Terms Of Operative Time Research Articles

Short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic head resection for the management of pancreatic-head cystic neoplasms

BackgroundIn this study, we aimed to investigate the short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic-head resection (LDPPHR) for the management of pancreatic-head cystic neoplasms.MethodsThis retrospective study included 60 patients who were treated with pancreatic-head cystic neoplasms at the Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to July 2022.ResultsNo significant difference was found between the two groups in terms of the baseline and pathological characteristics of patients (P > 0.05). The postoperative exhaust time was shorter in the LDPPHR group compared with the laparoscopic pancreaticoduodenectomy (LPD) group (2 (2 and 4) vs. 4 (3 and 5) days; P = 0.003). No significant difference was found between the two groups in terms of operative time, estimated blood loss, intraoperative transfusion, hemoglobin levels on the first postoperative day, total bilirubin before discharge, direct bilirubin before discharge, postoperative hospital stay, postoperative pancreatic fistula, bile leakage, hemorrhage, peritoneal effusion, abdominal infection, delayed gastric emptying, interventional embolization hemostasis, reoperation, and 30-day readmission (P > 0.05). No conversion and 90-day mortality were found in the two groups. The LDPPHR group showed a higher 3-month postoperative PNI, 6-month postoperative TG and 6-month postoperative BMI than the LPD group (P < 0.05).ConclusionsCompared with LPD, LDPPHR can decrease the postoperative exhaust time of patients, improve the short-term postoperative nutritional status, and does not decrease the safety of the perioperative period.

Laparo-endoscopic single-site versus conventional laparoscopic surgery for early-stage endometrial cancer: A randomized controlled non-inferiority trial

ObjectiveTo evaluate the feasibility and safety of laparo-endoscopic single-site surgery (LESS) compared with conventional laparoscopic surgery (CLS) for early-stage endometrial cancer. MethodsPatients with clinical stage IA, IB, grade 1–3 endometrial cancer were randomly assigned to undergo LESS or CLS. The primary endpoint was the non-inferiority of LESS to CLS in terms of operation time and the number of resected pelvic lymph nodes. We set the non-inferior margin of the operation time as within 15% (24 min) and the number of resected pelvic lymph nodes as within 20% (5.2 lymph nodes). ResultsThere was no significant difference between the LESS group (n = 53) and the CLS group (n = 54) in terms of age, weight, body mass index, parity, menopausal status, history of abdominal surgery, and preoperative CA-125 levels. The total operation time was comparable between the two groups. On average, 4.6 fewer pelvic lymph nodes were retrieved in the LESS group, which was within the non-inferiority margin. There were no significant differences in the incidence of intra- and postoperative complications, estimated blood loss, and postoperative hospital stay between the two groups. After a median follow-up time of 34 months (range, 2–242), the progression-free survival rates were 96.2% and 98.1% (P = 0.55) in the LESS group and the CLS group, and the overall survival rates were 98.1% and 100.0% (P = 0.31), respectively. ConclusionLESS surgical staging was non-inferior to CLS and had acceptable feasibility, safety, and efficacy for the surgical management of early-stage endometrial cancer.Trial registration: Clinicaltrial.gov identifier number: NCT01679522

A novel prostate cancer subtyping classifier based on luminal and basal phenotypes.

Prostate cancer (PCa) is a clinically heterogeneous disease. The creation of an expression-based subtyping model based on prostate-specific biological processes was sought. Unsupervised machine learning of gene expression profiles from prospectively collected primary prostate tumors (training, n=32,000; evaluation, n=68,547) was used to create a prostate subtyping classifier (PSC) based on basal versus luminal cell expression patterns and other gene signatures relevant to PCa biology. Subtype molecular pathways and clinical characteristics were explored in five other clinical cohorts. Clustering derived four subtypes: luminal differentiated (LD), luminal proliferating (LP), basal immune (BI), and basal neuroendocrine (BN). LP and LD tumors both had higher androgen receptor activity. LP tumors also had a higher expression of cell proliferation genes, MYC activity, and characteristics of homologous recombination deficiency. BI tumors possessed significant interferon γactivity and immune infiltration on immunohistochemistry. BN tumors were characterized by lower androgen receptor activity expression, lower immune infiltration, and enrichment with neuroendocrine expression patterns. Patients with LD tumors had less aggressive tumor characteristics and the longest time to metastasis after surgery. Only patients with BI tumors derived benefit from radiotherapy after surgery in terms of time to metastasis (hazard ratio [HR], 0.09; 95% CI, 0.01-0.71; n=855). In a phase 3 trial that randomized patients with metastatic PCa to androgen deprivation with or without docetaxel (n=108), only patients with LP tumors derived survival benefit from docetaxel (HR, 0.21; 95% CI, 0.09-0.51). With the use of expression profiles from over 100,000 tumors, a PSC was developed that identified four subtypes with distinct biological and clinical features. Prostate cancer can behave in an indolent or aggressive manner and vary in how it responds to certain treatments. To differentiate prostate cancer on the basis of biological features, we developed a novel RNA signature by using data from over 100,000 prostate tumors-the largest data set of its kind. This signature can inform patients and physicians on tumor aggressiveness and susceptibilities to treatments to help personalize cancer management.

