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Introduction: Rectal washout is proposed for eliminating free cancer cells, yet evidence on its efficacy in preventing local recurrence after anterior resection is inconclusive., Material and Methods: Contrasting rectal washout (RW) and non-rectal washout (NRW) in rectal cancer, a prospective study of randomized control trials (RCT) and non-randomized control trials (NRCT) from January 2005 to July 2023 was conducted using PubMed, Cochrane Library, and MEDLINE databases. Meta-statistical analysis in RevMan 5.4 addressed heterogeneity., Results: In analysis involving 19,855 patients (15127 RW, 4728 NRW) from eight studies, RW significantly reduced local recurrence (OR = 0.48), intraoperative RW (OR = 0.65), radical resection margins (OR = 1.89), and neoadjuvant therapy (OR = 0.99) (all p < 0.05). Subgroup RCT analysis reinforced these findings., Conclusions: Rectal washout correlates with improved outcomes, while non-washout patients benefit more from neoadjuvant therapy. Notably, rectal washout without neoadjuvant remains efficacious., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Peripheral artery disease (PAD) is a worldwide major health challenge, and it is a strong predictor of mortality and morbidity. The advances in PAD treatment have resulted in many therapeutic options or endovascular interventions (EVIs) for endovascular revascularization if drug therapy does not lead to substantial improvement. Randomized controlled trials (RCTs) have reported the efficacy of various EVIs such as atherectomy, stents, and medicated balloons over the traditional transluminal angioplasty; however, the standard treatment for PAD remains unclear due to the lack of head-to-head comparative studies between different EVIs. Additionally, the variable outcomes between clinical trials regarding the functional capacity and quality of life (QoL) make it difficult to ascertain the superiority of one particular EVI over another. Therefore, the latest PAD clinical trials should include head-to-head comparisons between different EVIs, and this review aimed to highlight the femoro-popliteal EVIs, evidence supporting each intervention and why those EVIs are used., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Metastatic disease is one of the main causes of death and factors affecting overall survival. It is known that selected patients with pulmonary oligometastases whose primary tumor is under control and who have adequate respiratory capacity may benefit from metastasectomy by resecting all detected lesions., Aim: To report our findings on the use of video-assisted thoracoscopic surgery (VATS) for pulmonary metastasectomy, with a focus on identifying suitable candidates., Material and Methods: Between August 2010 and 2023 a total of 532 pulmonary metastasectomy procedures were performed in our institution. Metastasectomy was performed with VATS for 281 of those patients., Results: VATS metastasectomy was performed in 131 patients with a single lesion on preoperative imaging, while 110 patients underwent metastasectomy for multiple lesions. The rate was significantly (p < 0.05) lower in the group with multiple lesions removed during surgery (38 months) than in the group with only one lesion removed during surgery (60 months). The predicted survival time in the group with other tumor histology (79 months) was significantly (p < 0.05) higher than in the groups with tumor histology carcinoma (41.4 months) and sarcoma (55.5 months)., Conclusions: The best prognosis after metastasectomy is provided in cases with a single nodule. Grade is also an important prognostic factor affecting survival, particularly for grade 1 tumor. The histopathological type of the primary tumor is also a significant prognostic factor affecting survival after pulmonary metastasectomy in secondary pulmonary neoplasms, particularly for sarcoma and carcinoma., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Uterine artery embolization (UAE) and hysterectomy are often used to treat uterine myoma. Nevertheless, the impact of these two treatments on postoperative ovarian function remains uncertain., Aim: To compare the postoperative ovarian function in individuals with uterine myoma who had UAE against hysterectomy., Material and Methods: Searches were conducted in the Wanfang, Web of Science, and PubMed databases to find qualifying studies. The data were combined and analyzed., Results: Seven publications were included in this meta-analysis. Uterus and uterine myoma volume were dramatically decreased by UAE (p < 0.00001 for both). The combined preoperative levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were similar in both groups. Three months postoperatively, the combined FSH (p = 0.28) and LH (p = 0.64) levels were similar in both groups, while the combined E2 level was notably higher in the UAE group compared to the hysterectomy group (p < 0.00001). Six months postoperatively, the combined postoperative FSH and LH levels were considerably lower in the UAE group compared to the hysterectomy group (p = 0.002 for both). However, the combined E2 levels were similar between the two groups (p = 0.07). Also, 12 months after surgery, the combined postoperative FSH and LH levels were remarkably lower in the UAE group compared to the hysterectomy group (p = 0.02 and p < 0.00001, respectively). However, the combined E2 levels were similar in both groups (p = 0.15)., Conclusions: UAE may provide superior preservation of postoperative ovarian function compared to hysterectomy in individuals with uterine myoma., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Prone positioning in critical care units may reduce mortality in specific patients who have been admitted with severe conditions., Aim: The current meta-analysis aims to assess the impact of prone compared to supine position besides the safety and tolerability of different enteral feeding techniques in critically ill patients regarding mortality, pneumonia, aspiration, and vomiting., Material and Methods: A systematic literature search found 25 relevant trials involving 1984 participants at the start of the study. Statistical analysis using the dichotomous analysis methods was used within the fixed model to calculate the odds ratio (OR) with 95% confidence intervals (CIs)., Results: In comparison with the post-pyloric nutrition group, gastric feeding had no significant impact on the mortality rate (OR = 1; 95% CI: 0.76-1.32). While the findings showed a significantly higher incidence of pneumonia with gastric feeding compared with post-pyloric nutrition (OR = 1.92; 95% CI: 1.43--2.57), there was no significant difference regarding pulmonary aspiration and vomiting (OR = 1.41; 95% CI: 0.75-2.65 and OR = 0.92; 95% CI:, 0.66-1.27, respectively). Reflux gastric content was significantly higher with gastric nutrition (OR = 8.23; 95% CI: 2.43-27.89)., Conclusions: From reduced gastrointestinal events to significantly higher vomiting rates, prone position during enteral feeding showed mixed effects. Post-pyloric feeding is more tolerated and safer compared with gastric feeding. The mortality rate is not significantly different between techniques., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Lateral lymph node dissection (LLND) has now been widely accepted as the optimal procedure to minimize lateral local recurrence (LLR) for selected cases with advanced lower rectal cancer in Asian countries. However, there is still controversy over the preservation or resection of the inferior vesical vessels (IVVs) during LLND due to concerns of impaired post-operative urinary function. Moreover, the standardized procedure for autonomic nerve preservation has not yet been established., Aim: To evaluate the early-stage postoperative voiding function in patients who underwent LLND with uni- versus bilateral resection of the IVVs and to introduce an autonomic nerve sparing technique with a fascial space priority approach (FSPA)., Material and Methods: LLND was performed in 106 consecutive patients with advanced low rectal cancer at Tianjin Union Medical Center from May 2017 to October 2022. Prospectively collected clinical data were retrospectively compared between patients who received uni-lateral and bilateral LLND. A video with narration was provided to introduce the stepwise procedure of autonomic nerve preservation during IVV resection., Results: The unilateral lymph node dissection (LND) group and the bilateral LND group included 75 and 31 cases, respectively. All LLNDs were performed with FSPA with IVV resection as a standard procedure. No significant differences were observed in overall catheterization days (p = 0.336) and re-catheterization rate (p = 0.575) between groups. No patients in either group suffered from long-term (≥ 30 days) voiding dysfunction., Conclusions: Autonomic nerve sparing is achievable with resection of IVVs during LLND. Satisfactory early-stage voiding function could be obtained with IVV resection on both sides., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Despite the remarkable progress in minimally invasive surgery, the potential association between laparoscopic gastrectomy and the risk of peritoneal metastasis remains uncertain., Aim: To investigate variations in tumour markers in intraperitoneal drainage fluid between laparoscopic radical gastrectomy and open radical gastrectomy for gastric cancer., Material and Methods: A total of 106 patients diagnosed with gastric cancer between July 2018 and November 2020 were included in this study, 45 of whom underwent laparoscopic radical gastrectomy (laparoscopic group) and 61 underwent open radical gastrectomy (open group). Variations in the levels of carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 199 (CA199), and α -fetoprotein (AFP) in the intraperitoneal drainage fluid were compared and analysed on postoperative days (PODs) 1, 2, 3, and 5 between the two groups. Additionally, the postoperative 3-year survival rates between the two groups were compared and analysed., Results: No significant differences in CEA, CA199, and AFP levels in the intraperitoneal