Traditional Laparoscopic Surgery Research Articles

Comparative analysis of the short and medium-term efficacy of the Da Vinci robot versus laparoscopic total mesangectomy for rectal cancer.

The Da Vinci robot-assisted surgery technique has been widely used in laparoscopic mesangectomy for rectal cancer. However, the short-term efficacy of these procedures compared to traditional laparoscopic surgery remains controversial. The purpose of this study was to compare and analyze the short- and medium-term efficacy of Da Vinci robot and laparoscopic surgery in total mesangectomy (TME) for rectal cancer, so as to provide guidance and reference for clinical practice. To investigate the safety and long-term efficacy of robotic and laparoscopic total mesorectal resection for the treatment of rectal cancer. The clinicopathologic data of 240 patients who underwent TME for rectal cancer in the Anorectal Department of People's Hospital of Xinjiang Uygur Autonomous Region from August 2018 to March 2023 were retrospectively analyzed. Among them, 112 patients underwent laparoscopic TME (L-TME) group, and 128 patients underwent robotic TME (R-TME) group. The intraoperative, postoperative, and follow-up conditions of the two groups were compared. The conversion rate of the L-TME group was greater than that of the R-TME group (5.4% vs 0.8%, χ 2 = 4.417, P = 0.036). The complication rate of the L-TME group was greater than that of the R-TME group (32.1% vs 17.2%, χ 2 = 7.290, P = 0.007). The percentage of positive annular margins in the L-TME group was greater than that in the R-TME group (7.1% vs 1.6%, χ 2 = 4.658, P = 0.031). The 3-year disease-free survival (DFS) rate and overall survival (OS) rate of the L-TME group were lower than those of the R-TME group (74.1% vs 85.2%, χ 2 = 4.962, P = 0.026; 81.3% vs 91.4%, χ 2 = 5.494, P = 0.019); in patients with American Joint Committee on Cancer stage III DFS rate and OS rate in the L-TME group were significantly lower than those in the R-TME group (52.5% vs 76.1%, χ 2 = 5.799, P = 0.016; 65.0% vs 84.8%, χ 2 = 4.787, P = 0.029). Compared with the L-TME group, the R-TME group had a better tumor prognosis and was more favorable for patients with rectal cancer, especially for patients with stage III rectal cancer.

Perceived comfort and tool usability during robot-assisted and traditional laparoscopic surgery: a survey study

It is known that over half of previously surveyed surgeons performing Robot-Assisted Laparoscopic Surgery (RALS) and three-quarters of those performing Traditional Laparoscopic Surgery (TLS) experience intraoperative pain. This survey study aimed to expand upon the ongoing impact of that pain as well as perceived tool usability associated with TLS and RALS, for which considerably less documentation exists. A survey regarding the presence and impact, either immediate or ongoing, of intraoperative pain and Likert scale questions regarding tool usability was administered to TLS and RALS surgeons on the European Association for Endoscopic Surgery (EAES) mailing list. Prevalence statistics as well as trends based on biological sex and glove size were obtained from the 323 responses. Most respondents were right-handed European males (83−88%) with a medium glove size (55.8%). Moderate or severe shoulder symptoms were experienced by one-third of TLS surgeons. Twenty-one percent of RALS surgeons experienced neck symptoms that impacted their concentration. Small-handed surgeons experienced wrist symptoms significantly more frequently than large-handed surgeons, regardless of modality. RALS was associated with a significantly more optimal back and wrist posture compared to TLS. TLS surgeons reported increased ease with applying and moderating force while operating. These results suggest that intraoperative pain may be severe enough in many cases to interfere with surgeon concentration, negatively impacting patient care. Continuing to understand the relationship between tool usability and comfort is crucial in guaranteeing the health and well-being of both surgeons and patients.

