclusions There is little difference between OPS and LS methods as it pertains to the quality of life. With LS being less invasive and having marginally better results, doctors should consider prioritising LS for patients with colorectal cancer liver metastasis as an alternative to OPS.

Outcomes of Laparoscopic Versus Open Liver Resection: A Case-control Study With Propensity Score Matching.

This study aimed to evaluate the perioperative outcomes of patients with benign and malignant liver lesions scheduled for laparoscopic and open surgery using a propensity score-matched approach to analyze additional cofactors influencing outcomes. In this study, we retrospectively reviewed 270 patients who underwent laparoscopic or open liver resection at our institute between October 2016 and November 2021. Patients were divided into open and laparoscopic liver resection groups and compared according to the intention to treat principle. In the purification process for the nonrandom nature of the study, a matching analysis was performed at a 1:1 case-control ratio. The PS model included selected data on body mass index, additional data on the American Society of Anesthesiology score, cirrhosis, lesion <2cm from the hilum, lesion <2cm from the hepatic vein or inferior vena cava, and type of neoadjuvant chemotherapy. The operation time and 30- and 90-day mortality rates were similar between the groups. The average length of hospital stay was 11 days in the open surgery group and 9 days in the laparoscopic surgery group after matching (P=0.011). The 30-day morbidity rate was statistically different between the groups before and after matching, favoring the laparoscopic group (P=0.001 and 0.006, respectively). After the propensity score-matched approch, the open group's Pringle time was shorter than that of the laparoscopic group. The total operative time was longer in the laparoscopic than in the open surgery group. This did not change after matching (300 vs. 240min). Laparoscopic surgery is a feasible and safe treatment option for patients with liver tumors, with promising results in terms of morbidity and hospital stay.

Anatomical classification of and laparoscopic surgery for left-sided colorectal cancer with persistent descending mesocolon

Objective: To investigate anatomical morphology and classification of persistent descending mesocolon (PDM) in patients with left-sided colorectal cancer, as well as the safety of laparoscopic radical surgery for these patients. Methods: This is a descriptive study of case series. Relevant clinical data of 995 patients with left colon and rectal cancer who had undergone radical surgery in Fujian Medical University Union Hospital from July 2021 to September 2022 were extracted from the colorectal surgery database of our institution and retrospectively analyzed. Twenty-four (2.4%) were identified as PDM and their imaging data and intra-operative videos were reviewed. We determined the distribution and morphology of the descending colon and mesocolon, and evaluated the feasibility and complications of laparoscopic surgery. We classified PDM according to its anatomical characteristics as follows: Type 0: PDM combined with malrotation of the midgut or persistent ascending mesocolon; Type 1: unfixed mesocolon at the junction between transverse and descending colon; Type 2: PDM with descending colon shifted medially (Type 2A) or to the right side (Type 2B) of the abdominal aorta at the level of the origin of the inferior mesentery artery (IMA); and Type 3: the mesocolon of the descending-sigmoid junction unfixed and the descending colon shifted medially and caudally to the origin of IMA. Results: The diagnosis of PDM was determined based on preoperative imaging findings in 9 of the 24 patients (37.5%) with left-sided colorectal cancer, while the remaining diagnoses were made during intraoperative assessment. Among 24 patients, 22 were male and 2 were female. The mean age was (63±9) years. We classified PDM as follows: Type 0 accounted for 4.2% (1/24); Type 1 for 8.3% (2/24); Types 2A and 2B for 37.5% (9/24) and 25.0% (6/24), respectively; and Type 3 accounted for 25.0% (6/24). All patients with PDM had adhesions of the mesocolon that required adhesiolysis. Additionally, 20 (83.3%) of them had adhesions between the mesentery of the ileum and colon. Twelve patients (50.0%) required mobilization of the splenic flexure. The inferior mesenteric artery branches had a common trunk in 14 patients (58.3%). Twenty-four patients underwent D3 surgery without conversion to laparotomy; the origin of the IMA being preserved in 22 (91.7%) of them. Proximal colon ischemia occurred intraoperatively in two patients (8.3%) who had undergone high ligation at the origin of the IMA. One of these patients had a juxta-anal low rectal cancer and underwent intersphincteric abdominoperineal resection because of poor preoperative anal function. Laparoscopic subtotal colectomy was considered necessary for the other patient. The duration of surgery was (260±100) minutes and the median estimated blood loss was 50 (20-200) mL. The median number of No. 253 lymph nodes harvested was 3 (0-20), and one patient (4.2%) had No.253 nodal metastases. The median postoperative hospital stay was 8 (4-23) days, and the incidence of complications 16.7% (4/24). There were no instances of postoperative colon ischemia or necrosis observed. One patient (4.2%) with stage IIA rectal cancer developed Grade B (Clavien-Dindo III) anastomotic leak and underwent elective ileostomy. The other complications were Grade I-II. Conclusions: PDM is frequently associated with mesenteric adhesions. Our proposed classification can assist surgeons in identifying the descending colon and mesocolon during adhesion lysis in laparoscopic surgery. It is crucial to protect the colorectal blood supply at the resection margin to minimize the need for unplanned extended colectomy, the Hartmann procedure, or permanent stomas.

