Surgery Research Articles

Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia: Surgical outcome, postoperative complications, and serum inflammation effects

BACKGROUND Laparoscopic surgery, with the advantage of less trauma, has been predominantly performed to treat pediatric inguinal hernia. However, the traditional three-port laparoscopic surgery remains extremely traumatic for children, whereas single-port laparoscopic surgery causes less damage to children than traditional laparoscopy. However, single-port laparoscopic surgery is more challenging; thus, studies on the effect of its application in pediatric inguinal hernia remain relatively limited. AIM To analyze the association of single-incision laparoscopic herniorrhaphy needle treatment with surgical outcomes, postoperative complications, and serum inflammation in pediatric inguinal hernia. METHODS This retrospective study included 113 pediatric patients with inguinal hernia who underwent surgery at the Children’s Hospital, Capital Institute of Pediatrics, from April 2022 to May 2023. Participants were categorized into the observation group (single-incision laparoscopic herniorrhaphy needle, n = 60) and the control group (two-port laparoscopic surgery, n = 53). Comparative analyses involved surgical duration, intraoperative blood loss, and length of hospital stay. C-reactive protein (CRP) and white blood cell count (WBC) levels were measured preoperatively and 24 hours postoperatively. Postoperative pain was evaluated with the face, legs, activity, cry, and Consolability scale. Further, the incidence of complications, recurrence, and reoperation rates was assessed. Logistic regression was employed to determine independent risk factors related to poor prognosis. RESULTS The observation group demonstrated significantly reduced intraoperative blood loss and shorter hospitalization compared to the control group (P < 0.05). Both groups demonstrated increased CRP and WBC levels postoperatively, but the observation group exhibited significantly lower levels (P < 0.05). Further, pain scores at 24 hours postoperatively were significantly lower in the observation group (P < 0.05). Additionally, the observation group experienced fewer adverse events, recurrence rates, and reoperations compared to the control group (P < 0.05). Logistic regression analysis determined increased postoperative stress markers and surgical technique as independent predictors of recurrence (P < 0.05). CONCLUSION Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia exhibits significant efficacy, effectively reduces postoperative complications, ensures a more concealed surgical incision, and promotes faster postoperative recovery than conventional two-port laparoscopy. This approach merits wider application.

Brief insight regarding the use of transanal, laparoscopic, and robotic total mesorectal excision for rectal cancer

In this article, we provide an important commentary on the original study Lu et al , which offers insight into the surgical efficacy of transanal total mesorectal excision (TaTME) vs laparoscopic total mesorectal excision (LapTME) in the management of low-lying locally advanced rectal cancer (LARC). We focus specifically on the rate of postoperative complications between the two using existing data from the literature. We additionally introduce robotic total mesorectal excision (RTME) and look at its postoperative complications relative to the TaTME and LapTME. LARC has been conventionally approached by open surgery. However, minimally invasive techniques have emerged over the past two decades as alternatives to open total mesorectal excision, namely robotic, laparoscopic, and transanal. Each approach has its supporters, but conflicting data on resection outcomes and complications has fueled ongoing debate over the optimal minimally invasive technique for low/mid-LARC. This article aims to extend on the data regarding the use of TaTME and RTME in the treatment of low/mid-LARC and further elaborate on their comparative efficacy relative to LapTME.

Short-term efficacy of laparoscopic radical resection for colorectal cancer and risk of unplanned reoperation after surgery

BACKGROUND Surgery is the first choice of treatment for patients with colorectal cancer. Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions. With the continuous development of medical technology, laparoscopic minimally invasive surgery has shown great advantages for the treatment of patients with celiac disease. AIM To investigate the short-term efficacy of laparoscopic radical surgery and traditional laparotomy for the treatment of colorectal cancer, and the differences in the risk analysis of unplanned reoperation after operation. METHODS As the research subjects, this study selected 100 patients with colorectal cancer who received surgical treatment at the Yulin First Hospital from January 2018 to January 2022. Among them, 50 patients who underwent laparoscopic radical resection were selected as the research group and 50 patients who underwent traditional laparotomy were selected as the control group. Data pertaining to clinical indexes, gastrointestinal hormones, nutrition indexes, the levels of inflammatory factors, quality of life, Visual Analog Scale score, and the postoperative complications of the two groups of patients before and after treatment were collected, and the therapeutic effects in the two groups were analyzed and compared. RESULTS Compared with the control group, perioperative bleeding, peristalsis recovery time, and hospital stays were significantly shorter in the research group. After surgery, the levels of gastrin (GAS) and motilin (MTL) were decreased in both groups, and the fluctuation range of GAS and MTL observed in the research group was significantly lower than that recorded in the control group. The hemoglobin (Hb) levels increased after surgery, and the level of Hb in the research group was significantly higher compared with the control group. After the operation, the expression levels of tumor necrosis factor-α, interleukin-6, and C-reactive protein and the total incidence of complications were significantly lower in the research group compared with the control group. One year after the operation, the quality of life of the two groups was greatly improved, with the quality of life in the research group being significantly better. CONCLUSION Laparoscopy was effective for colorectal surgery by reducing the occurrence of complications and inflammatory stress reaction; moreover, the quality of life of patients was significantly improved, which warrants further promotion.