The “Medical Cost” of Robot-Assisted Laparoscopic Surgery in Endometrial Cancer in Terms of Anesthesia Comparison with Traditional Laparoscopic Surgery

Objective :Minimally invasive surgeries have important advantages such as lower morbidity, shorter hospital stay, and earlier return to routine life. Robot-assisted laparoscopic surgery (RALS) plays a leading role in the development process of minimally invasive surgery. In this study, we compared patients with endometrial cancer who were operated with RALS and traditional laparoscopic surgery (TLS) methods in terms of processes related to anesthesia, such as peroperative fluid management and transfusion requirement, analgesic strategies, postoperative complications, duration of post-anesthesia care unit (PACU) and hospital stay
 Materials and Methods: Patients with American Society of Anaesthesiologists (ASA) scores II-III, over the age of 18, who were operated for endometrial cancer by TLS or RALS methods between January 2020 and March 2022 were included in the study. Patients age, ASA score, duration of surgery, peroperative fluid management, transfusion requirement, urine output, bleeding, postoperative Visual Analogue Scale (VAS) scores, the PACU admission were obtained from the standard anesthesia record form and preoperative and postoperative hemoglobin (Hb) values, length of hospital stay were obtained from the electronic database of the hospital. 
 Results: Intravenous fluid input, bleeding and urine output during the operation were statistically lower in group RALS. While there was no difference between the preoperative Hb values of the two groups, the postoperative Hb values were significantly lower in the TLS group. Perioperative bleeding and fluid replacement are lesser and the hospital stay is shorter in RALS. 
 Conclusion: TLS and RALS, which are minimally invasive surgical methods, are used in the treatment of endometrial cancer. The idea that RALS is more costly than TLS should be reconsidered, as RALS reduces costs with less perioperative bleeding and fluid replacement and shorter hospital stay

Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy

Robotic-assisted cholecystectomy is rapidly being adopted into practice, partly based on the belief that it offers specific technical and safety advantages over traditional laparoscopic surgery. Whether robotic-assisted cholecystectomy is safer than laparoscopic cholecystectomy remains unclear. To determine the uptake of robotic-assisted cholecystectomy and to analyze its comparative safety vs laparoscopic cholecystectomy. This retrospective cohort study used Medicare administrative claims data for nonfederal acute care hospitals from January 1, 2010, to December 31, 2019. Participants included 1 026 088 fee-for-service Medicare beneficiaries 66 to 99 years of age who underwent cholecystectomy with continuous Medicare coverage for 3 months before and 12 months after surgery. Data were analyzed August 17, 2022, to June 1, 2023. Surgical technique used to perform cholecystectomy: robotic-assisted vs laparoscopic approaches. The primary outcome was rate of bile duct injury requiring definitive surgical reconstruction within 1 year after cholecystectomy. Secondary outcomes were composite outcome of bile duct injury requiring less-invasive postoperative surgical or endoscopic biliary interventions, and overall incidence of 30-day complications. Multivariable logistic analysis was performed adjusting for patient factors and clustered within hospital referral regions. An instrumental variable analysis was performed, leveraging regional variation in the adoption of robotic-assisted cholecystectomy within hospital referral regions over time, to account for potential confounding from unmeasured differences between treatment groups. A total of 1 026 088 patients (mean [SD] age, 72 [12.0] years; 53.3% women) were included in the study. The use of robotic-assisted cholecystectomy increased 37-fold from 211 of 147 341 patients (0.1%) in 2010 to 6507 of 125 211 patients (5.2%) in 2019. Compared with laparoscopic cholecystectomy, robotic-assisted cholecystectomy was associated with a higher rate of bile duct injury necessitating a definitive operative repair within 1 year (0.7% vs 0.2%; relative risk [RR], 3.16 [95% CI, 2.57-3.75]). Robotic-assisted cholecystectomy was also associated with a higher rate of postoperative biliary interventions, such as endoscopic stenting (7.4% vs 6.0%; RR, 1.25 [95% CI, 1.16-1.33]). There was no significant difference in overall 30-day complication rates between the 2 procedures. The instrumental variable analysis, which was designed to account for potential unmeasured differences in treatment groups, also showed that robotic-assisted cholecystectomy was associated with a higher rate of bile duct injury (0.4% vs 0.2%; RR, 1.88 [95% CI, 1.14-2.63]). This cohort study's finding of significantly higher rates of bile duct injury with robotic-assisted cholecystectomy compared with laparoscopic cholecystectomy suggests that the utility of robotic-assisted cholecystectomy should be reconsidered, given the existence of an already minimally invasive, predictably safe laparoscopic approach.