Single-Port vs Multiple-Port Robot-Assisted Laparoscopic Pyeloplasty for the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis.

Background: Single-port robot-assisted pyeloplasty (SP-RP) has been performed in recent years. However, the advantages and disadvantages of SP-RP compared with multiple-port robot-assisted pyeloplasty (MP-RP) remain unclear. The purpose of this meta-analysis was to compare the safety and feasibility of the two technologies. Materials and Methods: Through a literature search using MEDLINE, EMBASE, and the Cochrane Library, studies comparing SP-RP and MP-RP were identified for meta-analysis. Comparisons of perioperative and postoperative outcomes between the groups were analyzed using weighted mean difference (WMD) and risk ratio. Results: Five retrospective cohort studies with 179 patients were included in this meta-analysis. The results showed that SP-RP was associated with shorter hospital stay (WMD: -0.6 minutes, 95% confidence interval [CI]: -1.19 to -0.02, p = 0.04), less postoperative pain (pain score, WMD: -0.84, 95% CI: -1.62 to -0.07, p = 0.03), and superior cosmetic appearance compared with MP-RP. In addition, no differences were found between the SP-RP and MP-RP groups in terms of operative time, blood loss, rate of complications, and recovery of renal function. Conclusion: SP-RP provided comparable effectiveness, safety, and superior outcomes in terms of cosmetic appearance and pain compared with MP-RP, which gives surgeons the confidence to adopt and promote these ultraminimal invasive surgeries.

Effect of augmented reality navigation technology on perioperative safety in partial nephrectomies: A meta-analysis and systematic review.

To evaluate the impact of augmented reality surgical navigation (ARSN) technology on short-term outcomes of partial nephrectomy (PN). A systematic literature search was conducted in PubMed, Embase, Cochrane, and Web of Science for eligible studies published through March 28, 2022. Two researchers independently performed the article screening, data extraction and quality review. Data analysis was performed using Cochrane Review Manager software. A total of 583 patients from eight studies were included in the analysis, with 313 in the ARSN-assisted PN group (AR group) and 270 in the conventional PN group (NAR group). ARSN-assisted PN showed better outcomes than conventional surgery in terms of operative time, estimated blood loss, global ischemia rate, warm ischemia time, and enucleation rate. However, there were no significant differences in the rate of Conversion to radical nephrectomy (RN), postoperative estimated glomerular filtration rate (eGFR), positive margin rate, and postoperative complication rate. The utilization of ARSN can improve the perioperative safety of PN. Compared with conventional PN, ARSN-assisted PN can reduce intraoperative blood loss, shorten operative time, and improve renal ischemia. Although direct evidence is lacking, our results still suggest a potential advantage of ARSN in improving renal recovery after PN. However, as the ARSN system is still in an exploratory stage, its relevance in PN have been poorly reported. Additional high-quality randomized controlled trial (RCT) studies will be required to confirm the effect of ARSN on PN. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301798, identifier PROSPERO ID: CRD42022301798.

Comparison of the efficacy of ETS with different segments for palmar, axillary and plantar hyperhidrosis