drainage fluid were observed between the two groups on postoperative days (PODs) 1, 2, 3, and 5 (p > 0.05). However, the level of CA125 in the intraperitoneal drainage fluid of the laparoscopic group was notably higher than that of the open group on POD 2 (p < 0.05); however, there were no significant differences between the two groups on PODs 1, 3, and 5 (p > 0.05). There was no significant difference in the 3-year postoperative survival rates between the two groups., Conclusions: There were no significant differences in CEA, CA125, CA199, and AFP levels in the intraperitoneal drainage fluid between laparoscopic radical gastrectomy and open radical gastrectomy for gastric cancer, confirming from another perspective that laparoscopic radical gastrectomy does not increase the risk of intraperitoneal metastasis., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: In patients with pulmonary nodules (PNs), computed tomography (CT)-guided localization is commonly performed prior to the resection of these nodules through video-assisted thoracic surgery (VATS)., Aim: To evaluate the relative clinical efficacy of coil and anchored needle (AN) insertion as approaches to preoperative CT-guided PN localization., Material and Methods: This single-center, prospective, open-label, randomized controlled trial (registration number: NCT05183945) enrolled consecutive patients from January 2022 to July 2022, assigning these patients at random to undergo either coil or AN localization prior to VATS. Efficacy and safety outcomes in these two groups were then compared., Results: This study enrolled in total 100 patients with 120 PNs who were assigned at random to the coil (patients = 50; PNs = 60) and AN (patients = 50; PNs = 60) localization groups. The respective technical success rates for coil and AN localization were 98.3% (59/60) and 100% (60/60), with no significant difference between the groups (p = 1.000). The coil group had a significantly longer median duration of localization relative to the AN group (16.0 min vs. 8.0 min, p < 0.001). Similar rates of localization-related pneumothorax (8.3% vs. 5.0%, p = 0.715) and pulmonary hemorrhage (5.0% vs. 13.3%, p = 0.110) were observed in both groups. In addition, the VATS resection procedures achieved 100% technical success rates in both of these localization groups., Conclusions: Both coil- and AN-based localization approaches can be successfully employed to localize PNs prior to VATS resection, with the AN localization procedure requiring less time to complete on average as compared to the coil-based approach., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: The effectiveness and safety of low pneumoperitoneum in laparoscopic pediatric inguinal hernia repair is unclear and required to explore., Aim: To evaluate the benefits of low (LPP) vs. standard pneumoperitoneum pressure (SPP) in laparoscopic pediatric inguinal hernia repair., Material and Methods: We performed a retrospective cohort analysis of patients with pediatric inguinal hernia. The patients were divided into LPP and SPP groups. Anesthesia and postoperative characteristics were analyzed., Results: We enrolled 169 eligible patients in this study. Anesthesia and postanesthesia care unit times in the LPP group were lower than those in the SPP group (p = 0.00, p = 0.01, respectively). The LPP group had lower values for peak partial pressure of end-tidal carbon dioxide (P ET CO 2 ; mm Hg) (33.37 ±4.09 vs. 36.56 ±4.08), trough P ET CO 2 (38.33 ±5.04 vs. 40.46 ±4.14), and P ET CO 2 at the end of surgery (35.29 ±4.59 vs. 38.76 ±4.22). The LPP group required less sufentanil citrate (8.76 ±4.07 ml vs. 18.03 ±16.04 ml) and midazolam (1.56 ±0.45 ml vs 1.79 ±0.59 ml) vs. the SPP group, respectively. There was no significant difference between the groups regarding postoperative complications., Conclusions: LPP was associated with shorter anesthesia and postanesthesia care unit times, and lower P ET CO 2 values compared with SPP. Compared with the SPP group, the LPP group had comparable operation times and postoperative complications. However, long-term outcome studies are needed., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Creation of colostomy is still a commonly performed procedure in emergency settings, when intestinal anastomosis cannot be performed safely. Reversing a stoma has been linked with high rates of morbidity and also mortality., Aim: The primary goal of the study was to identify the risk of postoperative complications in patients undergoing colostomy liquidation. The secondary goal was to assess perioperative care parameters., Material and Methods: The LIquidation of COlostomy (LICO) study is an open multicenter prospective cohort study that began in October 2022 and will continue until December 2023. Data from 20 Polish surgical departments were collected. Overall 45 patients were reported over the initial 3 months; based on that group we performed a preliminary analysis., Results: Mean operative time was 163 min. Patients were operated on by specialists in 93.3% of cases. Complications occurred in 15 (33.3%) patients. Wound infection was the most common complication (17.8%). In 3 (6.7%) cases anastomotic leakage was diagnosed, and in 2 of those cases reoperation was required. The overall mortality rate was 2.2%. The mean length of hospital stay was 10.1 days. Preoperative fasting was used in 53.3% of patients, and the mechanical bowel preparation rate was 75.6%. Only in 8.9% of cases was laparoscopic access used for stoma reversal, and only in 1 out of 45 cases was mesh used for incisional peristomal hernia prophylactics. The stoma site was closed by single sutures in 73.3%, and negative pressure assisted closure was performed in 6.7% of patients., Conclusions: Colostomy liquidation is associated with significant morbidity and minor mortality in the Polish population. Standardized perioperative care should be established for stoma reversal surgery., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Aim: The aim of the article was to systematically evaluate the clinical efficacy and safety of transanal endoscopic microsurgery (TEM) and endoscopic submucosal dissection (ESD) in the treatment of rectal tumors., Material and Methods: Control studies were conducted on cases included in the electronic databases Medline, Embase, Cochrane Library, and CNKI. Patients with colorectal tumors were included in the TEM and ESD groups for treatment, with the main indicators being R0 resection rate, postoperative perforation and bleeding incidence, and tumor recurrence rate. The meta-analysis was carried out using RevMan 5.3 software., Results: A total of 10 studies were included, with 736 patients. The analysis showed that for the recurrence rate in the TEM group compared to ESD, OR = 1.23, 95% CI = 0.56-2.72, p = 0.60; for the R0 resection rate between the TEM group and ESD group, OR = 1.35, 95% CI = 0.82-2.22, p = 0.24; for the incidence of perforation in the TEM and ESD groups, OR = 0.59, 95% CI = 0.25-1.40, p = 0.23. The inter-group comparison of these three items was statistically significant. Compared with the ESD group, the hospitalization time and the incidence of bleeding of the TEM group were both lower, with SD = 0.48, 95% CI = 0.26-0.69, p < 0.001 and OR = 0.35, 95% CI = 0.13-0.92, p = 0.03. The differences were statistically significant., Conclusions: Both TEM and ESD endoscopic treatment techniques can achieve a higher R0 resection rate and lower risk of tumor recurrence in the treatment of colorectal tumors. However, TEM may have higher surgical safety than ESD technology, and can shorten postoperative hospitalization time and lower postoperative bleeding rate., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: The global obesity epidemic affects over 1.9 billion adults, with an additional 650 million classified as obese. Endoscopic sleeve gastroplasty (ESG) is a type of minimally invasive endobariatric procedure. It is a less invasive alternative to laparoscopic sleeve gastrectomy (LSG). Although the effectiveness of ESG is lower, it might have a better safety profile., Aim: To assess the safety profile of ESG and describe complications classified as grade II or higher, using the Clavien-Dindo classification, with an overview of the learning curve., Material and Methods: We included 222 patients who underwent ESG at the Endoscopic and Bariatric Surgery Center of the hospital in Brzeziny from January 2021 to October 2023. The severity of complications was evaluated based on the Clavien-Dindo classification, considering complications of grade II or higher., Results: Among the studied group of patients, a total of 4 (1.8%) cases of perioperative bleeding into the gastrointestinal tract were recorded. One (0.5%) patient had the most severe grade IVb complication that required treatment in the Intensive Care Unit. All patients with serious adverse events (SAE) fully recovered. We did not observe an association between the learning curve, procedure duration, and the frequency or severity of postoperative complications., Conclusions: The presented results confirm the high safety of ESG in the treatment of obesity., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Sleeve gastrectomy (SG) is currently the most frequently performed bariatric procedure in the world. However, the occurrence of gastroesophageal reflux disease (GERD) after SG remains controversial and questionable., Aim: To determine the occurrence of GERD after SG using a pH-monitoring study., Material and Methods: This is a prospective study involving patients undergoing SG in one surgical centre. Inclusion criteria were eligibility for bariatric surgery, no symptoms of GERD, normal gastroscopy, and pH-monitoring before the surgery. Postoperative examinations were performed 6 months after surgery., Results: A total of 38 patients were analysed in the study. The mean age was 44.9 years, and the mean preoperative BMI was 42.6 kg/m 2 . Before surgery, all patients had normal pH values. After surgery, mean acid exposure time (AET), number of refluxes, and DeMeester score increased statistically significantly (p < 0.001). 