Laparoscopic management of intraductal oncocytic papillary neoplasm of the pancreas: Two case reports and review of literature

BACKGROUND Intraductal oncocytic papillary neoplasm (IOPN) of the pancreas is an extremely rare pancreatic tumor, with only sporadic cases reported in the literature. IOPN is difficult to diagnose and highly prone to misdiagnosis. IOPN carries a certain risk of progressing to invasive cancer. Surgical resection is the primary treatment for IOPN. According to the existing literature reports, the vast majority of patients with IOPN of the pancreas undergo open surgery, while only one case of laparoscopic surgery have been reported. CASE SUMMARY This report presents two cases of IOPN in elderly female patients, aged 60 and 61. Both patients were asymptomatic, and their pancreatic masses were discovered incidentally. Preoperative diagnosis of IOPN is challenging and prone to misdiagnosis. In the first case, the patient underwent a laparoscopic distal pancreatectomy and splenectomy. The surgical procedure spanned 342 minutes, with an estimated intraoperative blood loss of around 100 mL. The patient experienced an uneventful postoperative recovery and was discharged on the 8th postoperative day. For the second case, a laparoscopic pancreaticoduodenectomy was performed. The operation lasted for 431 minutes with an intraoperative blood loss of approximately 50 mL. The patient also demonstrated a favorable postoperative course and was discharged on the 24th postoperative day. Postoperative pathology and immunohistochemistry confirmed the diagnosis of IOPN. No recurrence was observed in either patient after follow-up periods of 8 and 10 months, respectively. CONCLUSION These cases demonstrate that laparoscopic surgery can be considered as one of the treatment options for IOPN of the pancreas.

Enhancing outcomes in severe lymphedema through combined treatment strategies

Lymphedema, particularly in its advanced stages, presents significant challenges in treatment, often necessitating a combination of therapies to manage symptoms effectively and improve patient outcomes. This article reviews the findings of Wang et al , regarding the use of lymphovenous anastomosis and complex decongestive therapy in treating severe, deformed stage III lymphedema with recurrent infections. The case report details the promising results achieved through this combined therapy, highlighting substantial reductions in limb volume and the complete resolution of recurrent lymphangitis. The patient experienced notable improvements in weight loss, physical function, and quality of life. Despite its strengths, the study has several limitations. It lacks specific details on the types of lymphovenous anastomoses performed and complex decongestive therapy protocols, such as frequency and adherence, making reproducibility difficult. The short follow-up period of six months limits understanding of long-term efficacy, and more consistent reporting of key metrics such as weight loss and body mass index would enhance outcome assessments. This article emphasizes the importance of integrating minimally invasive surgical techniques with conservative therapies to address both the symptoms and underlying causes of lymphedema. Further research is essential to standardize protocols and refine combined treatment strategies.

Precision en-bloc retroperitoneal paraganglioma resection performed laparoscopically: A case report