BackgroundTo compare the near and long-term outcomes of endoscopic thoracic sympathectomy (ETS) for palmar, axillary and plantar hyperhidrosis.MethodsWe retrospectively analyzed the clinical data of 218 patients with hyperhidrosis who were admitted to the Department of Thoracic Surgery of Gansu Provincial People’s Hospital for surgical treatment from April 2014 to August 2021. The patients were divided into three groups according to the method of ETS and the perioperative clinical data and postoperative follow-up data were collected to compare the near and long term outcomes of the three groups.ResultsThere were 197 eligible patients at follow-up, 60 patients in the R4 cut-off group, 95 patients in the R3 + R4 cut-off group and 42 patients in the R4 + R5 cut-off group. There were no statistically significant differences in baseline indicators such as sex, age and positive family history among the three groups (P > 0.05). There was no statistically significant difference between the three groups in terms of operative time (P = 0.148), intraoperative bleeding (P = 0.308) and postoperative hospital stay (P = 0.407). Postoperatively, all three groups showed significant relief of palmar hyperhidrosis symptoms, with the R3 + R4 group having an advantage in terms of relief of axillary hyperhidrosis symptoms, patient satisfaction and quality of life index at 6 months postoperatively and the R4 + R5 group having an advantage in terms of relief of plantar hyperhidrosis symptoms. The difference in compensatory hyperhidrosis at 12 months postoperatively was not statistically significant among the three groups (P = 0.867), but the incidence was higher in the R3 + R4 and R4 + R5 groups than that in the R4 group.ConclusionPatients with simple palmar hyperhidrosis can first consider R4 cut-off treatment; R3 + R4 cut-off is more effective in treating palmar hyperhidrosis combined with axillary hyperhidrosis; R4 + R5 cut-off is more effective in treating palmar hyperhidrosis combined with plantar hyperhidrosis. However, patients need to be informed that R3 + R4 and R4 + R5 dissection may increase the risk of severe compensatory hyperhidrosis after surgery.

Single-direction thoracoscopic lobectomy for incomplete pulmonary fissure in children with congenital pulmonary airway malformation: initial experience and propensity score-matched analysis.

To evaluate the safety and efficacy of single-direction lobectomy for congenital pulmonary airway malformation (CPAM), especially with incomplete pulmonary fissure (IPF). A total of 279 patients who underwent thoracoscopic lobectomy in our hospital from January 2019 to January 2022 were analyzed. Fifty-nine children were identified as the single-direction group, and the details of the surgical application are described. The degree of pulmonary fissure completeness was quantified intraoperatively. Propensity score matching was conducted and another 59 patients who underwent conventional lobectomy were matched as the control group. The median age of the patients was 4.9months and the mean body weight was 7.7kg. For patients with complete pulmonary fissure, there were no statistical differences between two groups in terms of operative time, intraoperative blood loss, length of chest tube, and hospital stay. For patients with IPF, there were statistical differences between the single-direction group and the control group in terms of operative times (89.10 ± 7.97min vs. 97.41 ± 7.51min, P < 0.001), intraoperative blood loss (10.86 ± 5.36mL vs. 14.14 ± 6.56mL P = 0.042), and postoperative complications (P = 0.035). IPF increases the operative difficulty of thoracoscopic lobectomy for CPAM, and the single-direction lobectomy technique is an effective and safe treatment for IPF.

Unilateral biportal endoscopy versus microscopic decompression in the treatment of lumbar spinal stenosis: A meta-analysis.

The aim of this study was to evaluate whether there is a superior clinical effect of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis. We searched CNKI, WANFANG, CQVIP, CBM, PubMed, and Web of Science up to January 2022, and selected studies that met our inclusion criteria. The results of this meta-analysis indicated that unilateral biportal endoscopy was demonstrated to be more beneficial for patients compared with microscopic decompression for the following outcomes: Operation time [standardized mean difference (SMD) = -0.943, 95% confidence interval (CI) (-1.856, -0.031), P = .043], hospital stays [SMD = -2.652, 95% CI (-4.390, -0.914), P = .003], EuroQol 5-Dimension questionnaire [SMD = 0.354, 95% CI (0.070, 0.638), P = .014], back pain visual analogue score [SMD = -0.506, 95% CI (-0.861, -0.151), P = .005], leg pain visual analogue score [SMD = -0.241, 95% CI (-0.371, -.0112), P = .000], the C-reactive protein level [SMD = -1.492,95% CI (-2.432, -0.552), P = .002]. Other outcomes demonstrated no significant differences between the 2 groups. For patients with lumbar spinal stenosis, unilateral biportal endoscopy was found to be more superior than microscopic decompression in terms of operation time, hospital stays, EuroQol 5-Dimension questionnaire, back visual analogue score, leg visual analogue score and the C-reactive protein level. There was no significant difference between the 2 groups in other outcome indicators.

Comparison of the perioperative outcomes of laparoscopic and open retroperitoneal lymph node dissection for low-stage (stage I/II) testicular germ cell tumors: a systematic review and meta-analysis.