27 (71.1%) patients each had AET > 6%, but only 9 (23.7%) reported GERD symptoms and the need for PPIs. The correlation between AET and %TWL was moderate positive, and the correlation between DeMeester score and %TWL was low positive (p = 0.011, p = 0.014, respectively)., Conclusions: GERD after SG seems to be a significant problem. More than two-thirds of patients had de novo GERD after SG in pH-monitoring, but only one-quarter of them required PPIs., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: The aim of the article was too investigate and compare the feasibility, safety, and early postoperative recovery associated with laparoscopic partial splenectomy (LPS) and open partial splenectomy (OPS) in patients with benign splenic tumours and traumatic splenic rupture., Material and Methods: A retrospective analysis was conducted on clinical data from 110 patients undergoing splenic resection at our hospital between March 2019 and May 2022. Among them, 35 patients underwent OPS, 25 underwent LPS for traumatic splenic rupture, while 50 patients with benign splenic tumours underwent either OPS (n = 20) or LPS (n = 30). Preoperative, intraoperative, and postoperative data were collected and compared. Statistical analysis was conducted using SPSS software., Results: There was no significant difference in the general data between the 2 groups of patients with benign splenic tumours and those with splenic trauma. Among patients with traumatic splenic rupture, the OPS group had a shorter operation time (p < 0.05). Regardless of whether they had traumatic splenic rupture or benign splenic tumours, the LPS group required less postoperative analgesia and had a shorter defecation recovery time (p < 0.05). Additionally, the LPS group displayed lower white blood cell count, white blood cell/lymphocyte ratio (WLR), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), C-reactive protein (CRP), calcitonin (PCT), and interleukin-6 (IL-6) than the OPS group on the first and third days post-surgery (p < 0.05)., Conclusions: In comparison to OPS, LPS presents significant advantages, including minimal surgical trauma, a reduced early postoperative inflammatory response, milder wound pain, and a faster recovery of gastrointestinal function., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Hypertensive intracerebral hemorrhage is one of the most serious complications of hypertension. The treatment focuses on reducing bleeding damage and promoting functional recovery., Aim: This study investigated the efficacy and prognosis of endoscopic intracranial hematoma removal (EIHR) and hematoma puncture and drainage (HPD) in treating hypertensive intracerebral hemorrhage (HICH)., Material and Methods: Ninety-two patients admitted to our hospital for EIHR and HPD between September 30, 2021 and September 30, 2022 were enrolled, including 14 cases of EIHR (endoscopy group) and 78 cases of HPD (puncture group). The efficacy of the two surgery modes in treating HICH patients was compared. Univariate logistic regression (ULR) and multivariate logistic regression (MLR) were employed to analyze the influences of different treatment methods on the prognosis of patients with HICH., Results: The average hematoma clearance rate (HCR) of all patients was 80.52%, and the patients in the endoscopy group had a higher HCR than those in the puncture group (73.00% vs. 86.00%) (p < 0.001). The good prognosis rate (GPR) shown by the Glasgow Outcome Scale (GOS) score in the endoscopy group was 69.23%, and that in the puncture group was 40.38%, a large but statistically non-significant difference (p > 0.05)., Conclusions: The HCR of EIHR was greatly higher based on that of HPD, but showed no great difference in prognostic effect. The higher the GCS score on admission, the lower the likelihood of poor prognosis., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: The current study aimed to compare the outcomes of endoscopic and minimally invasive surgical treatment for infected necrotizing pancreatitis., Material and Methods: A meta-analysis of clinical studies on minimally invasive operations for necrotic infection was conducted. A systematic review and study inclusion were done on multiple databases. English-language prospective comparison studies were included. Random design was used to analyze research with continuous and dichotomous variables., Results: Ten studies were included in the current study. When compared to minimally invasive surgery, endoscopic procedures showed significant beneficial outcomes regarding low post-operative complication rates (p = 0.006), new onset organ failure (p < 0.001), and pancreatic fistula (p < 0.001). However, there was no significant difference between the two interventions regarding hospital stay, postoperative bleeding, incisional hernia, endocrine insufficiency, and perforation of a visceral organ., Conclusions: Endoscopic therapy appears to have potential advantages over minimally invasive surgery. However, there is no difference between interventions regarding several parameters., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: The incidence of renal tumours is increasing annually, and imaging alone cannot meet the diagnostic needs., Aim: This single-centre study aimed to evaluate the predictors of diagnostic imaging-guided percutaneous renal mass biopsy (PRMB), its accuracy and safety, and subsequent changes to the treatment plan., Material and Methods: We retrospectively collected the clinical data of patients who had undergone PRMB. The diagnosis rate, pathological data, and complications were analysed. Potential predictors of a diagnostic PRMB were evaluated using logistic regression analysis. Changes to the treatment plan due to PRMB results were also analysed., Results: A total of 158 patients were included in this study. The univariate analysis showed that higher tumour diameter (OR = 1.223, 95% CI: 1.018-1.468, p = 0.031) and number of biopsy cores ≥ 2 (OR = 6.125, 95% CI: 2.006-18.703, p = 0.001) were significantly associated with diagnostic biopsy, and multivariate analysis results showed that higher tumour diameter (OR = 1.215, 95% CI: 1.008-1.463, p = 0.041) was an independent predictor of diagnostic biopsy. A nomogram including tumour diameter and number of biopsy cores was constructed to predict diagnostic biopsy. Compared with postoperative pathology, the concordance between biopsy and postoperative pathology at identifying malignancies, histologic type, and histologic grade were 100% (47/47), 85.1% (40/47), and 54.1% (20/37), respectively. The treatment plans of 15 patients (9.5%) changed based on the PRMB results. Fourteen patients (8.9%) had minor complications (Clavien-Dindo classification < 2)., Conclusions: Our results suggest that tumour diameter was an independent predictor of diagnostic biopsy. Furthermore, PRMB can be accurately and safely performed and may guide clinical decision-making for patients with renal tumours., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: The dissection of the preperitoneal space is performed using a monopolar instrument to prevent bleeding in laparoscopic transabdominal preperitoneal hernia repair (TAPP). It may also cause energy injuries and nerve damage., Aim: To assess the effectiveness and safety of dissection of the preperitoneal space without electrocoagulation (DPSWE) in TAPP throughout the process., Material and Methods: A retrospective analysis of data of 134 patients was made. The electrocoagulation group (EG) relied on monopolar instruments. In the non-electrocoagulation group (NEG) mainly scissors were used without electrocoagulation. The patients were followed for up for 3 months. Intraoperative and postoperative conditions and other complications were observed., Results: The VAS scores in the NEG were lower than those in the EG (p < 0.05). The operation time in the NEG was shorter than that in the EG (p < 0.05). Hospitalization expenses, scrotal seroma formation, and rupture of hernia sac in the NEG were lower than those in the EG (p < 0.05). The intraoperative bleeding volume above 20 ml in the NEG was higher than that in the EG. There was no significant difference in the incidence of postoperative bleeding, vas deferens injury, intestinal injury, surgical site infection, length of hospital stay, urinary retention and hernia recurrence in the NEG and the EG (p > 0.05). There was no significant difference in the incidence of surgical site infections (SSIs) in the NEG and the EG., Conclusions: DPSWE is effective and safe. DPSWE may reduce postoperative pain and have no significant increase in postoperative bleeding., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Laparoscopic liver resection is a challenging surgical procedure that may require prolonged operation time, particularly during the learning curve. Operation time significantly decreases with increasing experience; however, prolonged operation time may significantly increase the risk of postoperative complications., Aim: To assess whether prolonged operation time over the benchmark value influences short-term postoperative outcomes after laparoscopic liver resection., Material and Methods: A retrospective cohort study based on data from the National Polish Registry of Minimally Invasive Liver Surgery was performed. A total of 197 cases consisting of left lateral sectionectomy (LLS), left hemihepatectomy (LH), and right hemihepatectomy (RH) with established benchmark values for operation time were included. Data about potential confounders for prolonged operation time and worse short-term outcomes were exported., Results: Most cases (129; 65.5%) were performed during the learning curve, while the largest rate was observed in LLS (57; 78.1%). Median operation time exceeded the benchmark value in LLS (Me = 210 min) and LH (Me = 350 min), while in RH the benchmark value was exceeded in 39 (44.3%) cases. Textbook outcomes were achieved in 138 (70.1%) cases. Univariate analysis (OR = 1.11; 95% CI: 0.61-2.06; p = 0.720) and multivariate analysis (OR = 1.16; 95% CI: 0.50-2.68; p = 0.734) did not reveal a significant impact of prolonged surgery on failing to achieve a textbook