Search

Laparoscopic total mesorectal excision (L-TME) is difficult to perform because of its technical shortcomings in cases of difficult anatomical condition. In such situations, robotic TME (R-TME) tends to be the procedure of choice. This study aimed to compare R-TME and L-TME treatments for mid-low rectal cancer in patients with difficult anatomical conditions. This retrospective single-center study examined data from 01/2019 to 02/2021 of mid-low rectal cancer patients with difficult anatomical conditions. Perioperative data, short-term outcomes, and 2-year oncologic outcomes were compared between groups. The 106 patients were divided into R-TME (n = 56) and L-TME (n = 50). R-TME was associated with a lower diverting ileostomy rate (28.6% vs 50.0%, P = 0.005). R-TME involved a longer operation time (180 min vs 147.5 min, P < 0.001) but a similar procedure time (147.5 min vs 143.5 min, P = 0.110). More patients treated with R-TME experienced mild postoperative pain (33.9% vs 12.0%, P = 0.015) at a much higher cost ([$13740.8 ± 2038.13] vs [$9579.97 ± 2404.22], P < 0.001). The 2-year overall survival and disease-free survival rates were similar between the groups. R-TME, when performed by an experienced surgeon, can reduce the diverting ileostomy rate and relieve postoperative pain without a longer procedure time but at a higher cost. Larger trials of difficult patients with extended follow-up times are expected. [ABSTRACT FROM AUTHOR]

To safely perform minimally invasive hysterectomy (MIH), including laparoscopic hysterectomy and robot-assisted hysterectomy, partial ureterolysis, or visualizing only the ureter without dissection is often inadequate. Moreover, careless blunt dissection could injure the blood vessels. We present our surgical method for ureterolysis using sharp dissection during MIH. First, the outer portion of the ureter is dissected. Dissecting between the pelvic sidewall and the posterior leaf of the broad ligament creates a pararectal space outside the ureter, enabling the easy identification of the ureter running on the posterior leaf. Second, the inner portion of the ureter is dissected. After determining the location of the ureter, a better partial dissection of the ureter can be performed from the posterior leaf, instead of dissecting along the entire circumference. If fine surgery has to be performed, the ureter can be dissected by enclosing it within its sheath. We primarily perform dissections using a monopolar device, which allows a sharp dissection. Furthermore, in our method, we often include the dissection of the ureteral tunnel. It is important to understand the anatomy and membrane structure of the ureter in each patient and adjust the extent of ureterolysis based on individual differences. [ABSTRACT FROM AUTHOR]

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Computer-guided piezocision can be used to overcome the disadvantages of corticotomy in accelerating orthodontic tooth movement. The aim of this clinical pilot study was to determine the accuracy of this technique. STROBE guidelines were followed. Ten patients were selected and treated. Using new dedicated planning software, the piezocision cuts were properly positioned in virtual models. A surgical guide was designed and printed with slots to guide the scalpel blade first and then the piezoelectric micro-saw. The slots limit the cortical incisions coronally and apically, and also limit the depth of penetration of the piezoelectric micro-saw. The patients underwent CBCT before and immediately after surgery, and the pre- and postoperative images were matched. Using software, the planned piezocisions were compared to the actual piezocisions, and the entry point and depth deviations were measured. Descriptive statistics, kappa statistics, and the t -test were used for the data analysis. The mean deviation at the entry point was 0.67 mm (range 0.06–1.44 mm, standard deviation 0.31). The mean depth deviation was 0.54 mm (range 0.17–0.80 mm, standard deviation 0.21). The limits of the use of computer-guided piezocision are set by the maximum deviation observed; thus a safety distance of 1.5 mm should be considered, which confirms that this innovative technique is clinically applicable. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Lung Cancer is the property of Chinese Journal of Lung Cancer and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

With the advent of robot-assisted laparoscopic ureteral reimplantation (RALUR) for primary vesicoureteral reflux (VUR), understanding and minimizing its complications continues to be critical. Incidence of de novo hydronephrosis after RALUR could be indicative of an outcome that needs further study or could be a benign transient finding. In the present study, we hypothesized that the incidence of de novo hydronephrosis after RALUR is low and resolves spontaneously. An IRB-approved prospective single-institutional registry was utilized to identify all patients undergoing RALUR via an extravesical approach from 2012 to 2020. Patients with primary VUR and minimal (Grade I SFU) or no hydronephrosis prior to surgery were included. Patients who had other associated pathology or underwent concomitant procedures were excluded. Preoperative characteristics including VUR and hydronephrosis grades as well as post-operative clinical details and hydronephrosis grades were aggregated and analyzed. 86/172 (50%) patients (133 ureters), with median reflux grade of 3 (IQR: G2, G3) met the inclusion criteria. Patients underwent RALUR at a median age of 5.7 years (IQR: 3.4, 8.7) with median 36.2 months (IQR: 19.6, 63.6) follow-up. Renal ultrasound at 4–6 weeks post-op showed de novo hydronephrosis in 18 (13.5%) ureters; the complete resolution was seen in 13 ureters (72%) at a median of 4.5 months from surgery. Among the 5 with non-resolved hydronephrosis (SFU G2:4, G3:1), 2 patients (3 ureters) underwent subsequent interventions. The present study evaluating the natural history of de novo hydronephrosis after RALUR-EV performed for primary VUR, is to our knowledge the largest cohort of patients undergoing RALUR that this has been studied in. In our cohort, the incidence of de novo hydronephrosis after RALUR was 13.5%, similar to rates reported in two OUR cohorts, and significantly lower than reported incidence rates of 22–26% in several OUR cohorts, and 30% in a RALUR cohort. In the present cohort, hydronephrosis resolved spontaneously in more than 72% of cases. The median time from surgery until resolution of hydronephrosis was 4.5 (1.6, 10.5) months, which is shorter in comparison to the average time to resolution of 7.6 months, reported by Kim et al. in an earlier study. De novo hydronephrosis after RALUR can be followed with serial renal ultrasounds. The majority of de novo hydronephrosis post-RALUR is transient and resolves spontaneously within a year of surgery with a very low re-intervention rate. Summary Table Summary Table Number of Patients 86 Number of ureters 133 Age at surgery (years), median (IQR) 5.7 (3.4, 8.7) Follow-up duration (months), median (IQR) 36.2 (19.6, 63.6) Worsened/de novo hydronephrosis after RALUR 18 (13.5%) Grade 2 14 (10.5%) Grade 3 2 (1.5%) Grade 4 2 (1.5%) Resolution of de novo hydronephrosis 13 (72.2%) Time to hydronephrosis resolution (months), median (IQR) 4.5 (1.6, 10.5) Procedures performed after RALUR 3 (16.7%) [ABSTRACT FROM AUTHOR]