BACKGROUND Phaeochromocytoma and paragangliomas (PPGL) are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves, with an overall incidence of approximately 0.66 cases per 100000 people per year. Most PPGLs are asymptomatic, and a few develop symptoms, such as elevated blood pressure and rapid heart rate, because of the release of catecholamines. According to the literature, surgical resection is the mainstay of PPGL treatment. However, the choice between minimally invasive surgery and open surgery remains controversial, particularly in cases involving complex anatomical relationships. We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography (CT) angiography and three-dimensional reconstruction, resulting in a favorable outcome. CASE SUMMARY A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months, experiencing occasional pins and needles sensation and radiation from the right shoulder and back. Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma. Surgery was recommended, and an enhanced CT scan of the upper abdomen, along with preoperative three-dimensional reconstruction, was performed after admission. The imaging indicated that the mass, measuring approximately 4.1 cm × 3.8 cm × 4.8 cm, was situated between the abdominal aorta and the inferior vena cava, extending downward to the level of the left renal vein. After ruling out any contraindications to surgery, a minimally invasive laparoscopy was performed to excise the mass precisely. The surgery was successful without any postoperative complications, and the 2-month follow-up revealed no abnormal signs of recurrence. CONCLUSION This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor. The patient recovered well during the 2-month follow-up, and postoperative pathology revealed a paraganglioma.

Percutaneous Endovascular versus Open Non-Endovascular Treatment for Chronic Mesenteric Ischemia-A Meta-Analysis.

Aim of this review is to compare pooled data on early and late outcomes between endovascular and open treatment for chronic mesenteric ischemia (CMI). The present systematic review and meta-analysis was conducted under the PRISMA guidelines. The following databases were utilized: Pubmed, Embase, Scopus, and Cochrane Library. All eligible studies published online up to April 2024 were investigated. Eligible studies should compare early and/or late outcomes between endovascular repair (ER) and open surgery (OS) for CMI. Early outcomes included 30-day mortality, myocardial infarction (MI), pulmonary, gastrointestinal, and renal complications. Late outcomes included all-cause survival, symptom recurrence, and re-intervention. In total, 15 studies (published from 1995 to 2024) were evaluated (12,326 patients under ER versus 6008 patients under OS). Regarding 30-day outcomes, ER was associated with a lower 30-day mortality risk (pooled OR = 0.58; 95% CI [0.347-0.975]; p = 0.039), a lower 30-day MI risk (pooled OR = 0.59; 95% CI [0.351-0.989]; p=0.045), a lower pulmonary complications risk (pooled OR = 0.18; 95% CI [0.075-0.426]; p=0.0001), and a lower 30-day renal complications risk (pooled OR = 0.28; 95% CI [0.146-0.553]; p=.00002). Regarding late outcomes, ER was associated with a lower overall 5-year survival (pooled OR = 0.414; 95% CI [0.291-0.591]; p < 0.0001). ER was also associated with a higher 3-year symptom recurrence risk (pooled OR = 3.77; 95% CI [2.314-6.142]; p < 0.0001) and a higher 5-year re-intervention risk (pooled OR = 2.40; 95% CI [1.538-3.739]; p=0.0001). ER is associated with superior early outcomes and worse late outcomes compared to OS among patients treated for CMI.Clinical ImpactThis is the most updated meta-analysis comparing pooled data between percutaneous endovascular repair (ER) and open surgery (OS) for patients with chronic mesenteric ischemia. This review verifies the advantage of endovascular treatment regarding early outcomes. However, this benefit is lost in the long-term as far as mortality and re-interventions are concerned. These findings seem to further support the current endovascular-first approach. One should take into consideration that ER is probably selected for patients of worse clinical status. OS may be more suitable for fitter patients who are not candidates for ER.

Assessment of primary stability of glenoid bone block procedures used for patients with recurrent anterior shoulder instability - a biomechanical study in a synthetic bone model.

Anterior glenoid reconstruction using bone blocks is increasingly recognised as treatment option after critical bone loss. In this study, a biomechanical test setup is used to assess micromotion after bone block augmentation at the glenoid, comparing bone block augmentation with a spina-scapula block to the standard coracoid bone block (Latarjet). Twenty-four synthetic shoulder specimens were tested. Two surgical techniques (coracoid and spina-scapula bone block augmentation) were used on two different types of synthetic bone (Synbone and Sawbone). The specimens were cyclically loaded according to the 'rocking horse' setup defined in ASTM F2028. A mediolateral force of 170 N was applied on the bone block and a complete test comprised 5000 cycles. The Micromotion between bone block and glenoid was measured using a 3D Digital Image Correlation system. The measured micromotion divided into irreversible and reversible displacement of the augmented block. Medial irreversible displacement was the dominant component of the micromotion. The spina-scapula bone block showed a significantly higher irreversible displacement in medial direction compared to the coracoid block, when aggregating both types of synthetic bone (spina: 1.00 ± 0.39 mm, coracoid: 0.56 ± 0.39 mm, p = 0.01). The dominant irreversible medial displacement can be interpreted as initial settling behaviour.