outcome., Conclusions: Prolonging the time of laparoscopic liver resection does not significantly impair postoperative results. There is no reason related to the patients' safety to avoid prolonging the time of laparoscopic liver resection over the benchmark value., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: A meta-analysis was performed to examine the effects of wound catheter (WC) local anaesthetic infiltration (LAI) and epidural analgesia (EA) in open hepatectomy (OH)., Material and Methods: A systematic literature review was performed, which found 350 subjects with OH at the baseline of the studies; 159 of them were treated with WC local anaesthetic infiltration, and 191 used EA., Results: WC LAI substantially reduced the functional recovery time (MD = -0.64; 95% CI, -1.02 to -0.26, p < 0.001) and increased the pain score on the second postoperative day (MD = 0.25; 95% CI: 0.10-0.40, p < 0.001) compared to EA in OH patients. WC LAI did not vary from EA in OH patients in second postoperative opiate use (MD = -14.86; 95% CI: -32.88 to 3.16, p = 0.11) or overall complication rate (OR = 0.66; 95% CI: 0.41-1.04, p = 0.07)., Conclusions: WC LAI showed a non-significant difference in opiate consumption on the second postoperative day and in the overall complication rate, compared with EA, but it showed a lower functional recovery time and higher pain score., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: The increasing prevalence of obesity worldwide has raised concerns about its impact on surgical outcomes across various procedures. Laparoscopic cholecystectomy (LC), a common surgical intervention for benign gallbladder disease, is no exception. The relationship between obesity and LC outcomes remains complex and merits further investigation., Aim: This retrospective study aimed to assess the influence of obesity on the safety and surgical outcomes of LC., Material and Methods: Patients were divided into 2 groups: those with obesity (body mass index (BMI) ≥ 30 kg/m²) and non-obese controls (BMI < 30 kg/m²). Baseline characteristics, operative duration, hospitalization length, and post-operative complications, categorized by the Clavien-Dindo classification, were evaluated., Results: Among 116 patients with obesity and 176 non-obese controls, differences in age and gender were noted but were not clinically significant. Operative time was longer in the group with obesity. Hospitalization length and adverse event occurrence did not differ significantly. Importantly, post-operative complications showed no substantial differences between the groups, suggesting that obesity may not significantly increase the complication risk in this population., Conclusions: Obesity may not substantially elevate the risk of adverse events or severe complications following LC in this patient population. Careful patient selection, preoperative evaluation, and surgical technique remain crucial. Further research in larger, diverse populations is needed to validate these findings., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Obesity is a major public health problem and a well-known cause of multiple comorbidities. With the increasing application of minimally invasive surgery for benign and malignant liver lesions, the results of laparoscopic liver resection (LLR) in obese patients are of great interest., Aim: To evaluate the short-term operative outcomes after LLR in obese patients and compare them to patients with normal weight and overweight., Material and Methods: All 235 consecutive patients undergoing LLR from 2008 to 2023 were retrospectively analysed. Patients were categorized into 3 groups based on their body mass index (BMI): normal weight (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), and obese (≥ 30 kg/m 2 ). The groups were then compared regarding preoperative data and intra- and postoperative outcomes., Results: Despite higher ASA score and associated comorbidities in the obese group, there were no significant differences in intraoperative complication (blood loss, damage to surrounding structures, conversion rate) between BMI groups (20.8% vs. 16.8% vs. 22.7%, p = 0.619). There were no significant differences in overall morbidity (34.7% vs. 27.7% vs. 29.5%, p = 0.582), as well as major morbidity (15.9% vs. 11.8% vs. 11.4%, p = 0.784) or mortality rates (1.4% vs. 1.7% vs. 0.0%, p = 1.000). Univariate logistic regression did not show BMI or obesity as a predictive variable for intraoperative complication., Conclusions: Obesity is not a significant, strong risk factor for worse short-term outcomes, and LLR may be considered also in patients with overweight and obesity., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: The Pfannenstiel incision is often used in gynecological Cesarean section; however, there is limited research on the use of the Pfannenstiel incision for specimen extraction in laparoscopic surgery for the treatment of colorectal cancer., Aim: To evaluate the safety of using the Pfannenstiel incision for specimen extraction in laparoscopic surgery for colorectal cancer patients., Material and Methods: PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP and WanFangData were searched for studies published up to March 10, 2023; a random-effects model (RCT) and a fixed-effect model were used to evaluate the safety. Operative time, length of extraction skin incision, overall complications, superficial wound infection, organ/space surgical site infection and incisional hernia were evaluated., Results: A total of 5 studies were included in this research. There were no significant advantages in operation time, length of the incision, overall complications, superficial wound infection and organ/space surgical site in the Pfannenstiel group compared to the no Pfannenstiel group. However, the Pfannenstiel incision has a tendency to increase the length of the incision (SMD = 0.05; 95% CI = -0.22 to 0.33; p = 0.71) and the results of the remaining five (operative time,overall complications,incisional hernia, incisional infection and organ/space surgical site infection) are slightly skewed toward the Pfannenstiel incision. It is worth mentioning that incisional hernia (IH) may have an advantage in the Pfannenstiel group compared to the no Pfannenstiel group. Four studies were not at clear risk of bias and two studies were at risk of bias., Conclusions: Our study concludes that the Pfannenstiel incision has a good safety record and it is a good option for extracting specimens during laparoscopic surgery for colon cancer. The Pfannenstiel incision used for laparoscopic surgical specimen extraction has a significantly lower incidence of incisional hernia over no Pfannenstiel., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Surgery serves as a salvage procedure for non-curative resection of early-stage colorectal cancer under endoscopy. A standard method for performing additional surgery after endoscopic submucosal dissection (ESD) for early colorectal cancer has yet to be established., Aim: To enhance the understanding of different surgical outcomes by discussing additional treatment strategies following non-complete curative endoscopic resection of early colorectal cancer., Material and Methods: This retrospective study included 88 patients who were divided into three groups based on the surgical approach: conventional laparoscopic surgery (CLS), single-incision plus one-port laparoscopic surgery (SILS+1), and three-port laparoscopic surgery combined with natural orifice specimen extraction surgery (three-port NOSES). The study aimed to compare the surgical outcomes, safety, and postoperative recovery among these groups., Results: The SILS+1 and three-port NOSES groups demonstrated comparable safety and efficacy to the CLS group in terms of blood loss, complications, number of lymph node dissections, and length of bowel resection. However, the SILS+1 and three-port NOSES groups had advantages in terms of incision length (7.11 ±0.38, 4.24 ±0.33, 3.16 ±0.22, p < 0.001), postoperative pain (4.000 [3.0,5.0], 3.500 [3.0,4.0], 3.000 [3.0,4.0]; p = 0.003), cosmetic result (4.000 [3.8,5.0], 7.000 [7.0,8.0], 7.000 [7.0,8.0]; p < 0.001), and hospital stay (8.000 [7.0,9.0], 7.000 [6.3,8.0.], 7.000 [6.3,8.0]; p = 0.035)., Conclusions: Different strategies of reduced-port laparoscopic surgery have been demonstrated to be effective and safe in additional surgery after non-curative ESD. These techniques have shown reduced pain and increased satisfaction among patients. Reduced-port laparoscopic surgery is expected to become the preferred treatment option for these patients., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