Clinical study on laparoscopic minimally invasive surgery and transumbilical single-port laparoscopic surgery in the treatment of benign ovarian tumours and its influence on ovarian functions.

The objective of this study was to explore the influence of traditional laparoscopic surgery and transumbilical single-port laparoscopic surgery on ovarian function in patients with benign ovarian tumours. Forty-four patients with benign ovarian tumours who were treated in our hospital from January 2020 to June 2021 were selected and randomly divided into two groups, with 22 cases in each group according to random number table. The conventional group was treated with conventional laparoscopic surgery, while the modified group was treated with transumbilical single-port laparoscopic surgery. The measurement method was t -test, and the enumeration method was two tests. The clinical operation-related indicators, ovarian function (follicle-stimulating hormone, E 2 and luteinising hormone), complication incidence, Visual Analogue Scale (VAS) and landscaping satisfaction scores of the two groups were compared. There were no significant differences in complications and operation duration between the two groups ( P > 0.05). After treatment, the ovarian function indexes and beautification satisfaction scores of the modified group were significantly superior to those of the conventional group ( P < 0.05). Besides, the intraoperative bleeding volume, post-operative exhaust time, hospital stay and three-dimensional VAS scores on day 1 and day 3 after surgery of the modified group were lower than those of the conventional group ( P < 0.05). Transumbilical single-port laparoscopic surgery for benign ovarian tumours has a significant clinical effect, which can effectively reduce bleeding during the operation, improve ovarian function, relieve surgical pain, promote rapid post-operative recovery and improve patients' satisfaction with landscaping. It is worthy of clinical application.

Learning curves and procedural times in Senhance®-robotic assisted fundoplication: results from 237 consecutive patients undergoing robotic fundoplication in a single center as part of the European TRUST Robotic Surgery Registry Study.

Gastroesophageal reflux disease requiring an operative solution is common. Minimally invasive surgery to generate an anti-reflux barrier at the distal esophagus following the principle of the "floppy Nissen" technique has become the gold standard. Advanced robotic-assisted systems may deliver more consisted outcomes. This registry study analyzed safety and efficacy of the Senhance® surgical system in the surgical treatment of reflux disease and procedural proficiency. Data from 237 consecutive patients operated in a single center were evaluated. Historic standard laparoscopies from the same center were analyzed to compare robotic surgery learning curve effects. Using the Senhance® Surgical System, during the first 50 patients there was a significant decrease in surgery time which was maintained over the duration of study, pointing to the surgical staff's system-specific learning. After this phase, procedural times were comparable between the robotic-assisted and traditional laparoscopic surgery. The effect of learning was greater than for standard laparoscopy. For 237 patients, there were four conversions to laparoscopic surgery. Two serious adverse events were recorded, both cardiac in nature and not related to the use of the robot. Robotic fundoplication was swiftly implemented in a non-university hospital with 65 surgical beds. The operating time was no longer than in standard laparoscopy, the procedure was more standardized than open or laparoscopic surgery and hospitalization times may have been sustainably shortened. The autonomy at the system's digital platform (cockpit) to conduct robotic fundoplications is a big step forward in surgery.

Does transvaginal natural orifice transluminal endoscopic surgery affect female sexual function?: a prospective cohort study

BackgroundTo evaluate the effect of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) on female sexual function. Methods: The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2100050887, 07/09/2021). In this prospective cohort study, we prospectively analyzed the data of the female sexual function index (FSFI) questionnaire of 130 patients who underwent laparoscopy in Chengdu Women’s and Children’s Central Hospital due to gynecological benign diseases. The patients were assigned to the vNOTES group and the control group (underwent traditional laparoscopic surgery or transumbilical laparoendoscopic single-site surgery). Results: There were 4 cases dropout in the vNOTES group and 2 cases dropout in the control group. There was no difference in the ages (31.70 ± 5.02 vs. 30.37 ± 5.74, P>0.05), BMI (body mass index, 21.76 ± 3.16 vs. 23.30 ± 2.69, P>0.05), Education level, surgical types, and FSFI scores (22.31 ± 2.25 vs. 21.55 ± 3.38) between the vNOTES group and the control group before surgery. There was no difference in FSFI scores six months postoperation between the vNOTES group and the control group (21.61 ± 3.22 vs. 20.99 ± 3.26, P>0.05), and there was no difference in FSFI scores pre- and six months postoperation in vNOTES group (21.61 ± 3.22 vs. 22.31 ± 2.25, P>0.05). The time to start sexual life after surgery in the vNOTES group was later than that in the control group (39.34 ± 0.71 d versus 37.86 ± 0.69 d, P < 0.05). Conclusions: vNOTES has no significant adverse effect on female sexual function, however, the time to start sexual life after vNOTES is later than that after trans-abdominal laparoscopy.

Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis.

Hand size, strength, and stature all impact a surgeon's ability to perform Traditional Laparoscopic Surgery (TLS) comfortably and effectively. This is due to limitations in instrument and operating room design. This article aims to review performance, pain, and tool usability data based on biological sex and anthropometry. PubMed, Embase, and Cochrane databases were searched in May 2023. Retrieved articles were screened based on whether a full-text, English article was available in which original results were stratified by biological sex or physical proportions. Article quality was discussed using the Mixed Methods Appraisal Tool (MMAT). Data were summarized in three main themes: task performance, physical discomfort, and tool usability and fit. Task completion times, pain prevalence, and grip style results between male and female surgeons formed three meta-analyses. A total of 1354 articles were sourced, and 54 were deemed suitable for inclusion. The collated results showed that female participants, predominantly novices, took 2.6-30.1s longer to perform standardized laparoscopic tasks. Female surgeons reported pain at double the frequency of their male colleagues. Female surgeons and those with a smaller glove size were consistently more likely to report difficulty and require modified (potentially suboptimal) grip techniques with standard laparoscopic tools. The pain and stress reported by female or small-handed surgeons when using laparoscopic tools demonstrates the need for currently available instrument handles, including robotic hand controls, to become more size-inclusive. However, this study is limited by reporting bias and inconsistencies; furthermore, most data was collected in a simulated environment. Additional research into how anthropometric tool design impacts the live operating performance of experienced female surgeons would further inform this area of investigation.

Efficacy analysis of enhanced recovery after surgery in laparoscopic-assisted radical resection of type I choledochal cyst.

The objective of this study was to investigate the feasibility and effectiveness of laparoscopic-assisted radical resection of type I choledochal cyst (CC) guided by the principles of enhanced recovery after surgery (ERAS). A retrospective cohort study of type I CC admitted to our hospital between May 2020 and December 2021 were analyzed, a total of 41 patients with choledochal cyst underwent surgery during this period and 30 cases were selected based on inclusion and exclusion criteria. Patients (n = 15) who received the traditional treatment from May 2020 to March 2021 were included in the traditional group. Patients (n = 15) who received ERAS from April 2021 to December 2021 were included in the ERAS group. Both groups underwent surgery performed by the same surgical team. Preoperative data of the two groups were recorded, and relevant data were statistically analyzed and compared. There was a statistically significant difference in the dose of opioids. Significant differences were observed between the ERAS and traditional groups in the results of the FLACC pain assessment scale on the 1st and 2nd day after surgery, time of gastric tube, urinary catheter and abdominal drainage tube removal, time of first defecation after operation, time of first eating after operation, time to reach full food intake, results of CRP, ALB, and ALT on the 3rd and 7th postoperative day, postoperative hospital stay, and total treatment cost. No significant differences were observed between the two groups in terms of gender, age, body weight, cyst size, preoperative CRP, ALB, ALT, intraoperative blood loss, operation time, and the number of cases converted to laparotomy. Neither the FLACC pain assessment scale on the 3rd day after surgery, the incidence of postoperative complications, nor the rate of readmission within 30 days showed significant differences. Laparoscopic-assisted radical resection of type I CC guided by the principles of ERAS is safe and effective for children. The ERAS concept demonstrated advantages over traditional laparoscopic surgery, including reduced opioid use, shorter time to first postoperative defecation, earlier resumption of postoperative feeding, shorter time to reach full feeding, shorter postoperative hospital stay, and lower total treatment cost.

Muscle fatigue and physical discomfort reported by surgeons performing robotic-assisted surgery: a multinational survey.