From Carrel to Robotics: Renal Transplantation and the Evolution of its Surgical Technique.

Renal transplantation has become the standard of care for patients with end-stage renal disease (ESRD) due to significant advancements across various medical and surgical fields. This review highlights the evolution of renal transplantation techniques, while also exploring the latest tools and practices that promise to further improve their outcomes. Since the first successful renal transplant, numerous innovations have been implemented in the various stages of renal graft implantation. These include improved techniques in vascular and urinary anastomoses, graft positioning, and the recent emergence of modern technologies such as robotics and artificial intelligence (AI) which have shown promise in enhancing surgical performance. The field of renal transplantation is continuously evolving. As new and more efficient technologies continue to emerge, these too will become the standard of care and training. It is essential for transplant surgeons to understand the key historical developments that have led to our current level of expertise, so we can make effective use of these tools in further advancing the field.

Abstract 6320: Benfotiamine and fursultiamine prevent glioblastoma cells growth, invasion and migration

Abstract Glioblastoma is the most common malignant and aggressive brain tumor in adults. Recent advances in surgical techniques and adjuvant therapies have modestly improved the overall survival rate. Thus, there is a need for novel therapeutic approaches and preventive strategies to control glioblastoma. Lipophilic derivatives of vitamin B1 have been used for many health conditions due to their substantial antioxidant and anti-inflammatory properties. However, their chemopreventive effects in glioblastoma are not known. This study investigated the chemopreventive potential of benfotiamine and fursultiamine using glioblastoma cells. Human glioblastoma (U-87) cell lines grown in Eagle’s Minimum Essential Media (EMEM) were treated with various concentrations of benfotiamine and fursultiamine. Cell viability was determined by MTT assay in a time- and dose-dependent manner. Apoptotic cell death was determined by Annexin-V staining and live-dead cell assay kits. The expression of various pro-apoptotic and anti-apoptotic factors and other inflammatory factors, including Bad, Bax, Bcl-2, cIAP-1, cIAP-2, and procaspase 3, was determined using a human apoptosis antibody array. Our results suggest that benfotiamine and fursultiamine prevent the growth of U-87 cells in a dose- and time-dependent manner. Further, they prevented the invasion and migration of glioblastoma cells. They also elevated the caspase-3 activation and reduced the mitochondrial reactive oxygen species. These compounds also regulate the expression of various pro- and anti-apoptotic factors. These findings suggest vitamin B1 derivatives could prevent glioblastoma tumor growth by upregulating the caspase-3-mediated apoptotic signaling pathways. Next, we plan to inject glioblastoma cells into the athymic nude mice xenograft model and examine the growth of glioblastoma cells in the absence and presence of vitamin B1 derivatives. Citation Format: Breauna Keane, Swathi Senthil, Kota V. Ramana. Benfotiamine and fursultiamine prevent glioblastoma cells growth, invasion and migration [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr XX.

Abstract 1273: Advancing precision oncology: Development and utilization of breast cancer PDX models for in vivo drug discovery