The noticeable decline in the number of autopsies performed in recent years requires investigation into the causes of the phenomenon and attempts to prevent it. One potential cause of this trend is fear of disfiguring the body. Carrying out autopsies using a minimally invasive method may reduce the decrease in the number of autopsies performed. The first work on the development of the method and its continuation gave promising results. This allows us to start a discussion on attempts to introduce the method. The solution seems especially justified when the alternative is to completely abandon post-mortem examinations using the traditional method. Laparoscopy and thoracoscopy are tools that allow for accurate imaging and analysis of organ changes. Enriching them with additional tests using endoscopic techniques may have a positive impact on the accuracy of autopsy diagnoses. The development of a clear protocol for minimally invasive post-mortem diagnosis requires further research to determine the accuracy of the method., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: The relationship between different puncture points and perioperative complications and length of stay in hospital (LOS) in SCCAG patients has rarely been reported., Aim: To compare the curative effect and safety of the transradial artery approach and the transfemoral artery approach in combined heart-brain angiography., Material and Methods: 120 patients who received combined cardio-cerebral angiography in our hospital were selected and divided into a transradial artery approach group (TRA) and a transfemoral artery approach group (TFA) according to a random number table. The postoperative efficacy and safety of the 2 groups were compared., Results: There was no statistically significant difference in puncture time and operation time between the 2 groups (p > 0.05). Postoperative bed rest time, hospitalization time, and X-ray exposure time in the TRA group were shorter than those in the TFA group, and the difference was statistically significant (p < 0.05). Before operation and 3 days after operation, there was no significant difference in left ventricle ejection fraction between the 2 groups (p > 0. 05). The overall incidence of complications in the TFA group was higher than that in the TRA group. The incidence between haematoma and pseudoaneurysm in the TFA group was higher, and the difference was statistically significant (p < 0.05)., Conclusions: For simultaneous heart-brain angiography, interventional therapy via radial artery and femoral artery has good curative effect and can improve cardiac function. However, interventional therapy through the radial artery can shorten the postoperative bed rest time and hospitalization time, and reduce the incidence of complications., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Both hook-wire (HW) and anchored needle (AN) techniques can be used for preoperative computed tomography (CT)-guided localization for pulmonary nodules (PNs). But the outcomes associated with these two materials remain unclear., Aim: To assess the relative safety and efficacy of preoperative CT-guided HW and AN localization for PNs., Material and Methods: This was a retrospective analysis of data collected from two institutions. Consecutive patients with PNs between January 2020 and December 2021 who underwent preoperative CT-guided HW or AN localization followed by video-assisted thoracoscopic surgery (VATS) procedures were included in these analyses, which compared the safety and clinical efficiency of these two localization strategies., Results: In total, 98 patients (105 PNs) and 93 patients (107 PNs) underwent CT-guided HW and AN localization procedures, respectively. The HW and AN groups exhibited similar rates of successful PN localization (95.2% vs. 99.1%, p = 0.117), but the dislodgement rate in the HW group was significantly higher than that for the AN group (4.8% vs. 0.0%, p = 0.029). The mean pain score of patients in the HW group was significantly higher than that for the AN group (p = 0.001). HW and AN localization strategies were associated with comparable pneumothorax (21.4% vs. 16.1%, p = 0.349) and pulmonary hemorrhage (29.6% vs. 23.7%, p = 0.354) rates. All patients other than 1 individual in the HW group successfully underwent VATS-guided limited resection., Conclusions: These data suggest that AN represents a safe, well-tolerated, feasible preoperative localization strategy for PNs that may offer value as a replacement for HW localization., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Epidural analgesia has been studied for its potential advantages after surgery in a number of randomized clinical trials, with most finding improvements in pain and secondary endpoints like the incidence of postoperative complications., Aim: To assess the relationship between use of epidural analgesia and adverse cardiac outcomes expressed by myocardial infarction (MI)., Material and Methods: Fifty-three studies were recruited to quantify the influence of different surgical-related analgesic methods on clinical parameters (mortality and adverse events). The results of these trials were analysed using a random effects model, which was then used to calculate the mean difference (MD) with 95 per cent confidence intervals (CIs)., Results: Epidural analgesia resulted in preferred cardiac outcomes compared with traditional analgesia. These findings were supported by significantly lower MI events for the epidural analgesia group as follows: p = 0.005, p = 0,007, and p = 0.03 for the total number of included studies, studies with high risk of bias, and studies with low risk of bias, respectively. Studies with intermediate risk showed a non-significant difference between both groups (p = 0.7)., Conclusions: Epidural analgesia has a significant protective cardiac effect through the reduction of postoperative MI events among surgery subjects., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: While cryoablation (CA) and microwave ablation (MWA) have both been implemented as approaches to the treatment of adrenal metastasis (AM), the outcomes associated with these two therapeutic strategies remain unclear., Aim: To compare the safety and efficacy of CA and MWA as treatments for AM in patients with non-small-cell lung cancer (NSCLC)., Material and Methods: Consecutive patients with AM secondary to NSCLC from January 2015 to December 2020 underwent CA or MWA. Treatment-related outcomes and complications were retrospectively compared between these groups., Results: In total, 68 NSCLC patients with isolated AM were enrolled in this study, of whom 35 and 33 underwent treatment with CA and MWA, respectively. Primary complete ablation rates in the CA and MWA groups were 91.4% (32/35) and 93.9% (31/33) respectively (p = 1.000), while a 100% secondary complete ablation rate was observed for both groups. Hypertensive crisis incidence affected 11.4% (4/35) and 9.1% (3/33) of patients in the CA and MWA groups (p = 1.000), respectively, while 8 (22.9%) and 8 (24.2%) patients in these corresponding groups experienced local progression after ablation that was detected during the follow-up period (p = 0.893). Patients in the CA and MWA groups exhibited a median progression-free survival of 18 and 22 months, respectively (p = 0.411), while the corresponding median overall survival of patients in these groups was 25 and 29 months (p = 0.786)., Conclusions: CT-guided CA and MWA appear to exhibit similar safety and efficacy profiles when employed to treat isolated AM in NSCLC patients., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: Endovascular aortic repair (EVAR) is nowadays a widespread method of managing abdominal aortic aneurysm (AAA). Low-profile stent grafts (LPSGs) enable treatment of patients with complex and anatomically challenging aneurysms, and facilitate a percutaneous and thus less invasive procedure., Aim: To assess the outcomes of EVAR with low-profile versus standard-profile stent grafts (SPSGs)., Material and Methods: Thirty-one patients with abdominal aortic aneurysms (AAA) were treated by endovascular aortic repair (EVAR) using LPSGs. The control group of patients treated with SPSGs was matched with MedCalc software. The clinical records and the preoperative and follow-up computed tomography angiography of patients who underwent endovascular treatment of AAA were included in this study., Results: Patients in the LPSG group had significantly more often low access vessel diameter (< 6 mm) compared to the SPSG group (38.7% vs. 6.7%, p = 0.003). In 1-year follow-up, there was no rupture, no infection, no conversion to open repair and no aneurysm-related death. Five secondary interventions were necessary in the SPSG group and only 1 in the LPSG group (p = 0.09). Type of stent graft was not a risk factor of perioperative complications, presence of endoleak or reintervention (p > 0.05). Risk factors for perioperative complications were COPD and conical neck (OR = 6.3, 95% CI: 1.5-25, p = 0.01 and OR = 6.2, 95% CI: 1-39.76, p = 0.04). The risk factor for endoleak was lower maximal aneurysm diameter. The risk factor for reintervention was proximal neck diameter (OR = 0.77, 95% CI: 0.-0.97, p = 0.03)., Conclusions: Our study showed that use of LPSGs is a safe and viable method for patients with narrow access vessels who are not eligible for standard-profile systems., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

Introduction: In the era of an aging society and a growing number of obese people, an increasing number of older patients are consulting bariatric surgeons. The incidence of hypertension (HT) also rises with age and body weight, making the treatment of the elderly a significant challenge., Aim: To identify predictors of HT remission after bariatric surgery in patients over 65 years of age., Material and Methods: A retrospective study analyzed patients over 65 years old with HT who underwent laparoscopic bariatric procedures in Poland between 2008 and 2022. The data came from 11 bariatric centers. Patients were categorized into two groups: responders (R) and non-responders (NR). A multivariate logistic regression analysis was conducted to identify significant independent risk factors., Results: The study analyzed 244 patients, with complete HT remission observed in 55 (22.5%) patients. Almost 90% of patients showed improvement in HT. The mean follow-up time was 47.4 months. Factors contributing to HT remission included HT duration of less than 5 years, the use of single medication, and a significant correlation with %EWL., Conclusions: Bariatric surgery in patients aged over 65 has a positive effect on HT remission. The chance of HT remission increases with fewer medications, shorter HT duration, and greater weight loss after surgery., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Fundacja Videochirurgii.)