Robotic surgery has revolutionized surgical procedures and has provided many advantages over traditional laparoscopic and open surgeries. Despite the benefits, there are concerns about the physical discomfort and injuries that may be experienced by surgeons during robotic surgeries. This study aimed to identify the most common muscle groups implicated in robotic surgeons' physical pain and discomfort. A questionnaire was created and sent to 1000 robotic surgeons worldwide, with a response rate of 30.9%. The questionnaire consisted of thirty-seven multiple-choice questions, three short answer questions, and one multiple-option question pertaining to the surgeon's workload as well as their level of discomfort while and after performing surgery. The primary endpoint was to identify the most common muscle groups implicated in robotic surgeons' physical pain and discomfort. Secondary endpoints were to highlight any correlation between age group, BMI, hours of operation, workout regimen, and significant pain levels. The results showed that the most common muscle groups implicated in physical pain and discomfort were the neck, shoulders, and back, with many of the surgeons attributing their muscular fatigue and discomfort to the ergonomic design of the surgeon console. Despite the level of surgeon comfort the robotic console provides when compared to other conventional forms of surgery, the findings suggest the need for better ergonomic practices during robotic surgeries to minimize physical discomfort and injuries for surgeons.

Application of robotic surgery and traditional laparoscopic surgery in lymph node dissection for gynecological cancer: A meta‑analysis.

Since the advantages of robotic surgery and laparoscopic surgery in the number of lymph node resections are not well understood, this meta-analysis used evidence-based medicine to assess the difference in the number of lymph nodes retrieved in gynecological cancer between the two surgical methods to guide clinical treatment. In the present meta-analysis, the Pubmed, Embase, Cochrane, China National Knowledge Infrastructure and Wanfang libraries were searched for articles that were published from the time of the database's inception to January 2021, including cohort studies and randomized controlled trials, where the observation group underwent robotic surgery to treat gynecological cancers and the control group underwent laparoscopic surgery to treat gynecological cancers, including cervical and ovarian cancers and endometrial cancers. Duplicate publications, studies with no full text, incomplete information or where the authors were unable to perform data extraction, animal experiments, reviews and systematic reviews were excluded. STATA 15.1 was used to analyze the data. Robotic surgery resulted in a significant increase in the number of lymph nodes retrieved from the pelvis [standard mean difference (SMD)=0.24; 95% CI, 0.04-0.45; P=0.007] and para-aortic (SMD=0.41; 95% CI, 0.13-0.69; P=0.004) regions compared with the number retrieved by laparoscopic surgery. Furthermore, there was no significant difference in operating time between robotic and laparoscopic surgery, despite the use of different instruments (SMD=0.12; 95% CI, -0.35-0.58; P=0.616). The amount of blood lost during robotic surgery was significantly less compared with that lost during laparoscopic surgery [SMD=-0.40; 95% CI, -0.58-(-0.22); P<0.001]. The present study evaluated cancer recurrence and death in further detail, and no statistically significant difference was demonstrated between robotic surgery and laparoscopic surgery in terms of recurrence rate [odds ratio (OR)=0.59; 95% CI, 0.21-1.65; P=0.318] and mortality rate (OR=0.31; 95% CI, 0.08-1.30; P=0.109). The present study demonstrated that robotic surgery was able to retrieve more pelvic and para-aortic lymph nodes than traditional laparoscopic surgery, which was consistent with previous reports. With regards to blood loss, The difference in operation time between the two surgical methods was not statistically significant, whereas the estimated blood loss of robotic surgery was significantly lower than that of traditional laparoscopic surgery. There was no statistically significant difference in the recurrence rate and mortality rate of the two surgical modality.