Comparison of the perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) and open retroperitoneal lymph node dissection (O-RPLND) for low-stage (stage I/II) testicular germ cell tumors. The authors performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to PRISMA criteria, and the quality assessment of the included studies followed the AMSTAR guidelines. Four databases were searched, including Embase, PubMed, the Cochrane Library, and Web of Science. The search period was from the creation of each database to October 2022. The statistical analysis software uses Stata17. There were nine studies involving 579 patients. Compared with O-RPLND, L-RPLND was associated with shorter length of stay [weighted mean difference (WMD)=-3.99, 95% CI: -4.80 to -3.19, P <0.05], less estimated blood loss (WMD=-0.95, 95% CI: -1.35 to -0.54, P <0.05), shorter time to oral intake after surgery (WMD=-0.77, 95% CI: -1.50 to -0.03, P <0.05), and lower overall complications (odds ratio=0.58, 95% CI: 0.38-0.87, P <0.05). Subgroup analysis found that the complication rate of Clavien-Dindo grade II was lower in L-RPLND (odds ratio=0.24, 95% CI: 0.11-0.55, P <0.05). Interestingly, there was no statistically significant difference between the two groups in terms of operation time, lymph node yields, and recurrence rate during follow-up. L-RPLND is superior to O-RPLND and is worthy of clinical promotion.

MP70-16 IN PEDIATRIC PATIENTS WITH AN UPPER TRACT URINARY STONE OF LESS THAN 2 CM IN DIAMETER, DOES URETEROSCOPY COMPARED TO SHOCK WAVE LITHOTRIPSY IMPROVE THE STONE-FREE RATE? A SYSTEMATIC REVIEW AND META-ANALYSIS FROM THE EAU UROLITHIASIS PANNEL

You have accessJournal of UrologyCME1 Apr 2023MP70-16 IN PEDIATRIC PATIENTS WITH AN UPPER TRACT URINARY STONE OF LESS THAN 2 CM IN DIAMETER, DOES URETEROSCOPY COMPARED TO SHOCK WAVE LITHOTRIPSY IMPROVE THE STONE-FREE RATE? A SYSTEMATIC REVIEW AND META-ANALYSIS FROM THE EAU UROLITHIASIS PANNEL Robert Geraghty, Riccardo Lombardo, Lazaros Tzelves, Niall F Davis, Andreas Neisius, Ales Petřík, Giovanni Gambaro, Helene Ulrik Jung, Andreas Skolarikos, Thomas Tailly, and Bhaskar Somani Robert GeraghtyRobert Geraghty More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Lazaros TzelvesLazaros Tzelves More articles by this author , Niall F DavisNiall F Davis More articles by this author , Andreas NeisiusAndreas Neisius More articles by this author , Ales PetříkAles Petřík More articles by this author , Giovanni GambaroGiovanni Gambaro More articles by this author , Helene Ulrik JungHelene Ulrik Jung More articles by this author , Andreas SkolarikosAndreas Skolarikos More articles by this author , Thomas TaillyThomas Tailly More articles by this author , and Bhaskar SomaniBhaskar Somani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine which treatment between ureteroscopy (RIRS) and shockwave lithotripsy (ESWL) has a better stone free rate in paediatric patients (<18 years) with upper tract stones (<2 cm) METHODS: Using PubMed, Web of Science, and the Cochrane database, we identified studies published until August 2022 reporting surgical outcomes of paediatrics patients undergoing ULT and ESWL with renal stone < 2 cm. Protocol was registered in the PROSPERO database. Only comparative studies were considered for analysis. Stone free rate, operative time and complications were analyzed. Review manager was used for analysis. RESULTS: A total of 7 studies were included in the analysis and out of them three were randomized clinical trials. A total of 786 patients were analyzed. Mean age ranged from 6.5 to 11.5 years. The ESWL group presented a range of stone free rates between 20 and 90% while the RIRS group presented a range of stone free rates between 37 and 97%. The meta-analysis of the three randomized clinical trials favored the RIRS group over the ESWL group in terms of stone-free rate (RR: 0.84; p<0,05) (Figure). Only four studies included complication rate and rates were comparable between both groups. In terms of operative time only four studies included data and most of them favored ESWL over RIRS (Figure). Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1010 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Geraghty More articles by this author Riccardo Lombardo More articles by this author Lazaros Tzelves More articles by this author Niall F Davis More articles by this author Andreas Neisius More articles by this author Ales Petřík More articles by this author Giovanni Gambaro More articles by this author Helene Ulrik Jung More articles by this author Andreas Skolarikos More articles by this author Thomas Tailly More articles by this author Bhaskar Somani More articles by this author Expand All Advertisement PDF downloadLoading ...