Abstract Breast cancer is a highly heterogeneous disease that poses significant challenges for drug development and personalized treatment. Patient-derived xenograft (PDX) models have emerged as essential tools for preclinical research, faithfully preserving the genetic, transcriptomic, and histopathological features of primary tumors, including intratumoral heterogeneity and the tumor microenvironment. The Nature publication, “A human breast cancer-derived xenograft and organoid platform for drug discovery and precision oncology”, highlights the utility of breast PDX models in advancing precision medicine and accelerating therapeutic discovery. Through a collaboration with the University of Utah, TD2 has developed three well-characterized in vivo breast cancer PDX models: HCI-015, HCI-043, and HCI-044. HCI-015 and HCI-043 are triple-negative breast cancer (TNBC) models, with HCI-015 harboring BRCA1 and BRCA2 deletions. HCI-044 is an estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), and HER2-negative. These models were selected based on their organoid performance and clinically relevant drug responses. For example, HCI-015 was sensitive to docetaxel and a Notch inhibitor but refractory to navitoclax, while HCI-043 showed high sensitivity to eribulin. The ER+ HCI-044 demonstrated minimal dependence on estrogen supplementation, with growth maintained despite ovariectomy. To preserve tumor heterogeneity and the microenvironment, TD2 developed a low-passage tumor propagation process using orthotopic implantation into the fourth mammary fat pad via a surgical technique. Tumors in HCI-015 and HCI-043 established and grew progressively within 35 days, while HCI-044 required 60 days but maintained reliable growth. Pilot studies confirmed the reproducibility of tumor propagation and response profiles, supporting their use in efficacy testing. For efficacy evaluations, PDX tumors were implanted into female NSG or CIEA NOG mice, and therapeutic regimens were assessed. HCI-015 was highly sensitive to docetaxel, achieving 100% complete regression (CR), while tamoxifen treatment confirmed its ER-negative status, resulting in progressive disease (PD). Similarly, HCI-043 demonstrated 100% CR with carboplatin and eribulin. For the ER+/PR+ HCI-044 model, tamoxifen treatment resulted in PD, but eribulin achieved 100% CR, highlighting subtype-specific therapeutic responses. Despite their transformative potential, breast PDX models face limitations, including cost and incomplete human immune system representation. However, by optimizing these models and integrating patient history, researchers are advancing their fidelity and expanding their applications. These models bridge the gap between preclinical research and clinical outcomes, offering new opportunities to accelerate targeted therapy development and improve patient care. Citation Format: Erin E. Trachet, Chelsea Holmquist, Stephanie Nagl, Paul M. Gonzales. Advancing precision oncology: Development and utilization of breast cancer PDX models for in vivo drug discovery [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 1273.

Efficacy and Safety of Posterior Minimally Invasive Sacroiliac Joint Fusion: A Narrative Review of Recent Evidence.

Chronic low back pain is one of the top three causes of diminished quality of life in well-developed countries. There are many etiologies of lower back pain, and sometimes, the pain is of true spinal pathology. However, this is not always the case, and sacroiliac joint (SIJ) pain has been described as an etiology in 15-30% or more of patients who are experiencing low back pain. Overlooking SIJ dysfunction as the cause of low back pain has considerable consequences on the patient's quality of life and healthcare-associated costs. SIJ dysfunction has been gaining recognition through well-described algorithms and reports on how to diagnose and differentiate types of low back pain. When conservative management fails in patients with SIJ dysfunction, fusion of the SIJ is a possibility. SIJ fusion was introduced as an open procedure but was often seen as a "last resort" related to the high complication rates and intensity of the procedure consistent with long operative time, high blood loss, and extended hospital stays. Minimally invasive surgical techniques for SIJ fusion were developed and have produced quality relief for some patients. Most minimally invasive SIJ fusion procedures are performed through a lateral approach. However, newer studies have shown evidence of a posterior or posterior oblique approach that may be more desirable for patients. The posterior approach to SIJ fusion has demonstrated a shorter operative time, smaller incision, and quicker return to activities of daily living. This narrative review aims to highlight up to date evidence on the efficacy and safety posterior minimally invasive SIJ fusion.

O-Arm Navigated MIS-TLIF Avoids Violation and Delays Degeneration of the Supradjacent Facet Joint.

O-arm navigated MIS-TLIF is one of the novel surgical techniques for treating lumbar spondylolisthesis, but there still lacks enough evidence regarding intraoperative facet joint violation (FJV) and postoperative facet joint degeneration (FJD). This study aimed to compare clinical outcomes, accuracy of screw placement, and supradjacent FJV between the O-arm navigated MIS-TLIF group (NavMIS-TLIF group) and the open-TLIF group for the treatment of low-grade lumbar spondylolisthesis, and further, to investigate the risk factors influencing FJD. We retrospectively reviewed a cohort of patients with low-grade lumbar spondylolisthesis who had received O-Arm navigated MIS-TLIF or open TLIF from May 2018 to May 2023. All the patients were followed up for at least 1 year. The demographic and perioperative data were recorded. The ODI and VAS scores were collected before surgery, 3 months postoperatively, and at the final follow-up. Slip parameters were measured before surgery and at the last follow-up. The screw convergence angle at the upper instrumented vertebra was evaluated based on postoperative CT images. Accuracy of screw placement and supradjacent FJV were assessed after surgery. The FJD was assessed at the final follow-up in comparison to that before surgery. Each group had 42 patients. VAS back pain of the NavMIS-TLIF group at the 3-month follow-up was lower than that of the open-TLIF group, yet there was no significant difference in ODI and VAS scores between the groups at the final follow-up. Both groups had similar slip reduction results. The clinically accurate rate of screw placement in the NavMIS-TLIF group was 99.4%, significantly higher than 94.0% in the open-TLIF group. At the upper instrumented vertebra, the screw convergence angle of the NavMIS-TLIF group was significantly larger than that of the open-TLIF group. The incidence of FJV in the NavMIS-TLIF group (23.8%) was significantly lower than that in the open-TLIF group (53.6%). There was no significant difference in preoperative FJD between the two groups, while at the last follow-up, the open-TLIF group had more cases of FJD. The screw convergence angle had a negative correlation with FJV and the aggravation of FJD, and FJV was positively associated with the aggravation of FJD. Multivariable logistic regression showed that FJV served as an independent risk factor for the aggravation of FJD. O-arm navigated MIS-TLIF has similar clinical outcomes and higher accuracy of screw placement compared to open TLIF. O-arm navigated MIS-TLIF reduces the incidence of FJV significantly, which probably helps to delay FJD.