The strategy of laparoscopic surgery for asymptomatic antenatally diagnosed choledochal cyst

BackgroundThe aim was to investigate the characteristics, surgical management, and outcomes of asymptomatic patients with antenatally diagnosed choledochal cysts (ADCCs) and to justify the strategy of laparoscopic surgery (LS) for them in our hospital.MethodsWe developed our LS strategy for asymptomatic ADCCs. Patients with asymptomatic ADCCs who underwent LS or open surgery (OS) during January 2010 and January 2020 were included. Patients with recorded symptomatic ADCCs were exclude. All data of group LS and group OS were statistically compared and analyzed.ResultsTwenty-five patients received LS and 18 patients received OS were included. There was no significant difference in baseline characteristics between the groups. A total of 65.1% of biliary sludge formation was detected preoperatively by ultrasonography (US) (72.0% in group LS, 55.6% in group OS, P = 0.26). Compared to the OS group, the LS group had a longer operative time (313.4 ± 27.2 vs. 154.0 ± 11.9 min, P = 0.02), shorter postoperative fasting period (3.1 ± 1.2 vs. 6.2 ± 2.3 days, P = 0.03), and shorter postoperative hospital stay (5.1 ± 1.9 vs. 9.2 ± 1.1 days, P = 0.03). The incidence of late complications, such as reflux cholangitis, adhesive intestinal obstruction, and biliary enteric anastomotic stricture with stone formation, was not significantly different between the two groups. The liver function and liver stiffness of all patients in the two groups were normal.ConclusionsBased on the strategy for asymptomatic ADCCs in our hospital, the perioperative safety and midterm follow-up results after LS were satisfactory and comparable to those after OS.

Histopathological differences between vitiligo and lichen sclerosus et atrophicus using quantitative immunohistochemical analysis.

Lichen sclerosus et atrophicus (LS) is rare skin condition characterized by the presence of whitish patches primarily affecting the genital and perianal areas, though it can occur other parts of the body. LS may result in skin depigmentation without textural changes and should be differentiated from vitiligo. However, the histopathological features of hypopigmentation during vitiligo and LS have rarely been compared and have not been precisely described using quantitative immunohistochemical analysis. This study, therefore, aimed to investigate and compare the pigmentary characteristics of LS and vitiligo lesions using histochemical and immunohistochemical staining. We included 31 and 46 patients diagnosed with LS and vitiligo, respectively, at Ajou University Hospital between March 2009 and March 2020 in this study. Their medical charts and skin biopsy specimens were retrospectively reviewed. Additionally, Fontana-Masson staining for melanin and immunohistochemical staining for Melan-A, NKI/beteb, tyrosinase, and microphthalmia-associated transcription factor was performed. The melanin content, as well as the number of melanocytes was, in general, significantly higher in the epidermis of patients in the LS group compared with that in the vitiligo group. However, 22.6% of LS tissues showed less melanin pigmentation, 25.8% of LS specimens exhibited a lower number of melanocytes, and 29.0% of LS specimens demonstrated less melanocyte activity when compared with the average of vitiligo specimens. As lower melanin pigmentation and the near absence number of melanocytes were also observed in several LS specimens, both the clinical and histological findings must be comprehensively reviewed to differentiate vitiligo from LS.

Right ventricular dysfunction as a predictor of complicated course in left heart surgery