Summary: Objective: Four fixation techniques for a fibrinogen and thrombin coated collagen fleece, used as a scaffold in the cartilage repair, were compared simulating the initial postoperative period in the cadaveric knee joints. Methods: Full-thickness chondral lesions were made on the medial femoral condyles of seven human cadaveric inferior extremities. Four scaffolds without seeded chondrocytes were implanted into each lesion using four fixation techniques consecutively: self-adhesion without additional material (SA), fibrin sealant (FS), bone sutures (BS), and periosteal cover (PC). After each implantation 150 cycles of continuous passive motion (CPM) were performed. Two cases were additionally exposed to 50 cycles of 10 and 20kg loading each after the completion of CPM. The scaffolds were evaluated after every 30 cycles, and the fixation strength was tested after the motion was completed. Results: All the SA scaffolds were detached before 60 cycles. The other scaffolds remained stable throughout the testing with only minor disruptions. The endpoint fixation strength was higher for BS and PC than for the FS scaffolds. The FS scaffolds were detached as a result of additional load cycles, while the BS and PC scaffolds showed substantial deformations. Conclusion: SA of tested scaffold did not provide sufficient fixation. The FS fixation was easy to perform and assured satisfactory scaffold stability. BS and PC provided excellent scaffold stability, but the techniques were difficult and caused additional injuries. Regardless of the fixation technique used, the tested collagen scaffold may not be exposed to loading in the initial postoperative period. [Copyright &y& Elsevier]

Summary Objective To describe robotic-assisted laparoscopic artificial urinary sphincter (RAL-AUS) placement and a Malone antegrade continent enema (MACE) procedure on a 6-year-old girl. Patients and results Our patient is a 6-year-old girl with myelomeningocele. She was totally incontinent of urine and chronic constipated despite aggressive bowel regimen. Preoperative workup included renal and bladder ultrasound showing normal findings. Video-urodynamics was also obtained showing low leak point pressure (25 cm H 2 O) with no reflux. RAL-AUS was performed totally intra-corporally with no complications. The total operative time was 5 h 42 min. Estimated blood loss was minimal. The patient was discharged on postoperative day 4 with the AUS deactivated. Follow-up cystoscopy and activation of the AUS was done 6 weeks later. At 3-month follow-up, the patient was fully recovered and remained completely dry between voids. Also her bowel movements improved significantly with the MACE. Both patient and family appeared comfortable in using the AUS. Conclusion To our knowledge, this is the first case described of RAL-AUS placement in the pediatric population. We believe this can be safely accomplished with good outcomes. The robotic approach provides an advantage in performing deep pelvic surgeries and facilitates concomitant intra-abdominal procedures. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend both percutaneous catheter ablation (CA) and surgical ablation in the treatment of atrial fibrillation, with different levels of evidence. No direct comparison has been made between minimally invasive thoracoscopic pulmonary vein isolation with left atrial appendage ligation (surgical MIPI) versus percutaneous CA comprising of pulmonary vein isolation as primary treatment of atrial fibrillation. We, therefore, conducted a randomized controlled trial comparing the safety and efficacy of these 2 treatment modalities.Methods: Eighty patients were enrolled in the study and underwent implantable loop recorder implantation. Twenty-eight patients did not reach randomization criteria. A total of 52 patients with symptomatic paroxysmal or early persistent atrial fibrillation were randomized, 26 to CA and 26 to surgical MIPI. The primary end point was defined as freedom of atrial tachyarrhythmias, without the use of antiarrhythmic drugs. The safety end point was freedom of complications.Results: Median age was 57 years (range, 37-75), and 78% were men. Paroxysmal atrial fibrillation was present in 74%. Follow-up duration was ≥2 years in all patients. CA was noninferior to MIPI in terms of single-procedure arrhythmia-free survival after 2 years of follow-up (56.0% versus 29.2%; HR, 0.56; 95% CI, 0.26-1.20; log-rank P=0.059). Procedure-related major adverse events occurred significantly more often in MIPI than CA (20.8% versus 0%; P=0.029).Conclusions: Percutaneous pulmonary vein isolation was noninferior to MIPI in terms of efficacy and resulted in less complications.Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00703157. [ABSTRACT FROM AUTHOR]