The introduction of minimally invasive surgeries for gastrointestinal tumours has been associated with many favourable postoperative outcomes and a reduced impact on nutritional status. The literature review begins by discussing the impact of minimally invasive procedures on the nutritional status of patients with gastrointestinal tumours, followed by indications for enteral nutrition (EN) in this population, including preoperative nutritional support and postoperative nutritional support. The review then examines the evidence that favours the use of EN in this population, including studies demonstrating improved outcomes with preoperative EN and reduced postoperative complications with postoperative EN. It also discusses potential strategies for improving outcomes with EN, such as early initiation of feeding and individualized nutrition plans. Overall, current evidence shows that EN improves outcomes, reduces complications, and enhances the quality of life. However, the optimal timing, composition of EN, and long-term outcomes are still unclear, indicating the need for future investigations., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: For patients with gastric cancer who have undergone gastrectomy, recent research has shown that enteral immunonutrition (EIN) is more successful than enteral nutrition (EN) at boosting host immunity and, in turn, improving prognosis. The claimed outcomes, however, are inconsistent., Aim: This meta-analysis examines how EIN affects biochemical, immunological, and clinical outcomes for gastrectomy (GC) patients following gastrectomy and EIN formulae evidence networks., Material and Methods: A comprehensive search of the Medline, EMBASE, Scopus, and Cochrane Library databases identified English-language peer-reviewed journal papers. The odds ratio (OR) and standard mean difference (SMD) were calculated, along with their 95% confidence intervals. The heterogeneity was assessed using Cochrane Q and I 2 statistics and the appropriate p-value. The analysis used RevMan 5.3., Results: This meta-analysis included 10 RCTs involving 1409 GC patients, 714 of whom were assigned to EIN and 695 to EN. After EIN treatment, serum proalbumin, serum transferrin, lymphocyte count, and CD4+/CD8+ ratio had statistically significant standardised mean differences (SMDs) of 2.39, 2.39, 1.34, and 0.72, respectively. EIN reduces postoperative infectious complications with an OR of 0.63 (95% CI: 0.41-0.77) for infections, an OR of 0.63 for complications, and an SMD of -1.05 for systemic inflammations. A network diagram with high-quality data and a well-defined network design with consistent and accurate connection shows that EIN can improve serum protein levels, immunological parameters, and post-operative problems., Conclusions: The use of EIN has been shown to enhance cellular immunity, regulate inflammatory response, and decrease postoperative complications in GC patients who underwent major GI surgery., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: For complicated surgical patients, enhanced recovery after surgery (ERAS) decreases stress and hospital stays. It accelerates recovery and lowers readmissions, morbidity, and death. ERAS's effectiveness in stomach cancer laparoscopic-assisted gastrectomy (LAG) or robotic gastrectomy is still debated., Aim: This study assesses the efficacy and safety of the ERAS program for patients undergoing gastrectomy for gastric cancer., Material and Methods: PRISMA-compliant searches were performed in Medline, Embase, PubMed, the Web of Sciences, and the Cochrane Library databases until March 2023. The search included articles that compared ERAS protocol results for gastric cancer surgery patients to conventional care. RevMan performed meta-analysis, and the Cochrane Risk of Bias Assessment Tool assessed study quality., Results: This meta-analysis contained 11 carefully chosen randomized controlled trials (RCTs) involving 1790 people. The ERAS group had 902 participants, while the traditional care group had 888. The ERAS group had a shorter post-operative hospital stay, with a weighted mean difference (WMD) of -1.12 days (95% CI: -1.89 to -0.35, p = 0.00001), I 2 = 89%, and a lower number of patients with post-operative problems, with an odds ratio (OR) of 0.73 (95% CI: 0.55 to 0.97; p = 0.03), I 2 = 60%., Conclusions: The ERAS procedure has been shown to be effective as well as beneficial for patients undergoing either laparoscopic-assisted or robotic gastrectomy for gastric cancer, since it lowers post-operative complications and accelerates recovery with improved results., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Preoperative computed tomography (CT)-guided localization can shorten the time of video-assisted thoracoscopic surgery (VATS) and accurately aid in pulmonary nodule removal., Aim: To discuss the application value and safety of 2 kinds of breast localization needles and anchor localization needles in clinical practice for pulmonary nodules under CT guidance before VATS., Material and Methods: We retrospectively studied 215 patients with 247 pulmonary nodules, who underwent CT-guided pulmonary nodule location before VATS. The 2 kinds of localization needles were randomly used, and we collected and analysed the clinical data., Results: We used breast and anchor localization needles in 27.9% and 72.1% of cases, respectively. Differences were observed in puncture localization time, detachment rate, and visual analogue scale (VAS). The detachment rate (0%) and positioning time (median: 12 min) were less in the anchor than in the breast localization needle group (8.7% and median: 13 min, respectively). The median VAS was approximately 2 and 5 in the anchor and breast localization needle groups, respectively. Surgical pathology revealed that 155 (62.8%) pulmonary nodules were malignant while 92 (37.2%) were benign. The primary distinction in surgical procedures is the higher proportion of segmental resections in the middle and inner band group (19.3%) compared to the periphery band group (4.2%)., Conclusions: Unlike breast localization needles, anchor localization needles can reduce pain and discomfort after positioning, and they are not easy to decouple. These 2 needles are safe for CT-guided localization, which can shorten the time of VATS and accurately aid in pulmonary nodule removal., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Endoscopic parathyroidectomy(EPTX) has been gradually introduced as a minimally invasive treatment for refractory secondary hyperparathyroidism (SHPT). However, it is uncertain about the efficacy and safety compared between EPTX and open parathyroidectomy (OPTX) for refractory SHPT., Aim: This meta-analysis was conducted to evaluate the efficacy and safety of EPTX and OPTX for secondary hyperp arathyroidism (SHPT)., Material and Methods: Databases including PubMed, EMbase, Cochrane Library, CNKI, and Wanfang were searched. Eligible studies comparing EPTX and OPTX for refractory SHPT were included., Results: Compared with OPTX, EPTX has the shorter hospital stay (p < 0.01) and lower incidences of hoarseness or recurrent laryngeal nerve injury (p = 0.04). There was no significant difference between EPTX and OPTX concerning operation time (p = 0.49), intraoperative blood loss (p = 0.24), postoperative parathyroid hormone levels (p = 0.22), postoperative calcium levels (p = 0.93), postoperative phosphorus levels (p = 0.37), and complications including neck ecchymosis (p = 0.87), subcutaneous haematoma (p = 0.18), and wound infection (p = 0.11)., Conclusions: EPTX and OPTX are both effective methods for refractory SHPT. EPTX had the shorter hospital stay and lower incidences of hoarseness or recurrent laryngeal nerve injury., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Most anastomotic leaks in the upper gastrointestinal (GI) tract can be treated with minimally invasive techniques dominated by endoluminal vacuum therapy (EVT) or stent implantation. Chronic leaks often require additional solutions, such as tissue adhesives or cellular growth stimulants., Aim: To present a treatment strategy for postoperative leakage of upper GI anastomoses with noninvasive procedures., Material and Methods: A group of 19 patients treated in the period 2015-2023 with postoperative upper GI tract leakage was enrolled for endoscopic treatment. The indication for the therapy was anastomotic dehiscence not exceeding half of the circumference and the absence of severe septic complications. All patients were managed using endoscopic vacuum therapy (EVT) or a self-expanding stent while persistent fistulas were additionally treated with alternative methods., Results: The EVT was successfully implemented in 13 cases, but 7 patients required alternative methods to achieve definitive healing. Self-expanding stent placement was performed in 6 patients; however, in 3 cases a periprosthetic leakage occurred. In this group, 2 patients had the stent removed and the third one died due to septic complications. Post-treatment stenosis was identified in 5 patients after EVT that required balloon dilation with acceptable resolution in all cases., Conclusions: Early detected anastomotic dehiscence limited to half of the circumference most effectively responded to the noninvasive treatment. Nutritional support as well as complementary endoscopic solutions such as tissue adhesives, growth stimulants and hemostatic clips increase the percentage of complete healing., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: The constantly increasing prevalence of obesity in the population and the lengthening of life expectancy affect the appearance of the problem of pathological obesity also in the elderly. At the same time, an increase in the number of bariatric procedures (also revisional) performed in elderly patients is observed., Aim: To assess the indications for revisional bariatric procedures along with the safety and postoperative results in the group of patients over 60 years of age., Material and Methods: The study was conducted in 2019-2020 among patients undergoing revisional bariatric procedures in Polish bariatric centers. The data were obtained through a multicenter, observational retrospective study., Results: Our data consist of 55 (8.1%) patients older than 60 years of age who underwent revisional bariatric procedures. Revisional procedures in the group of patients over 60 years of age had fewer postoperative complications (16.4% vs. 23.1%, p < 0.05). Remission of type II diabetes or arterial hypertension was achieved to a lesser extent in patients operated on over the age of 60 (13% and 15%, respectively) compared to patients operated on under the age of 60 (47% and 34%, respectively; p < 0.05)., Conclusions: Revisional bariatric procedures in the group of patients over 60 years of age do not cause an increased risk of postoperative complications or prolonged