Aim. To analyze the right ventricular (RV) functionality in a cohort of heterogeneous cardiac surgical patients with left-sided valvular heart disease and determine the contribution of RV dysfunction in the complicated postoperative period according to echocardiography.Material and methods. A single-center prospective study of patients with left heart defects operated on in 2022 was conducted. Age ranged was 20-81 years, with a median age of 58 years. The study was conducted on a PHILIPS EPIQ CVx system using an X5-1 probe.Results. To estimate the risk of a complicated postoperative period depending on various indicators of RV systolic function assessment, ROC-analysis was performed. The ROC curve of the RV free wall longitudinal strain (RV FW LS) was characterized by the highest AUC value among other RV functional measures, equal to 0,81±0,06 (95% confidence interval (CI): 0,68-0,93), p&lt;0,001. A value of 20% was selected as the cut-off point of RV FW LS for predicting a complicated postoperative period. The RV FW LS &lt;20% was 19,2 times more likely to develop a complicated course (95% CI: 5,64 to 65,50), compared with the RV FW LS group ≥20%; p&lt;0,05. The odds of heart failure (HF) in the RV FW LS &lt;20% group were 22,78 times higher (95% CI: 5,90 to 88,04), compared with the RV FW LS ≥20% group; p&lt;0,05.Conclusion. The RV FW LS &lt;20% can be considered an independent predictor of complicated postoperative period with a multiple increase in the risk of complications, mainly the risk of heart failure. The assessment of RV FW LS can significantly help in risk stratification, being the reason for the reclassification of a number of patients in the high-risk group with a possible modification of surgical strategy.

Transferencia de habilidades prácticas desde el laboratorio a cirugía in vivo utilizando el sistema robótico Avatera: Estudio experimental

ObjectiveTo evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. Material and methodsAn in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 hours dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. ResultsAll procedures were completed successfully by all groups except the pyeloplasty by Group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. ConclusionsAlthough further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study.

Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National Inpatient Database in Japan

BackgroundLaparoscopic surgery for pediatric intussusception has recently become more common as an alternative to open surgery. However, the differences in outcomes between laparoscopic and open surgery remain unclear. Thus, this study aimed to compare short-term surgical outcomes and recurrence rates between patients treated with laparoscopic and open surgery for pediatric intussusception. MethodsPatients aged <18 years who underwent laparoscopic (n = 192) and open (n = 416) surgery for intussusception between April 2016 and March 2021 were retrospectively identified using a Japanese nationwide inpatient database. Propensity-score overlap weighting analyses were conducted to compare the outcomes between the laparoscopic and open surgery groups. The outcomes included in-hospital morbidity, reoperation, readmission for intussusception, bowel resection, the diagnosis of Meckel's diverticulum, duration of anesthesia, postoperative length of hospital stay, and total hospitalization costs. ResultsThe laparoscopic surgery group was older, heavier, and had fewer congenital malformations and emergency admissions than the open surgery group did. Overlap weighting analyses showed no significant differences in in-hospital morbidity (odds ratio [95% confidence interval], 0.88 [0.35−2.23]), reoperation (1.88 [0.24−14.9]), readmission for intussusception within 30 days (0.80 [0.12−5.30]) and 1 year (0.90 [0.28−2.93]), bowel resection (0.69 [0.46–1.02]), the diagnosis of Meckel's diverticulum (0.97 [0.50−1.90]), duration of anesthesia (difference, 11 [-1−24] minutes), postoperative length of stay (difference, −1.9 [-4.2−0.4] days), or total hospitalization costs (difference, 612 [ −746−1970] US dollars) between the groups. ConclusionsIn this large nationwide cohort, no significant differences in outcomes were observed between laparoscopic and open surgery. Laparoscopic surgery is an acceptable treatment option for pediatric intussusception. Levels of EvidenceLevel III.

Stoma-site approach single-port laparoscopic versus conventional multi-port laparoscopic Miles procedure for low rectal cancer: A prospective, randomized controlled trial

The aim of this study was to compare perioperative outcomes of patients with low rectal cancer after stoma-site approach single-port laparoscopic Miles procedure or conventional multi-port laparoscopic Miles procedure, as well as to evaluate the safety and efficacy of stoma-site approach single-port laparoscopic surgery in low rectal cancer. Between September 2020 and September 2021, 51 low rectal cancer patients scheduled for Miles procedure at the Department of Gastrointestinal Surgery of Affiliated Hospital of North Sichuan Medical College were randomly assigned to the single-port laparoscopic surgery group (SPLS) and the multi-port laparoscopic surgery (MPLS) group. The perioperative outcomes were compared between the two groups. In this study, 25 patients underwent SPLS and 26 underwent MPLS. All patients completed the study, and there were no perioperative deaths in either group. Observation indicators such as intraoperative bleeding (39mL vs. 41mL), number of lymph nodes (20.12±3.29 vs. 21.84±3.74), average hospital stay (7.15±1.52 vs. 7.64±1.66), and time to flatulence (2.5d vs. 2.5d) showed no significant differences between the SPLS and MPLS groups (p>0.05). However, the operation duration (180min vs. 118 min) and perioperative complications showed statistically significant differences between the two groups (p<0.05). In addition, patients in the SPLS group had significantly higher satisfaction scores than those in the MPLS group (p<0.05). For patients with low rectal cancer requiring Miles surgery, stoma-site approach single-port laparoscopic surgery has comparable safety and efficacy to multi-port laparoscopic surgery.