Customized treatment for myopic traction maculopathy based on the MTM staging system: Long-term results in naïve eyes.

PurposeTo explore the long-term anatomical and functional outcomes in naïve patients with Myopic Traction Maculopathy (MTM) treated with either macular buckle (MB) plus pars plana vitrectomy (PPV) or primary MB as unique treatment according to MTM Staging System (MSS).MethodsRetrospective study involving 206 consecutive naïve patients with MTM who underwent either MB plus PPV or primary MB. Postoperative anatomical and functional outcomes, including the MTM stage and its progression, axial length (AL), and best-corrected visual acuity (BCVA) changes, were evaluated at one month (i.e., "early follow-up"), six months (i.e., intermediate follow-up"), 12 months postoperatively (i.e., "late follow-up") and at last follow-up ranging between 12 and 156 months postoperatively (i.e., "final follow-up").ResultsRetinal and foveal anatomical results significantly improved in patients who underwent either primary MB plus PPV or MB (p < 0.001), with 100% and 92.1% of patients who underwent complete resolution, respectively. For every MTM stage, the BCVA significantly improved over the follow-up visits. (p < 0.001). At the last visit, 84 (41%) eyes improved to 0.5 decimal or more. In patients treated before 2020, when applying more combined PPV treatments, there was a high rate of early iatrogenic full-thickness macular holes (p = 0.005). The results obtained since 2020, when the customized treatment was employed, led to better results without sight-threatening complications.ConclusionsThe MTM Staging System should be the foundation for treating MTM. It should precisely assess the optimal surgical technique and the ideal time to perform it concerning the various stages to maximize anatomical and functional success.

Abstract 5220: Regulating tumor-associated macrophage polarization via inhibition of hedgehog signaling for treating colorectal cancer liver metastasis

Abstract Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related mortality worldwide. The liver is the most frequent site of metastasis in patients with CRC. Approximately 15-25% of patients with CRC have synchronous liver metastasis (LM). Despite the development of surgical techniques and targeted therapy, the prognosis of colorectal cancer liver metastasis (CRLM) remains poor. The tumor microenvironment (TME) is composed of cancerous and non-cancerous cells, including fibroblasts, endothelial cells and immune cells, as well as non-cellular components. As a major component of immune cells in the TME, tumor-associated-macrophages (TAMs) account for up to 50% of cells in the tumor mass and are generally relevant to worse prognosis in cancer patients. TAMs are an important component of the immunosuppressive TME, but the precise mechanisms of the interactions between TAMs and tumor cells are still not completely understood. The hedgehog (Hh) signaling pathway is aberrantly activated in multiple types of human cancer. Hh signaling pathway plays an important role in tumorigenesis, including promoting tumor invasion, metastasis, and multi-drug resistance. However, it remains to be elucidated how Hh ligands ac on stromal cells within the TME to promote tumor growth and what cell types are involved in this process. In this study, we established an irinotecan-resistant colorectal cancer cell lines to represent liver metastatic colorectal cancer. We then found that irinotecan-resistant colorectal cancer cells significantly increased SHH secretion using quantitative reverse transcription PCR (qRT-PCR) and an ELISA assay. Subsequently, we used a THP-1 and bone marrow-derived monocytes (BMDMs) to determine whether Hh signaling and metastatic colorectal cancer cells affect the polarization and activity of macrophages. We found that tumor cells-derived SHH induced M2 polarization of TAMs under tumor cells-derived conditioned medium and co-culture systems using Western blot and Flow cytometry analysis. Moreover, phagocytosis ability of macrophages was decreased with irinotecan-resistant colorectal cancer cells compared with irinotecan-parent colorectal cancer cells under co-culture systems. To further investigate whether inhibition of Hh signaling affects macrophage polarization, we treated with Vismodegib, a Hh signaling inhibitor. M2 macrophage polarization increased by SHH was reduced by Hh signaling inhibitor treatment. Furthermore, TISIDB revealed that SHH was strongly negatively correlated with macrophage abundance and CD80, CD86 in COAD patients In conclusion, our study identified a novel mechanism for macrophage polarization through Shh signaling pathway and provided insights into developing macrophage-targeted therapeutic strategies for CRLM patients. Citation Format: Bu Gyeom Kim, Bo Ram Kim, Dae Yeong Kim, Hyemi Yun, Okhyeon Kim, Yoon Namgung, Jun Woo Bong, Sanghee Kang, Sun Il Lee, Sang Cheul Oh. Regulating tumor-associated macrophage polarization via inhibition of hedgehog signaling for treating colorectal cancer liver metastasis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5220.