A comparison of the efficacy and safety of natural orifice specimen extraction and conventional laparoscopic surgery in patients with sigmoid colon/high rectal cancer

This study aimed to investigate the efficacy and safety of natural orifice specimen extraction surgery (NOSES) compared to conventional laparoscopic radical resection in the treatment of patients with sigmoid colon/high rectal cancer. The control group (n = 62) underwent traditional laparoscopic radical resection, and the observation group (n = 62) underwent transanal NOSES laparoscopic radical resection. The operation length; amount of bleeding; number of lymph node dissections and days of hospitalization after surgery; visual pain scores on the first and third days after surgery; first leaving bed, anal exhaust, eating a liquid diet, and effective sleep times; and the postoperative complications (abdominal or incision infection or anastomotic fistula) of the two groups of patients were compared and analyzed. The effective sleep time of the observation group on the first day after the operation was 12.3 ± 2.9 h, which was longer than that of the control group (10.6 ± 3.2 h), and the difference was statistically significant (p < 0.001). The pain degree of the two groups on the third day after the operation was lower than that on the first day, and the pain score of the observation group was lower than that of the control group (2.0 ± 1.0 vs. 3.2 ± 1.2, p < 0.001). The postoperative hospital stay in the observation group was significantly shorter than that in the control group (9.7 ± 2.3 vs. 11.2 ± 2.6, p < 0.001). The incidence of postoperative complications in the observation group was significantly lower than that in the control group (3.2% vs. 12.9%, p = 0.048). In addition, it was found that the first leaving bed, anal exhaust and liquid diet times in the observation group were significantly shorter than those in the control group (p < 0.001). Laparoscopic radical resection NOSES in patients with sigmoid colon cancer or high rectal cancer leads to lower postoperative pain and longer sleep time than in patients who undergo traditional laparoscopic radical surgery. The complication rate of this procedure is low, and the curative effect is safe and positive.

Robot-assisted laparoscopic repair in hiatal hernia with kyphosis: A case report with meta-analysis

Abstract BACKGROUND: Hiatal hernia is a high incidence disease, of which, partial patients requiring surgery have gastroesophageal reflux or dysphagia. Although minimally invasive surgery has been widely utilized in recent years, the optimal surgical therapy still remains controversial. In this study, we reported a kyphosis patient undergoing robot-assisted laparoscopic hiatal hernia repair and launched a meta-analysis aiming to evaluate the advantages of this surgery strategy. MATERIALS AND METHODS: Six databases (Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, EMBASE, ClincialTrials.gov database and Web of Science) were searched from inception to September 20, 2022. All studies describing the patients undergoing robotic hiatal hernia or laparoscopic hiatal hernia were included. And the meta-analysis was performed using R package meta (v6.0.0). RESULTS: We reported a 75-year-old female patient of short stature and with severe kyphosis was diagnosed with hiatal hernia and underwent a robotic surgery. For meta-analysis, 1,128 articles were identified in the initial database search, and among them, 6 articles were included in the final analysis. The results showed that robotic surgery had no advantage in operation time and intraoperative complications rate compared with traditional laparoscopic surgery (both P &lt; 0.01). Regardless of the statistical significance, robotic surgery tended to have a lower conversion and postoperative complication rate, as well as the length of hospital stay. CONCLUSIONS: Robotics have some advantages in the surgical treatment of hiatal hernia compared with the conventional laparoscopic surgery, the use of which can facilitate the treatment for some challenging cases.

Minimally Invasive Approaches for Cholecystectomy

Abstract Surgical removal of the gallbladder is cholecystectomy. In Western countries, laparoscopic cholecystectomy (LC) is widely used procedure. Single-incision LC (SILC), mini LC (MLC) these surgeries developed by doctors, also natural orifice transluminal endoscopic surgery to lessen the invasiveness of the treatment. The goal of this study was to see how effective these novel less invasive techniques for LC are in treating gallstone disease. The current literature is inadequate for a proper management of new LC procedures. None of these methods have shown to be superior to traditional LC. SILC is now not recommended since it is linked to the predominance of bile duct damage also incisional hernia. Even though hybrid transvaginal cholecystectomy is becoming more popular in objective practice, cholecystectomies are still experimental. As a result of the fact that it is standardized, because MLC is standardized and nearly identical to traditional laparoscopic surgery, it may provide limited benefits without increasing postoperative problems, making it suitable for routine elective cholecystectomy. The technological issues could be addressed by modifying new surgical equipment that needs to grow with the nuances of SILC and cholecystectomy. Regardless of where these treatments may be used in the upcoming days, robotization may be required to make them the standard of care.

Laparoscopic radical transverse colectomy with transrectal specimen extraction: A novel natural orifice specimen extraction procedure: A case report.