One quick and simple fixation method: posterior malleolus fractures in spiral tibial fractures

ObjectiveSpiral fracture of tibia combined with posterior malleolar fracture (PMF) is a special and regular injury. There is no uniform fixation method for PMF in this kind of injury. Intramedullary nail is the first choice for the treatment of tibial spiral fracture. We proposed a minimally invasive percutaneous screw combined with intramedullary nail technology to fix the PMF in the tibial spiral fracture. This study aims to explore the effectiveness and advantages of this technology.Materials and methodsFrom January 2017 to February 2020, 116 cases of spiral fracture of tibia combined with PMF who were operated in our hospital were divided into Fixation Group (FG) and No Fixation Group (NG) according to whether PMF was fixed. After minimally invasive percutaneous screw fixation of ankle fracture in FG patients, the tibial intramedullary nail was inserted to fix the fracture. Collected the operation and postoperative recovery of the two groups of patients, including the operation time, intraoperative blood loss, AOFAS score, VAS score and dorsiflexion restriction of ankle joint at the last follow-up, and compared whether there is any difference between the two groups of patients.ResultsThe fracture of both groups healed.2 patients in NG had secondary displacement of PMF during operation, and the fracture finally healed after fixation. There were statistical differences between the two groups in terms of operation time, AOFAS score and weight bearing time. The operation time of FG was 67.9±11.2 min, and that of NG was 60.8±9.4 min; The weight bearing time of FG was 57.35±34.72 days, and that of NG was 69.17±21.43 days; The AOFAS score of FG was 92.50±3.46, and that of NG was 91.00±4.16. There were no significant difference in blood loss, VAS and dorsiflexion restriction of ankle joint between the two groups. The blood loss of FG was 66.8±12.3 ml, the blood loss of NG was 65.6±11.7 ml, the VAS score of FG was 1.37±0.47, the VAS score of NG was 1.43±0.51, the dorsiflexion restriction of FG was 5.8±4.1; the NG was 6.1±5.7.ConclusionFor the injury of tibial spiral fracture combined with PMF, our fixation technology can achieve minimally invasive fixation of PMF with percutaneous screws on the basis of intramedullary nail fixation of tibial fracture, promoting early functional exercise of ankle joint and early weight bearing of patients. This fixation technology is also characterized by simple and fast operation.

Completely 3-dimensional laparoscopic pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: an analysis of 100 consecutive cases.

Although laparoscopic pancreaticoduodenectomy (LPD) is increasingly performed in high-volume centers, pancreaticojejunostomy (PJ) is still the most challenging procedure. Pancreatic anastomotic leakage remains a major complication after PD. Thus, various technical modifications regarding PJ, such as the Blumgart technique, have been attempted to simplify the procedure and minimize anastomotic leakage. Three-dimensional (3D) laparoscopic systems have been shown to be particularly helpful in performing difficult and precise tasks. We present a modified Blumgart anastomosis in 3D-LPD and investigate its clinical outcomes. A retrospective analysis of 100 patients who underwent 3D-LPD with modified Blumgart PJ from September 2018 to January 2020 was conducted. Data on the preoperative characteristics, operative outcomes, and postoperative characteristics of the patients were collected and analyzed. The mean operative time and duration of PJ were 348.2 and 25.1min, respectively. The mean estimated blood loss was 112mL. The overall rate of postoperative complications over Clavien‒Dindo classification III was 18%. The incidence of clinically relevant postoperative pancreatic fistula was 11%. The median postoperative hospital stay was 14.2days. Only one patient required reoperation (1%), and no patient died in the hospital or 90days after the operation. High BMI, small main pancreatic duct diameter, and soft pancreatic consistency had a significant influence on the occurrence of CR-POPF. The surgical outcome of 3D-LPD with modified Blumgart PJ seems to be comparable to other studies in terms of operation time, blood loss, hospital stay, and complication incidence. We consider the modified Blumgart technique in 3D-LPD to be novel, reliable, safe, and favorable for PJ in the PD procedure.