Pre- and post-operative safety considerations for patients undergoing percutaneous nephrolithotomy.

Percutaneous nephrolithotomy (PCNL) is a widely used surgical procedure for treating large and complex kidney stones. Although effective, it carries risks of complications such as bleeding, infection, and injury to adjacent structures. Optimisation of procedural techniques and perioperative care can help minimize these risks. This review examines key pre- and post-operative safety considerations for PCNL patients. Topics include pre-operative imaging, patient positioning, puncture techniques, tract dilation, postoperative drainage, and complication management. The literature search involved analyzing recent studies and clinical guidelines to identify best practices. The search was conducted in several databases, including PubMed, Embase, the Cochrane Library and clinical guidelines. Training modalities for improving procedural skills are discussed. Improving the safety of PCNL requires a combination of meticulous surgical technique, proper patient selection, and adherence to standardized protocols. Continuous skill development and technological advancements will further improve patient outcomes.

Compliant Control System for Throat Swab Sampling

In contemporary medical conditions, we can see medical robots in many medical places. For example, in modern surgery, it is not difficult to learn that the cutting-edge robot-assisted minimally invasive technology has more and more applications to replace the traditional open surgery. For example, cardiac luminal intervention, colonoscopy, vascular intervention and so on. The existence of these assisted robots greatly improves the success rate of surgery. Since a medical robot can perform minimally invasive surgery, it can also be competent for sampling viruses in daily life. In this paper, we will summarize the control mode of virus sampling robot in the past, and propose a robot with flexible linear control, which can realize more accurate positioning and sampling of virus sampling on patients, so as to realize the accuracy and efficiency in the sampling process.

Minimally Invasive Approach Utilizing Linear Stapler for Midline Incisional Hernia: Stapler Repair Technique

ABSTRACTAimWe successfully established the stapler repair technique (SRT), a straightforward laparoscopic Rives‐Stoppa approach utilizing a linear stapler. This study retrospectively evaluated its short‐term outcomes to determine its safety and efficacy.MethodsThe surgical outcomes of 87 patients who underwent laparoscopic median incisional hernia repair at our hospital were reviewed between August 2017 and May 2024. Patients were treated with intraperitoneal onlay mesh (IPOM), laparoscopic trans‐abdominal retromuscular (TARM), or SRT.ResultsAmong these patients, 37 were treated with IPOM, 16 with TARM, and 34 with SRT, with no significant differences in patient characteristics. The median surgical time (range) was 96 min (50–211) for IPOM, 256 min (196–300) for TARM, and 112 min (60–289) for SRT, respectively. The median mesh areas (ranges) were 210 cm2 (80–500) for IPOM, 500 cm2 (270–780) for TARM, and 379 cm2 (176–864) for SRT, respectively. The SRT group had significantly shorter operative times (p &lt; 0.001) and smaller mesh areas (p = 0.005) than the TARM group. Compared to the IPOM group, there was no significant difference in operative time in the SRT group (p = 0.444), but the mesh area was significantly larger (p &lt; 0.001). The SRT group had no significant intraoperative complications or conversions to open surgery.ConclusionSRT offers a comparable operative time to IPOM and a significantly shorter time than TARM. Additionally, SRT can be performed extraperitoneally with no significant intraoperative complications or conversion to open surgery. These findings suggest that SRT is a safe and effective minimally invasive approach in median laparoscopic incisional hernia repair.