Transverse colon cancer accounts for about 10% of all colonic cancers. The resection of cancers in the transverse colon is technically more challenging, compared with other cancer locations in the colon because the variable anatomy of the middle colic vessels demands excellent surgical skills and the anatomical location of the transverse colon is related to major organs. We report a novel laparoscopic technique for the first time used in surgery of transverse colon cancer which combines a total intracorporeal anastomosis with natural orifice specimen extraction to solve the problems of traditional laparoscopic surgery. A 48-year-old male patient, whose diagnosis was transverse colon adenocarcinoma, was admitted to the hospital. The surgery was performed in accordance with the procedure of totally laparoscopic right hemicolectomy and the specimen was extracted by opening the rectum. Natural orifice specimen extraction surgery has many advantages, including less pain, better cosmesis and minimising risks of complications and also has comparable long-term outcomes compared to conventional laparoscopic surgery.

Effect of Fast-Track Surgery under ERAS protocol in Laparoscopic Hysterectomy: A Randomized Controlled Trial

Background & Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic laparoscopic surgeries. The purpose of this study is to evaluate enhanced recovery after surgery (ERAS) for total laparoscopic hysterectomy.Materials & Methods: 260 patients underwent for laparoscopic hysterectomy surgery. All patients were divided into two groups as follows: one group received traditional laparoscopic hysterectomy surgery and the intervention group was treated under ERAS protocol. ERAS protocol includes not receiving preoperative mechanical bowel preparation and laxatives as well as fasting 6 h and not drinking liquids 2h before surgery. The patients were allowed to resume the ordinary diet 6h post-operation. Ondansetron 4 mg were prescribed after surgery for nausea and vomiting, pain was controlled with non-narcotic analgesics diclofenac suppository 100 mg/q12 h and paracetamol 1000 mg/q6 h until discharge. Urinary catheter was removed whenever possible and early ambulation occurred 6h after the surgery.Results: A total of 260 patients were studied. Regarding the length of hospitalization, significant differences were shown between the groups (P<0.001). Return to daily functions was occurred earlier in the fast-track surgery group than another group. Complications and VAS pain scores showed no significant differences between the groups.Conclusion: Our results show that ERAS surgery has fewer side effects and better outcomes which make it more suitable for patients undergoing laparoscopic hysterectomy.

Ureteral identification with indocyanine green in laparoscopic colorectal surgery.

Fluorescence-guided surgery has emerged as a complement of traditional laparoscopic surgery with the advantage that is adaptable to existent platforms. The purpose of this article is to describe our technique for ureteral identification with indocyanine green (ICG) during laparoscopic colorectal surgery. We report a case series of all patients who underwent laparoscopic colorectal surgery and ureteral injection of ICG in a private third level hospital. We performed 30 laparoscopic colorectal surgeries in which we used this technique to identify the ureters. Mean age was 52.6 ± 15.28 years; 16 (53.3%) were men. The indication for surgery was diverticulitis in 18 patients. Mean urological operative time was 22.4minutes. There were no immediate or delayed adverse effects attributable to intra-ureteral ICG administration. Although ureteric iatrogenic injury is uncommon, when it does happen, it significantly increases the patient's morbidity. We consider this technique has the potential to make laparoscopic surgeries safer mostly in patients with cancer, diverticular disease or endometriosis who have extensive fibrosis, adhesions, and inflammation.

Application Progress of Transumbilical Single-Port Laparoscopic Surgery for Myomectomy

Uterine fibroids are the most common gynecological benign tumors in women during reproductive period, which often lead to anemia, abortion, infertility, and seriously affect the physical and mental health of patients. At present, the treatment of uterine fibroids includes conservative observation, drug therapy and surgical treatment. For patients with uterine preservation needs, laparoscopic myomectomy is currently the preferred surgical method for uterine fibroid preservation. In recent years, with the development of minimally invasive technology, transumbilical single-site surgery (TU-LESS) has been widely used in gynecological minimally invasive surgery. Compared with traditional laparoscopic surgery, TU-LESS can not only ensure the operation effect, but also has the advantages of less trauma, faster recovery and no trace after operation, especially suitable for female patients; However, due to the problems of limited visual field, "chopstick effect", difficulty in forming "operation triangle", difficulty in suturing and tumor extraction, the application of TU-LESS in myomectomy is relatively backward, and there are still many surgical difficulties to be overcome in the process of operation, which requires a certain learning curve to master the surgical skills. With the continuous practice and exploration, the application of transumbilical single-port laparoscopic myomectomy (SPLM) will become more and more mature with the summary of operation skills and the invention of special instruments. This article reviews the application progress of transumbilical single-port laparoscopy in myomectomy and the key points and difficulties in learning this operation.