Comparison of curative effect between Tianji robot assisted screw placement and traditional cannulated screw internal fixation for femoral neck fracture

To investigate the clinical efficacy and advantages of Tianji orthopedic robot assisted cannulated screw internal fixation for femoral neck fracture. The clinical data of 41 patients with femoral neck fracture who underwent internal fixation with cannulated screws from January 2019 to January 2022 were retrospectively analyzed. According to different surgical methods, they were divided into Tianji robot group and traditional cannulated screw fixation group (traditional operation group). Among them, there were 18 patients in Tianji robot group including 8 males and 10 females with age of (56.00±4.22) years old, Garden typeⅠ (4 cases), type Ⅱ (11 cases), type Ⅲ (2 cases), and type Ⅳ (1 case). There were 23 patients in the traditional operation group, including 10 males and 13 females, aged (54.87±4.81) years old;there were 5 cases of Garden typeⅠ, 14 cases of type Ⅱ, 3 cases of type Ⅲ and 1 case of type Ⅳ. The operation time, intraoperative blood loss, fluoroscopy times, guide needle placement times, operation costs and other indicators were observed and compared between two groups. Harris score was used to evaluate hip joint function 12 months after operation. The wounds of all patients healed in Grade A without complications. There were significant differences between two groups in terms of operation time, times of intraoperative fluoroscopy, times of guide needle placement, amount of intraoperative bleeding, and operation cost (P<0.05). All 41 patients were followed up for at least 12 months. The fractures of both groups were healed. There was no infection, screw loosening, fracture displacement and femoral head necrosis in Tianji robot group during follow-up;Screw loosening occurred in 2 patients in the traditional operation group during follow-up. At 12 months after operation, Harris hip joint function score of Tianji robot group was higher than that of traditional operation group in daily activity, lameness, joint activity score and total score (P<0.05). Tianji robot assisted nail placement is a better method for the treatment of femoral neck fracture, which improves the surgical efficiency, is more accurate, has higher success rate of one-time nail placement, shorter operation time, less radiation, and has better hip joint function recovery after surgery.

Gastric Carcinoma and Role of Proximal Gastrectomy

Objective: Comparative analysis of different surgical methods for the treatment of gastric carcinoma with proximal gastrectomy. Study Design: Retrospective study Place and Duration of Study: Department of Surgery Unit-2, Ghulam Muhammad Mahar Medical College, Teaching Hospital, Sukkur, Department of Surgery, Wah Medical College POF Hospital, Wah Cantt and from Department of Surgery, CMH Kharian Medical College, Kharian from 1st January 2015 to 30th June 2021. Methodology: One hundred patients were retrospectively evaluated for the proximal gastrectomy with the previously conducted procedures of open gastrectomy as well as laparoscopic gastrectomy. The patients were compared for the various types of gastrectomy used with the new established proximal gastrectomy method. The patient distribution was based on available resources and patients’ consent. Patients were identified as into two groups where group 1 patients were placed for open total gastrectomy whereas group 2 patients were defined as laparoscopic proximal gastrectomy. All the patients were compared in terms of operation time, recurrence rate and associated complications. Results: Mean age of the study participants were 54.5±3.3 years. Higher frequency of males participants were observed as compared to the females. Estimated blood loss was considerably different in both study groups. Excess blood loss was seen in total gastrectomy in contrast to laparoscopic procedure. Less complication was observed in open gastrectomy than to laparoscopic proximal gastrectomy. Conclusion: Minimally invasive surgical method could be the standard surgical procedure for gastric oncology treatment in which function of the stomach can be preserved along with safety profiles. Therefore, LPG can be a preferable treatment option for other available treatment options. Keywords: Invasive, Oncology, Laparoscopic, Complications, Gastric

Clinical efficacy of robot-assisted subxiphoid versus lateral thoracic approach in the treatment of anterior mediastinal tumors

BackgroundThe purpose of this study was to compare the perioperative efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) for treating anterior mediastinal tumors through the subxiphoid and lateral thoracic approaches under the anesthesia of nontracheal intubation (i.e., laryngeal mask airway).MethodsWe retrospectively analyzed the clinical data of 116 patients with anterior mediastinal tumors treated by RATS under laryngeal mask anesthesia completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People’s Hospital, from October 2016 to October 2022. There were a total of 52 patients including 24 males and 28 females, with an average age of 45.40±4.94 years, in the subxiphoid approach (subxiphoid group). On the other hand, there were a total of 64 patients including 34 males and 30 females, with a mean age of 46.86±5.46 years in the lateral thoracic approach (lateral thoracic group). Furthermore, we have detailedly compared and analyzed the operating time, intraoperative bleeding, and total postoperative drainage in the two groups.ResultsAll patients in both groups successfully completed resection of the anterior mediastinal tumor without occurring perioperative death. Compared with the lateral thoracic group, the subxiphoid group has more advantages in terms of total postoperative drainage (P=0.035), postoperative drainage time (P=0.015), postoperative hospital stay (P=0.030), and visual analog scale (VAS) pain on postoperative days 2 (P=0.006) and 3 (P=0.002). However, the lateral thoracic group has more advantages in the aspect of docking time (P=0.020). There was no statistically significant difference between the two groups in terms of operative time (P=0.517), total operative time (P=0.187), postoperative day 1 VAS pain score (P=0.084), and postoperative complications (P=0.715).ConclusionThe subxiphoid approach of RATS under laryngeal mask anesthesia is safe and feasible for resecting anterior mediastinal tumors. Compared with the lateral thoracic approach, the subxiphoid approach has advantages in terms of rapid postoperative recovery and postoperative patient pain, and patient acceptance is also higher and thus is worth promoting in hospitals where it is available.