hospital stay. The possibility of achieving remission or improvement in the treatment of comorbidities in patients operated on over 60 years of age is relatively lower compared to a younger group., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Laparoscopic sleeve gastrectomy (LSG) has gained prominence as a therapeutic option for obesity and metabolic diseases. The choice of staple line reinforcement technique in LSG remains a subject of debate, particularly concerning postoperative bleeding complications., Aim: The aim of this retrospective analysis is to assess the influence of different staple line reinforcement techniques on the occurrence of bleeding complications LSG., Material and Methods: We conducted a retrospective analysis of patients undergoing LSG between September 2021 and April 2023 at our institution. Patients were stratified into two groups based on the staple line reinforcement method: continuous suturing (n = 53) and clipping (n = 28). Surgical outcomes, including operative time, length of hospital stay, and bleeding complications, were assessed. Complications were classified using the Clavien-Dindo classification., Results: Continuous suturing was associated with a significantly longer operative time (88.15 min vs. 74.64 min, p < 0.05) but a similar length of hospital stay. Notably, no bleeding complications occurred in the continuous suturing group, while the clipping group experienced postoperative bleeding in 7.14% of cases (p < 0.05). Continuous suturing exhibited a slightly higher incidence of minor complications classified as Class I in the Clavien-Dindo classification (7.55% vs. 0%)., Conclusions: This retrospective analysis suggests that continuous suturing may provide enhanced hemostasis along the staple line, reducing the risk of postoperative bleeding compared to clipping. Despite the longer operative time and a slightly higher rate of minor complications, the clinical significance of these findings should be considered within the context of individual patient risk profiles., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: In this prospective observational study, we aimed to evaluate the consequences of laparoscopic fascia space priority lymph node dissection on urination and sexual function., Aim: To assess the consequences of laparoscopic lateral lymph node dissection (LLND) using the fascial space priority approach on urinary and sexual function in patients with advanced middle and low rectal cancer., Material and Methods: Consecutive patients undergoing laparoscopic LLND using the fascial space priority approach from December 2020 to November 2022 were identified from Tianjin Union Medical Center. Clinical data including patient characteristics, surgical details, and pathology were analysed. The urinary function was assessed by international prostate symptom score (IPSS) questionnaire and residual urine volume. The sexual function was investigated using the international index of erectile function (IIEF) questionnaire., Results: A total of 51 patients, mean age 60.5 ±10.9 years, were identified. The lymph nodes were positive in 70.6% (36/51) of the patients. There was no significant difference between the preoperative IPSS score and that at 6 months (5.2 ±2.1 vs. 5.6 ±1.5; p = 0.16). And there was no significant difference between the residual urine volume and that at 6 months (9.5 ±10.6 vs. 8.6 ±6.3; p = 0.61). The IIEF score before the surgery showed no significant difference from that at 6 months after the surgery (21.1 ±2.2 vs. 20.6 ±2.3; p = 0.26)., Conclusions: Laparoscopic LLND using a fascial space priority approach can effectively protect the autonomic nerves. The procedure reduces short-term urination and sexual function, but it has little effect on long-term function., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: In patients undergoing cancer surgery, it is ambiguous whether propofol-based total intravenous anesthesia (TIVA) elicits a significantly higher overall survival rate than volatile anesthetics (VA). Consequently, evaluating the impact of TIVA and VA on long-term oncological outcomes is crucial., Aim: This study compared TIVA versus VA for cancer surgery patients and investigated the potential correlation between anesthetics and their long-term surgical outcomes., Material and Methods: A comprehensive search of Medline, EMBASE, Scopus, and Cochrane Library identified English-language peer-reviewed journal papers. The statistical measurements of hazard ratio (HR) and 95% CI were calculated. We assessed heterogeneity using Cochrane Q and I 2 statistics and the appropriate p-value. The analysis used RevMan 5.3., Results: The meta-analysis included 10 studies with 14036 cancer patients, 6264 of whom received TIVA and 7777 VA. In this study, we examined the long-term oncological outcomes of cancer surgery patients with TIVA and VA. Our data show that the TIVA group had a considerably higher overall survival rate (HR = 0.49, 95% CI: 0.30-0.80) and recurrence-free survival rate (HR = 0.56, 95% CI: 0.32-0.97). Each outcome was statistically significant (p < 0.05)., Conclusions: The present study concludes that TIVA is a more effective anesthetic agent than VA in obtaining better long-term oncological outcomes in cancer patients after surgery as it provides a higher overall survival rate, a higher recurrence-free survival rate and fewer post-operative pathological findings in patients who have undergone surgery for cancer as compared to VA., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: The diagnosis of pulmonary nodules (PNs) has traditionally relied on computed tomography (CT)-guided biopsy. To reduce radiation exposure, low-dose CT-guided PN biopsy has been employed., Aim: This meta-analysis aimed at evaluating the efficacy and safety of low-dose CT-guided biopsy in the diagnosis of PNs., Material and Methods: PubMed, Web of Science, and Wanfang were searched for relevant articles until June 2023. Comparing low-dose CT to normal-dose CT, we considered factors such as diagnostic yield, diagnostic accuracy, biopsy process time, dose-length product (DLP) value, the frequency of pneumothorax and pulmonary bleeding, and the frequency with which complications necessitated the placement of a chest tube., Results: This meta-analysis included data from a total of 6 investigations. There was a total of 459 patients who had a CT-guided PN biopsy performed at a low dosage, and 384 patients who had a normal-dose CT-guided PN biopsy. There were no statistically significant differences between the low-dose CT and normal-dose CT groups in terms of diagnostic accuracy (p = 0.08), diagnostic yield (p = 0.55), biopsy procedure duration (p = 0.30), pneumothorax (p = 0.61), pulmonary hemorrhage (p = 0.29), or complications requiring a chest tube (p = 0.48). Low-dose CT patients obtained a DLP that was 91% lower than those in the standard-dose CT group (p = 0.01). According to Egger's test, there is a significant possibility of publication bias in DLP (p = 0.034)., Conclusions: The diagnostic and safety results of low-dose CT-driven PN biopsy are equivalent to those of the standard one, although patients are much less exposed to radiation., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Pelvic organ prolapse (POP), a common and benign condition, is characterized by the descent of one or more aspects of the vagina and uterus. A wide variety of mesh-based surgical techniques have been proved to be effective in the treatment of pelvic organ prolapse (POP)., Aim: To evaluate the efficacy of a modified laparoscopic lateral suspension with mesh (mLLSM) in patients with apical and anterior pelvic organ prolapse., Material and Methods: All patients diagnosed with apical and anterior pelvic organ prolapse underwent a modified laparoscopic lateral suspension with mesh (mLLSM). Perioperative parameters including surgical time, blood loss and complications were recorded. At the minimal 12-month follow-up, primary outcome measures included both anatomical and functional points. The anatomical cure rate was evaluated using the Pelvic Organ Prolapse Questionnaire (POP-Q) assessment. Patient satisfaction was evaluated using questionnaires., Results: Mean surgical time was 91.56 ±15.33 min; mean estimated blood loss was 55.42 ±36.73 ml; no intraoperative complications were noted in the perioperative period. After a minimal 12-month follow-up period, rates of anatomical success and subjective satisfaction were 96.33% and 94.50%, respectively. Symptom severity and quality of life also improved significantly., Conclusions: We found mLLSM to be a safe and effective treatment for patients suffering apical and anterior pelvic organ prolapse. We found mLLSM to result in excellent outcomes and fewer mesh complications, underscoring its potential as an alternative treatment option for the management of apical and anterior pelvic organ prolapse., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: For patients diagnosed with hepatocellular carcinoma (HCC) not eligible for surgical tumor resection, transarterial chemoembolization (TACE) is commonly employed as a therapeutic strategy. After TACE is complete, a variety of other therapeutic approaches can be employed to improve patient overall survival (OS) and progression-free survival (PFS)., Aim: This study was developed with the goal of comparing the relative clinical efficacy and long-term outcomes observed in HCC patients who underwent combination TACE and radioactive seed insertion (RSI) treatment to those of patients who only underwent TACE treatment., Material and Methods: This retrospective analysis included a total of 80 patients with HCC who underwent treatment via TACE with (n = 39) or without (n = 41) RSI. Treatment responses and long-term outcomes in these two groups were compared with one another., Results: The baseline characteristics of both groups were comparable. None of the patients experienced adverse complications related to treatment. Individuals in the combination treatment group experienced complete response (59.0% vs. 22.0%, p = 0.001) and total response (92.3% vs. 58.5%, p = 0.001) rates that were