Infective native visceral artery aneurysm (INVAA): A systematic review of etiology, treatment, and outcomes.

The present review introduces the term 'infective native visceral artery aneurysm (INVAA)' and provides a systematic review of the literature on this topic. The terms 'mycotic' and 'infected' have been replaced by the term 'infective native' to more accurately describe aneurysms of this type. A systematic search of MEDLINE, Embase, Google Scholar, and Scopus databases was performed to identify articles reporting on INVAAs to April 2024. Inclusion criteria encompassed studies describing 'mycotic' or 'infected' primary visceral aneurysms, excluding patients with concurrent aneurysms in the aorta. The search yielded 356 articles, with 161 meeting the inclusion criteria, covering 175 patients. The median age was 48 years (IQR: 33-60 years), predominantly men (n = 127, 72.6%). INVAA was most frequently reported in the superior mesenteric artery (37.5%, n = 65), followed by the hepatic (22.9%, n = 40) and splenic arteries (14.3%, n = 25). Endocarditis was the predominant etiology in 67.4% (n = 118) of cases. Gram-positive pathogens were identified in 58.8% (n = 103) of cases. Treatment modalities included open surgery (49.7%, n = 87), endovascular interventions (37.7%, n = 66), and medical management (12.0%, n = 21). The overall proportion of patients who died was 13.7% (n = 24). In multivariable modeling, cerebral aneurysms (OR: 4.0, 95% CI 1.17, 12.8; p = 0.02), gastrointestinal bleed (OR: 5.79, 95% CI 1.86, 17.6; p < 0.01), and chronic kidney disease (OR: 16.0, 95% CI 2.3, 136; p < 0.01) were associated with increased odds of death. The optimal treatment for INVAA remains undefined, highlighting the need for standardization of reporting and prospective registries to enhance the understanding and management of this complex disease.

Optimizing Peripheral Nerve Regeneration: Surgical Techniques, Biomolecular and Regenerative Strategies—A Narrative Review

Peripheral nerve injury disrupts the function of the peripheral nervous system, leading to sensory, motor, and autonomic deficits. While peripheral nerves possess an intrinsic regenerative capacity, complete sensory and motor recovery remains challenging due to the unpredictable nature of the healing process, which is influenced by the extent of the injury, age, and timely intervention. Recent advances in microsurgical techniques, imaging technologies, and a deeper understanding of nerve microanatomy have enhanced functional outcomes in nerve repair. Nerve injury initiates complex pathophysiological responses, including Wallerian degeneration, macrophage activation, Schwann cell dedifferentiation, and axonal sprouting. Complete nerve disruptions require surgical intervention to restore nerve continuity and function. Direct nerve repair is the gold standard for clean transections with minimal nerve gaps. However, in cases with larger nerve gaps or when direct repair is not feasible, alternatives such as autologous nerve grafting, vascularized nerve grafts, nerve conduits, allografts, and nerve transfers may be employed. Autologous nerve grafts provide excellent biocompatibility but are limited by donor site morbidity and availability. Vascularized grafts are used for large nerve gaps and poorly vascularized recipient beds, while nerve conduits serve as a promising solution for smaller gaps. Nerve transfers are utilized when neither direct repair nor grafting is possible, often involving re-routing intact regional nerves to restore function. Nerve conduits play a pivotal role in nerve regeneration by bridging nerve gaps, with significant advancements made in material composition and design. Emerging trends in nerve regeneration include the use of 3D bioprinting for personalized conduits, gene therapy for targeted growth factor delivery, and nanotechnology for nanofiber-based conduits and stem cell therapy. Advancements in molecular sciences have provided critical insights into the cellular and biochemical mechanisms underlying nerve repair, leading to targeted therapies that enhance axonal regeneration, remyelination, and functional recovery in peripheral nerve injuries. This review explores the current strategies for the therapeutic management of peripheral nerve injuries, highlighting their indications, benefits, and limitations, while emphasizing the need for tailored approaches based on injury severity and patient factors.