An evaluation of the use of double-curved endoscopes for gastric gastrointestinal stromal tumors

Background Endoscopic full-thickness resection (EFTR) is a standard treatment method for gastric gastrointestinal stromal tumors (gGISTs). Evidence of the safety and efficacy of a double-curved endoscope (DCE) in EFTR of gGISTs is limited. We aimed to compare the operative outcomes of DCE versus single-curved endoscopes (SCE) in EFTR of gGISTs. Material and methods This retrospective observational study was conducted at four Chinese tertiary institutes. From January 2019 to November 2021, 104 patients who underwent EFTR by SCE (n = 57) or DCE (n = 47) were enrolled. One-to-one propensity score matching (PSM) was performed between the two groups to compare the demographics and operative outcomes. Results All gGISTs were resected successfully with no recurrence during follow-up. The median (range) tumor size was 1.2 (0.5, 3.5) cm in DCE and 2.0 (0.6, 4.8) cm in SCE (p < .001), and the procedure time was shorter in the DCE group than in the SCE group (50.0 min vs. 62.0 min, p < .05). After PSM, 41 pairs were selected, and no difference was noted in demographics. The procedure time was also shorter in the DCE group than in the SCE group (50.0 min vs. 55.0 min, p < .05). Subgroup analysis showed that the DCE group had a shorter procedure time in the gastric fundus than the SCE group (47.0 min vs. 55.0 min, p < .05). In multiple linear regression analysis, significant factors related to prolonged procedure time were the type of endoscope of SCE and larger tumor size (p < .05). Conclusions EFTR of gGISTs using DCE is safe and effective. Compared with SCE, DCE had an advantage in terms of operative time, especially in the gastric fundus.

Prospective randomized comparison of three-dimensional (3D) versus conventional laparoscopy in total colectomy for ulcerative colitis.

3D laparoscopy has been proposed with the aim of improving the depth perception and overall operative performance. To aim of this study is to compare 3D laparoscopy with conventional 2D laparoscopy in terms of operative time and visual parameters. This is a prospective, randomized, single-center trial designed to determine 10% reduction in the mean operative time. Ulcerative colitis patients >18 years of age who underwent laparoscopic total abdominal colectomy with end ileostomy between 2015 and 2020 were included. Patients were randomized into 3D and 2D laparoscopy groups. Duration of operation and surgeons' evaluation of the visualization system were the primary outcomes. Fifty-three subjects (26 in 2D, 27 in 3D group) were included in the analysis, with 56% being male. Mean age and body mass index were 40 (16.3) years and 23.5 (4.7) kg/m2 , respectively. Twenty-five subjects underwent single port laparoscopic surgery, of whom 13 were in 3D and 12 in 2D group. Mean operative time was 75.3 (30.8) versus 82.7 (38.6) minutes (P=0.4) for 3D and 2D groups, respectively. Operative times spent for individual steps were comparable. Post-operative minor complications (8 in 3D versus 8 in 2D, P=1) and median number of times for scope maintenance were also similar between the groups. 69% of the visual evaluation survey results favoured 3D over 2D (P=0.014). Three-dimensional laparoscopy for total colectomy in ulcerative colitis patients is safe and feasible option providing better visualization with no difference in operative time.

Efficacy and Safety of Minimally Invasive Thyroid Surgery: A Network Meta-Analysis.

