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Background: Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods: A bibliographic search using major databases was performed using the terms "emergency surgery" "diaphragmatic hernia," "traumatic diaphragmatic rupture" and "congenital diaphragmatic hernia." GRADE methodology was used to evaluate the evidence and give recommendations. Results: CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Conclusions: Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving. [ABSTRACT FROM AUTHOR]

Aim To investigate the rate of laparoscopic colectomies for colon cancer using registries and population-based studies. To provide a position paper on mini-invasive (MIS) colon cancer surgery based on the opinion of experts leader in this field. Methods A systematic review of the literature was conducted using PRISMA guidelines for the rate of laparoscopy in colon cancer. Moreover, Delphi methodology was used to reach consensus among 35 international experts in four study rounds. Consensus was defined as an agreement ≥75.0%. Domains of interest included nosology, essential technical/oncological requirements, outcomes and MIS training. Results Forty-four studies from 42 articles were reviewed. Although it is still sub-optimal, the rate of MIS for colon cancer increased over the years and it is currently >50% in Korea, Netherlands, UK and Australia. The remaining European countries are un-investigated and presented lower rates with highest variations, ranging 7–35%. Using Delphi methodology, a laparoscopic colectomy was defined as a “colon resection performed using key-hole surgery independently from the type of anastomosis”. The panel defined also the oncological requirements recognized essential for the procedure and agreed that when performed by experienced surgeons, it should be marked as best practice in guidelines, given the principles of oncologic surgery be respected (R0 procedure, vessel ligation and mesocolon integrity). Conclusion The rate of MIS colectomies for cancer in Europe should be further investigated. A panel of leaders in this field defined laparoscopic colectomy as a best practice procedure when performed by an experienced surgeon respecting the standards of surgical oncology. [ABSTRACT FROM AUTHOR]

Abstract: The use of the laparoscopic approach to perform antireflux procedures has increased dramatically since its introduction in 1991. To date, no prospective randomized studies comparing open surgery to the minimal invasive approach in children have been reported. Many retrospective reviews and case series have demonstrated that laparoscopic antireflux procedures are safe and effective once the learning curve is achieved. This position paper is coauthored by the New Technology Committee of the American Pediatric Surgery Association. The goal is to discuss the ongoing controversies and summarize the available evidence to identify the risks and benefits of laparoscopic antireflux procedures. [Copyright &y& Elsevier]

Background: Minimally invasive single-port surgery is always associated with large incisions up to 2–3 cm, complicated handling due to the lack of triangulation, and instrument crossing. The aim of this prospective study was to report how medical students without any laparoscopic experience perform several laparoscopic tasks (rope pass, paper cut, peg transfer, recapping, and needle threading) with the new SymphonX single-port platform and to examine the learning curves in comparison to the laparoscopic multi-port technique. Methods: A set of 5 laparoscopic skill tests (Rope Pass, Paper cut, Peg Transfer, Recapping, Needle Thread) were performed with 3 repetitions. Medical students performed all tests with both standard laparoscopic instruments and the new platform. Time and errors were recorded. Results: A total of 114 medical students (61 females) with a median age of 23 years completed the study. All subjects were able to perform the skill tests with both standard laparoscopic multi-port and the single-port laparoscopic system and were able to significantly improve their performance over the three trials for all five tasks—rope pass (p < 0.001), paper cut (p < 0.001), peg transfer (p < 0.001), needle threading (p < 0.001), and recapping (p < 0.001). In 3 out of 5 tasks, medical students performed the tasks faster using the standard multi-port system—rope pass (p < 0.001), paper cut (p < 0.001), and peg transfer (p < 0.001). In the task recapping, medical students performed the task faster using the new single-port system (p = 0.003). In the task needle threading, there was no significant difference between the standard multi-port system and the new single-port system (p > 0.05). Conclusion: This is the first study analyzing learning curves of the commercially available SymphonX platform for abdominal laparoscopic surgery when used by novices. The learning curve and the error rate are promising. [ABSTRACT FROM AUTHOR]

Background: The aim of this research was to study the epidemiology, microbiology, prophylaxis, and antibiotic therapy of surgical site infections (SSIs), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), and identify the risk factors for these infections. In Italy SSIs occur in about 5 % of all surgical procedures. They are predominantly caused by staphylococci, and 30 % of them are diagnosed after discharge. In every surgical specialty there are specific procedures more associated with SSIs. Methods: The authors conducted a systematic review of the literature on SSIs, especially MRSA infections, and used the Delphi method to identify risk factors for these resistant infections. Results: Risk factors associated with MRSA SSIs identified by the Delphi method were: patients from long-term care facilities, recent hospitalization (within the preceding 30 days), Charlson score > 5 points, chronic obstructive pulmonary disease and thoracic surgery, antibiotic therapy with beta-lactams (especially cephalosporins and carbapenem) and/or quinolones in the preceding 30 days, age 75 years or older, current duration of hospitalization >16 days, and surgery with prothesis implantation. Protective factors were adequate antibiotic prophylaxis, laparoscopic surgery and the presence of an active, in-hospital surveillance program for the control of infections. MRSA therapy, especially with agents that enable the patient's rapid discharge from hospital is described. Conclusion: The prevention, identification and treatment of SSIs, especially those caused by MRSA, should be implemented in surgical units in order to improve clinical and economic outcomes. [ABSTRACT FROM AUTHOR]