significantly better than those of patients that underwent TACE alone. Combination treatment was also associated with significant prolongation of patient PFS (13 vs. 7 months, p = 0.019) and OS (23 vs. 15 months, p = 0.005), with Cox regression analyses identifying combination treatment as a predictor of prolonged PFS and OS., Conclusions: These data suggest that a combination of TACE and RSI can contribute to significant improvements in HCC patient therapeutic response rates, OS, and PFS relative to TACE alone., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: The Enhanced Recovery After Surgery (ERAS) protocol reduces surgery-related stress and hospital stays for complicated surgical patients. It speeds recovery, reduces readmissions, and lowers morbidity and mortality. However, the efficacy of ERAS in colorectal surgery is still debatable., Aim: To evaluate the effectiveness and safety of the ERAS program for patients undergoing colorectal surgery., Material and Methods: PRISMA-compliant searches were performed on Medline, Embase, PubMed, the Web of Sciences, and the Cochrane Database up to March 2023. The included articles compared ERAS protocol results for colorectal surgery patients to those of conventional care. RevMan was used for the meta-analysis, and the Cochrane RoB Tool was used to assess the study quality., Results: The meta-analysis included 12 randomized controlled trials with a total of 1920 participants. There were 880 individuals in ERAS care and 1002 in conventional care. Weighted mean difference: -1.07 days, 95% confidence interval (CI): -1.53 to -0.60, p = 0.00001), overall length of stay: -4.12 days, 95% CI: -5.86 to -2.38, p = 0.00001), and post-operative hospital stay: -1.91 days, 95% CI: -4.73 to -0.91, p = 0.00001). Readmissions were higher in the ERAS group than in the normal care group (odds ratio (OR) = 1.20, 95% CI: 0.82 to 1.75, p = 0.35). Post-operative complications were lower in the ERAS care group (OR = 0.42; 95% CI: 0.27 to 0.65, p < 0.0001) and SSIs (OR = 0.75; 95% CI 0.52 to 1.08, p = 0.00001) than in the routine care group., Conclusions: Care provided in line with the ERAS protocol has been shown to be successful and beneficial for patients following colorectal surgery, because it minimizes post-operative problems and length of hospital stay, and improves outcomes., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Following abdominal surgery, surgical site infections (SSIs) are a common complication. The effectiveness of wound edge protectors in preventing SSI remains uncertain., Aim: To determine the clinical effectiveness of a wound edge protector (WEP) in preventing surgical site infections (SSIs) after abdominal surgery., Material and Methods: A systematic search of the Cochrane Library, PubMed, Embase, and Web of Science yielded all relevant articles published through October 2022. The major evidence regarding the efficacy of WEPs in minimizing SSIs in abdominal surgery patients relative to the standard of care was determined by searching the literature. The primary outcome was SSI as clinically defined by CDC. To combine qualitative factors, risk ratios (RRs) were used., Results: WEPs were related to a decreased incidence of SSI overall (RR = 0.75; 95% CI: 0.61-0.91; p = 0.004). WEPs are efficient in lowering the incidence of SSI at various abdominal surgical sites, with RR = 0.67; 95% CI: 0.47-0.96; p = 0.03 for pancreatoduodenectomy, RR = 0.52; 95% CI: 0.31-0.86; p = 0.01 for colorectal surgery, and RR = 0.39; 95% CI: 0.21-0.73; p = 0.003 for abdominal surgery. Moreover, both kinds of WEPs (single-ring and double-ring devices) were successful in lowering the risk of SSIs, with RR = 0.66; 95% CI: 0.47-0.93; p = 0.02 for double-ring devices and RR = 0.76; 95% CI: 0.58-0.98; p = 0.04 for single-ring devices., Conclusions: These findings demonstrate that double- and single-ring wound edge protection devices are effective in preventing surgical site infections following pancreatoduodenectomy, colorectal, and abdominal procedures., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Enhanced recovery after surgery (ERAS) is rarely used in minimally invasive endoscopic surgery, especially in endoscopic retrograde cholangiopancreatography (ERCP)., Aim: This study evaluated the safety and efficacy of the ERAS protocol in patients undergoing ERCP for choledocholithiasis., Material and Methods: The study had a retrospective design and included patients with biliary tract stones who underwent ERCP between June 2019 and November 2022. Patients who received the ERAS protocol between June 2021 and November 2022 were enrolled as an ERAS group, and those who received traditional perioperative treatment between December 2019 and May 2021 were enrolled as a control group., Results: A total of 349 patients were enrolled (ERAS group, n = 185; control group, n = 164). The cannulation and stone extraction success rates were significantly higher in the ERAS group than in the control group (p < 0.05). The incidence of postoperative pancreatitis was significantly lower in the ERAS group (p = 0.02), but there were no significant differences in other complications. The postoperative hospital stay was significantly shorter in the ERAS group than in the control group (p < 0.001), with no statistically significant differences in costs according to surgical period, or in total costs, between the 2 groups., Conclusions: Application of the ERAS protocol is safe and feasible in patients undergoing ERCP for choledocholithiasis. The ERAS protocol can accelerate recovery, reduce postoperative pain, and shorten the hospital stay without increasing the cost of treatment., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Colorectal cancer is a clinically common malignancy arising in the digestive tract., Aim: To evaluate the influence of goal-directed fluid therapy (GDFT) guided by the Vigileo-FloTrac TM system on intestinal mucosal barrier function in elderly patients with colorectal cancer., Material and Methods: A prospective study was conducted on 106 elderly patients with colorectal cancer. They were divided into control and research groups (n = 53) using a random number table, and subjected to conventional fluid therapy and Vigileo-FloTrac TM system-guided GDFT, respectively. Their intraoperative indicators, postoperative indicators, and changes of haemodynamics, oxygen metabolism, intestinal mucosal barrier function at different time points, and incidence rates of complications were compared., Results: Compared with the control group, the intraoperative urine volume, colloid fluid volume, crystalloid fluid volume, and total infusion volume were lower, and the first postoperative exhaust time, first postoperative feeding time, and hospital stay were shorter in the research group (p < 0.05). At T 1 and T 2 , mean artery pressure, heart rate, central venous pressure, oxygen consumption, oxygen delivery, and oxygen extraction ratio in the research group were lower than in the control group, but all of them first rose and then fell in the 2 groups (p < 0.05). On the 3 rd day after surgery, the levels of serum endothelin, diamine oxidase and D-lactate declined in both groups, and the decline was more obvious in the research group (p < 0.05)., Conclusions: GDFT guided by the Vigileo-FloTrac TM system is beneficial to the prognosis of patients by effectively decreasing fluid infusion., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Obesity affects over 600,000 people in Poland, and bariatric surgery is a vital part of the multidisciplinary approach to treatment. To improve outcomes, Poland's public health institutions implemented the KOS-BAR programme, a multicentre nationwide pilot initiative that includes psychiatric evaluations of patients. The aim of this study was to assess the prevalence of mental disorders, verify diagnoses, and evaluate pharmacotherapy efficacy for patients under psychiatric treatment and selected for bariatric surgery. Of the 180 patients evaluated, 40% had a history of mental disorders, with depressive and eating disorders being the most common diagnoses. Patients selected for revision surgery had a higher incidence of depressive and compulsive eating disorders. Psychiatric support can improve patient cooperation and optimize long-term outcomes after bariatric surgery. A more complete evaluation of the psychological profile and depressive disorder's impact on bariatric treatment outcomes will be the next step for this group of patients., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: To achieve effective weight loss and remission of comorbidities, various surgical methods are used in the treatment of obesity. The most common procedures performed worldwide are followed by the newest ones., Aim: To present the results of the first group of patients from a high-volume bariatric centre in central Europe and to compare single anastomosis sleeve ileal (SASI) as a primary and revisional procedure., Material and Methods: We retrospectively analysed patients who underwent SASI for obesity from December 2018 to June 2022 by the same team of surgeons. There were 2 groups of patients. The first group consisted of patients who underwent SASI as their first bariatric procedure (primary group - PG). The second group consisted of patients who underwent SASI after previous SG procedure due to weight regain and/or symptoms of gastroesophageal reflux disease (GERD) (revisional group - RG)., Results: There were 15 patients (80% female) in the PG, and 14 patients (88% female) in the RG. In the PG, %TWL 12 and 36 months after surgery was 37.8% and 43.9% respectively. In the RG, %TWL 12 and 24 months after surgery was 13.8% and 20.9%, respectively. Most patients had complete remission of T2D and HT after surgery. In the RG, 9 (81.8%) patients had remission of GERD. The worsening of GERD was reported in 4 (40%) patients in the PG., Conclusions: SASI may be an effective and safe method of treatment of obesity. SASI may be an effective method of revisional bariatric surgery performed for GERD, but not for weight regain., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)