Short-term outcomes of single-incision robotic colectomy versus conventional multiport laparoscopic colectomy for colon cancer.

Since the da Vinci SP (dVSP) surgical system was introduced, single-incision robotic surgery (SIRS) for colorectal diseases has gained increasing acceptance. Comparison of the short-term outcomes between SIRS using dVSP and those of conventional multiport laparoscopic surgery (CMLS) was performed to verify its efficacy and safety in colon cancer. The medical records of 237 patients who underwent curative resection for colon cancer by a single surgeon were retrospectively reviewed. Patients were divided into two groups according to surgical modality: SIRS (RS group) and CMLS (LS group). Intra- and postoperative outcomes were analyzed. Of the 237 patients, 140 were included in the analysis. Patients in the RS group (n = 43) were predominantly female, younger, and had better general performance than those in the LS group (n = 97). The total operation time was longer in the RS group than in the LS group (232.8 ± 46.0 vs. 204.1 ± 41.7min, P < 0.001). The RS group showed faster first flatus passing (2.5 ± 0.9 vs. 3.1 ± 1.2days, P = 0.003) and less opioid analgesic requirement (analgesic withdrawal within 3 postoperative days: 37.2% vs. 18.6%, P = 0.018) than the LS group. The RS group showed a higher immediate postoperative albumin level (3.9 ± 0.3 vs. 3.6 ± 0.4g/dL, P < 0.001) and lower C-reactive protein level (6.6 ± 5.2 vs. 9.3 ± 5.5mg/dL, P = 0.007) than the LS group during the postoperative period. On multivariate analysis after adjusting for deviated patient characteristics, no significant difference was observed in short-term outcomes, except for operation time. SIRS with dVSP showed short-term outcomes comparable with those of CMLS for colon cancer.

Outcome of laparoscopic versus open repair of perforated peptic ulcers in low-risk patients

Background Peptic ulcer perforation (PPU) represents the main indication for emergent surgical intervention for peptic ulcer disease. The study aimed to assess the efficacy and safety of laparoscopic repair (PPU) in comparison with open repair in low-risk patients. Methods A retrospective study was conducted in a tertiary medical institution that included 98 patients diagnosed with PPU in line with the inclusion criteria. An analysis was performed to compare patients who underwent laparoscopic surgery (LS) (n=31) and patients submitted to open surgery (OS) of PPU (n=67). Characterization of LS and OS was achieved in terms of patients’ demographics, Bœy’s score, PULP score, and intraoperative and postoperative data. Results The patient’s mean age in the LS and OS groups were 48.8 and 51.1 years, respectively. Most patients in both groups were men (87.1% and 86.5%, respectively). The mean time for resumption of oral intake after surgery was 2.93 ±1.06 (1–7) days in the laparoscopy group compared with 3.79±0.8 (2–7) days in the laparotomy group (P&lt;0.0001). The average length of hospital stay was 5.77± 1.8 (4–13) days in the LS group and 7.22±1.6 (5–12) days in the OS group (P=0.0001). Early complications (&lt;30 days) were found in 12 patients (12.2%); 3 (9.6%) in the LS group and 9 (13.4%) in the OS group (P=0.5). Conclusion Repair of PPU by laparoscopy is a better alternative to the open approach regarding reduction of postoperative hospital stay and fast return to daily activity with less postoperative ileus and wound complications.

Phenotypic resistance to pyrethroid associated to metabolic mechanism in Vgsc-L995F-resistant Anopheles gambiae malaria mosquitoes.