7490 Perioperative Outcomes of the "Chopsticks Technique" Single-Site Laparoscopy Versus Traditional Laparoscopy for Endometrial Cancer

<h3>Study Objective</h3> To describe the new "chopsticks technique" single-site laparoscopic surgery technology and to compare the perioperative outcomes of the new "chopsticks technique" laparoendoscopic single-site surgery (LESS) versus traditional laparoscopic surgery (TLS) in the staging surgery of endometrial cancer (EC). <h3>Design</h3> Retrospective case-control study based on propensity score matching (PSM). <h3>Setting</h3> Department of gynecology at a tertiary medical center. <h3>Patients or Participants</h3> From August 2018 to August 2020 at Southwest Hospital in Chongqing, China, patients diagnosed with endometrial cancer, a total of 26 cases conducted LESS were matched with a cohort of 52 cases who underwent TLS. <h3>Interventions</h3> A propensity score matching was performed to reduce the bias due to the imbalanced baseline features between the two groups, and the perioperative outcomes were compared between matched cohorts. <h3>Measurements and Main Results</h3> We retrospectively reviewed 535 cases of patients diagnosed with endometrial cancer from our institutional database. A 1:2 propensity score matching was conducted matched by age, BMI, history of surgery, FIGO staging between the two groups. After matching, the variables were well balanced with no differences at baseline between groups. The operations in both groups were successfully completed without conversion to laparotomy. There were no statistically significant differences in the amount of intraoperative blood loss, number of lymph nodes removed, postoperative exhaust time, postoperative indwelling drainage time, postoperative hospital stay, etc. between the two groups (P>0.05). Meanwhile, compared with the TLS group, the LESS group has longer operation time, a lower pain score of 24-hour after surgery and a more satisfactory postoperative cosmetic effect, of which the difference was statistically significant (P <0.05). <h3>Conclusion</h3> It is undoubtedly safe and feasible for staging endometrial cancer to employ the "chopsticks technique" single-site laparoendoscopic with minimum scars from abdominal incisions, which results less pain and outstanding cosmetic effects. However, further prospective, randomized studies with larger samples are needed.

Comparison of clinical efficacy of single-incision and traditional laparoscopic surgery for colorectal cancer: A meta-analysis of randomized controlled trials and propensity-score matched studies.

Single-incision laparoscopy surgery (SILS) is a new laparoscopic technique that has emerged in the past decade. Whether it has advantages over conventionl laparoscopy surgery (CLS) is inconclusive. This article aimed to compare the short- and long-term outcomes of single-incision laparoscopic surgery and conventional laparoscopic surgery for colorectal cancer through high-quality literature text mining and meta-analysis. Relevant articles were searched on the PubMed, Embase, and Cochrane Library databases from January 2012 to November 2021. All data was from randomized controlled trials (RCTs) in order to increase the confidence of the analytical results.The main outcomes were intraoperative and postoperative complications. A total of 10 RCTs were included, involving 1609 patients. The quality of the included studies was generally high. No significant difference was found between SILS and CLS in the postoperative complications, operation time, postoperative hospital stay, number of lymph nodes removed, readmission, reoperation, complication level I- II, complication level IIIa, complication level IIIb, prolonged Ileus, blood loss, infection, anastomotic leakage and operation time. The results showed that SILS group had a higher rate of intraoperative complications, but it had lower incision length and better cosmetic effects. These results indicate that SILS did not have a comprehensive and obvious advantage over the CLS. On the contrary, SILS has higher intraoperative complications, which may be related to the more difficulty of SILS operation, but SILS still has better cosmetic effects, which is in line with the concept of surgical development. Therefore, the SILS needs to be selected in patients with higher cosmetic requirements and performed by more experienced surgeons.