Minimally invasive and remote surgical approaches for thyroid tumors have been developed primarily for cosmetic benefit. However, conventional meta-analysis could not provide comparative data between new techniques. This network meta-analysis would be able to provide data for clinicians and patients to compare cosmetic satisfaction and morbidity by comparing surgical methods. The PubMed, EMBASE, MEDLINE, SCOPUS, Web of Science, Cochrane Trials, and Google Scholar. The nine interventions included minimally invasive video-assisted thyroidectomy (MIVA), endoscopic and robotic bilateral axillo-breast-approach thyroidectomy (EBAB and RBAB, respectively), endoscopic and robotic retro-auricular thyroidectomy (EPA and RPA, respectively), endoscopic or robotic transaxillary thyroidectomy (EAx and RAx, respectively), endoscopic and robotic transoral approaches (EO and RO, respectively), and a conventional thyroidectomy. We recorded the operative outcomes and perioperative complications; pairwise and network meta-analyses were performed. EO, RBAB, and RO were associated with good patient cosmetic satisfaction. EAx, EBAB, EO, RAx, and RBAB were associated with significantly more postoperative drainage than the other methods. Postoperatively, more flap problems and wound infections were found in the RO than control group, and more transient vocal cord palsy was found in the EAx and EBAB groups. MIVA ranked first in terms of operative time, postoperative drainage amount, postoperative pain, and hospitalization, but cosmetic satisfaction was low. EAx, RAx, and MIVA ranked higher than the other approaches in terms of operative bleeding. It was confirmed that minimally invasive thyroidectomy achieves high cosmetic satisfaction and is not inferior to conventional thyroidectomy in terms of surgical results or perioperative complications. Laryngoscope, 133:2470-2479, 2023.

R-LESS-RP versus C-LESS-RP: a single-institution retrospective comparative study

This study aimed to compare the peri- and postoperative outcomes of patients treated with conventional versus robot-assisted laparoendoscopic single-site radical prostatectomy (C-LESS-RP vs. R-LESS-RP). Data of patients with prostate cancer (106 who underwent C-LESS-RP, 124 underwent R-LESS-RP) were retrospectively collected and analyzed. All operations were performed by the same surgeon from January 8, 2018, to January 6, 2021, in the same institution. Information on clinical characteristics and perioperative outcomes was obtained from records at the medical institution. Postoperative outcomes were acquired from follow-up. Intergroup differences were retrospectively analyzed and compared. All patients had similar clinical characteristics in meaningful aspects. The perioperative outcomes were better with R-LESS-RP than with C-LESS-RP in terms of operation time (120 min vs. 150 min, p < 0.05), estimated blood loss (17.68 ml vs. 33.68 ml, p < 0.05), and analgesic duration (0 days vs. 1 days, p < 0.05). The drainage tube duration and postoperative stay did not differ significantly between groups. However, R-LESS-RP was more expensive than C-LESS-RP (56559.510 CNY vs. 44818.27 CNY, p < 0.05). The patients who underwent R-LESS-RP had better urinary incontinence recovery and higher European quality of life visual analog scale scores than those who underwent C-LESS-RP. However, no significant intergroup difference was noted in biochemical recurrence. In conclusion, R-LESS-RP could achieve better perioperative outcomes, especially for those skilled surgeons who have mastered C-LESS-RP. Additionally, R-LESS-RP accelerated the recovery from urinary incontinence effectively and presented some benefits in health-related quality of life with additional costs.

Comparison of Perioperative Outcomes and Complications of Laparoscopic and Robotic Nephroureterectomy Approaches in Patients with Upper-Tract Urothelial Carcinoma.

For medical institutions without robotic equipment, it remains uncertain whether laparoscopic radical nephroureterectomy (LNU) can achieve results similar to those of robotic surgery for the treatment of upper tract urothelial carcinoma (UTUC). This meta-analysis aimed to compare the efficacy and safety of robot-assisted radical nephroureterectomy (RANU) with that of LNU using a large sample size of patients. A systematic meta-analysis was performed using data (available to May 2022) acquired from multiple scientific databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, according to the protocols registered with PROSPERO (CRD42021264046), were followed to perform this cumulative analysis. Nine high-quality studies were included in this analysis, considering factors such as operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), positive surgical margins (PSM), and complications. Statistical indicators revealed no significant differences between the RANU and LNU groups in terms of OT (weighted mean difference [WMD] 29.41, 95% confidence interval [CI] -1.10 to 59.92; p=0.22), EBL (WMD -55.30, 95% CI -171.14 to 60.54; p=0.13), LOS (WMD -0.39, 95% CI -1.03 to 0.25; p=0.12), PSM (odds ratio [OR] 1.22, 95% CI 0.44-3.36; p=0.17], or complications (OR 0.91, 95% CI 0.49-1.69; p=0.13). The meta-analysis showed that the perioperative and safety indicators of both RANU and LNU were similar and both showed favorable outcomes in UTUC treatment. However, some uncertainties remain in the implementation and selection of lymph nodes for dissection.