Background: The indiscriminate use of insecticides in agriculture and public health lead to a selection of resistance mechanisms in malaria vectors compromising vector control tools and strategies. This study investigated the metabolic response in the Vgsc-L995F Anopheles gambiae Tiassalé resistance strain after long-term exposure of larvae and adults to deltamethrin insecticide. Methods: Vgsc-L995F An. gambiae Tiassalé strain larvae were exposed over 20 generations to deltamethrin (LS) and adults to PermaNet 2.0 (AS) and combining exposure at larvae and adult stages (LAS) and compared to unexposed (NS) group. All four groups were subjected to the standard World Health Organization (WHO) susceptibility tube tests using deltamethrin (0.05%), bendiocarb (0.1%) and malathion (5%). Vgsc-L995F/S knockdown-resistance ( kdr) mutation frequency was screened using multiplex assays based on Taqman real-time polymerase chain reaction (PCR) method. Additionally, expression levels of detoxification enzymes associated to pyrethroid resistance, including CYP4G16, CYP6M2, CYP6P1, CYP6P3, CYP6P4, CYP6Z1 and CYP9K1, and glutathione S-transferase GSTe2 were measured. Results: Our results indicated that deltamethrin resistance was a response to insecticide selection pressure in LS, AS and LAS groups, while susceptibility was observed in NS group. The vectors showed varied mortality rates with bendiocarb and full susceptibility to malathion throughout the selection with LS, AS and LAS groups. Vgsc-L995F mutation stayed at high allelic frequency level in all groups with a frequency between 87% and 100%. Among the overexpressed genes, CYP6P4 gene was the most overexpressed in LS, AS and LAS groups. Conclusion: Long-term exposure of larvae and adults of Vgsc-L995F resistant- An. gambiae Tiassalé strain to deltamethrin and PermaNet 2.0 net induced resistance to deltamethrin under a significant effect of cytochromes P450 detoxification enzymes. These outcomes highlight the necessity of investigating metabolic resistance mechanisms in the target population and not solely kdr resistance mechanisms prior the implementation of vector control strategies for a better impact.

Preserving or peeling the inferior mesenteric arterial sheath during laparoscopic rectal cancer surgery: a prospective study of surgical outcomes

BackgroundWe mainly evaluated whether preserving the inferior mesenteric artery (IMA) sheath to dissecting IMA root lymph nodes (also called No.253 lymph nodes) would benefit patients in terms of comparable lymph-node yield removed during operation and postoperative complications in laparoscopic radical resection of rectal cancer.MethodsThis is a prospective study included 141 rectal cancer patients who received laparoscopic radical resection during September 2018 to December 2020. All patients were randomly assigned to the preserved group (n = 71) and the peeled group (n = 70). The baseline characteristics, pathological features, intraoperative and postoperative data outcomes and complications were analyzed by independent samples t test, chi-square test or Fisher’s exact test between the 2 groups.ResultsThe baseline characteristic and pathological features had no statistical difference between the 2 groups. The preserved group had a shorter operative time (P = 0.002), a shorter lymph node dissection time (P < 0.001), less intraoperative bleeding (P = 0.004), an earlier time to first flatus (P = 0.013), an earlier time to fluid intake (P = 0.033) and a shorter length of hospitalization (P = 0.012) than the peeled group. The differences between the 2 groups were not statistically significant (P > 0.05) in regard to the total number of lymph nodes cleared, positive lymph nodes, bleeding, anastomotic leakage, pneumonia, wound infection, abscess, ileus, urinary retention, urinary tract infection and chyle leakage.ConclusionPreserving of the IMA sheath in laparoscopic radical surgery for rectal cancer will reduce the total operation time and the length of hospitalization. This surgical method could lead to lower complication rate and faster recovery.Trial registrationThe study was approved by the Ethics Committee of The First Affiliated Hospital of Wannan Medical College and registered by the China Clinical Trials Registry (ChiCTR2200060830, Date of Registration:2022-06-12 -retrospective registration) http://www.chictr.org.cn/index.aspx.

Effect of laser engraving on shear bond strength of polyetheretherketone to indirect composite and denture-base resins

Background/purposePolyetheretherketone (PEEK) is a highly sought-after thermoplastic due to its exceptional mechanical properties and biocompatibility. However, bonding PEEK to indirect composite resin (ICR) or denture-based resin (DBR) can be challenging. Laser engraving technology has shown potential to improve bonding for other materials; thus, this study aims to evaluate its effectiveness for PEEK. Materials and methodsThe experiment involved preparing ingot-shaped PEEK samples, which were then categorized into four groups based on the treatment method employed: without treatment, air abrasion, sulfuric acid etching, and laser engraving (LS). Subsequently, the samples were bonded to ICR or DBR, and their shear bond strength (SBS) was tested with or without thermocycling using a universal testing machine. Furthermore, the failure mode was observed, with statistical analyses conducted to compare the results. ResultsThe grid-like microslit structure of LS group displayed the highest SBS for bonding PEEK to ICR or DBR (P < 0.05). During the bonding of PEEK to ICR, resin residue and penetration into the microslits were frequently observed in the LS group, indicating cohesive failure. However, when PEEK was bonded to DBR, mixture failure was frequently observed without thermocycling. After thermocycling, only the LS group showed cohesive failure, while the majority of specimens exhibited mixture failure. ConclusionLaser engraving significantly improves the SBS between PEEK and both ICR and DBR. Furthermore, it was observed that resin had penetrated the microslits, indicating that laser engraving has great potential as a surface treatment method.