Appendectomy is one of the most frequently performed operative procedures in general surgery departments of every size and category. Laparoscopic Appendectomy -- LA - as compared to Open Appendectomy -- OA - was very controversial at first but has found increasing acceptance all over the World, although the percentage of its acceptance is different in the various single National setting. Various meta-analyses and Cochrane reviews have compared LA with OA and different technical details. Furthermore, new surgical methods have recently emerged, namely, the single-port/incision laparoscopic appendectomy and NOTES technique. Their distribution among the hospitals, however, is unclear. Using laparoscopic mini-instruments with trocars of 2-3.5 mm diameter is proposed as a reliable alternative due to less postoperative pain and improved aesthetics. How to proceed in case of an inconspicuous appendix during a procedure planned as an appendectomy remains controversial despite existing study results. But the main question still is: operate or not operate an acute appendicitis, in the meaning of an attempt of a conservative antibiotic therapy. Therefore, we have done a literature survey on the performance of appendectomies and their technical details as well as the management of the intraoperative finding of an inconspicuous appendix in order to write down -- under the light of the latest evidence -- a position paper. [ABSTRACT FROM AUTHOR]

This article presents information about several research papers which were presented during the conference of Association of Laparoscopic Surgeons of Great Britain and Ireland. The conference was held during November 25-26, 2004, in Liverpool, England. The first paper is "Totally Laparoscopic Anatomical Left Lateral Hepatic Sectionectomy: Technique and Initial Experience." Results show that totally laparoscopic left lateral sectionectomy is feasible and safe in selected patients. Another study is "Applications of Minimally Invasive Surgery in Patients With Gastric Outlet Obstruction and Obstructive Jaundice." It was found that gastric and biliary bypass can be performed safely by the laparoscopic approach in all comers with benign or malignant disease who require surgery to palliate or prevent gastric outlet obstruction or obstructive jaundice.

The article presents abstracts of scientific papers related to laparoscopic surgery including "Single Access Laparoscopic Segmental and Total Colectomy in Routine Practice," by M. N. Baig and colleagues, "Outcome of Laparoscopic Common Bile Duct (CBD) Exploration With and Without CBD Drainage," by F. Hanif and colleagues, and "Construct Validity of Fresh Frozen Human Cadaver as a Method of Training in Minimal Access Surgery," by M. Sharma and colleagues.

Over the last three decades, emergency surgery for perforated sigmoid diverticulitis has evolved dramatically but remains controversial. Diverticulitis is categorized as uncomplicated (amenable to outpatient treatment) versus complicated (requiring hospitalization).Patients with complicated diverticulitis undergo computerized tomography (CT) scanning and the CT findings are used categorize the severity of disease. Treatment of stage I (phlegmon with or without small abscess) and stage II (phlegmon with large abscess) diverticulitis (which includes bowel rest, intravenous antibiotics and percutaneous drainage (PCD) of the larger abscesses) has not changed much over last two decades. On the other hand, treatment of stage III (purulent peritonitis) and stage IV (feculent peritonitis) diverticulitis has evolved dramatically and remains morbid. In the 1980s a two stage procedure (1st--segmental sigmoid resection with end colostomy and 2nd--colostomy closure after three to six months) was standard of care for most general surgeons. However, it was recognized that half of these patients never had their colostomy reversed and that colostomy closure was a morbid procedure. As a result starting in the 1990s colorectal surgical specialists increasing performed a one stage primary resection anastomosis (PRA) and demonstrated similar outcomes to the two stage procedure. In the mid 2000s, the colorectal surgeons promoted this as standard of care. But unfortunately despite advances in perioperative care and their excellent surgical skills, PRA for stage III/IV diverticulitis continued to have a high mortality (10-15%). The survivors require prolonged hospital stays and often do not fully recover. Recent case series indicate that a substantial portion of the patients who previously were subjected to emergency sigmoid colectomy can be successfully treated with less invasive nonoperative management with salvage PCD and/or laparoscopic lavage and drainage. These patients experience a surprisingly lower mortality and more rapid recovery. They are also spared the need for a colostomy and do not appear to benefit from a delayed elective sigmoid colectomy. While we await the final results ongoing prospective randomized clinical trials testing these less invasive alternatives, we have proposed (based primarily on case series and our expert opinions) what we believe safe and rationale management strategy. [ABSTRACT FROM AUTHOR]

The article presents abstracts on colon cancer including survival difference between left and right-sided colon cancer, colorectal neoplasia screening using immunochemical faecal occult blood test (FIT) in Singapore and the impact of laparoscopic colorectal surgery in managing liver metastases.

2 Talebpour M, Sadid D, Talebpour A. Comparison of short-term effectiveness and postoperative complications: laparoscopic gastric plication vs laparoscopic sleeve gastrectomy. Response to the Response to Letter to the Editor by Talebpour M. et al. in Regard to Our Recently Published Paper Titled "How Bad Is "Bad"? Talebpour M. and colleagues acknowledge that laparoscopic sleeve gastrectomy (LSG) is superior to laparoscopic gastric plication (LGP) in terms of weight loss but proceed to state that the two procedures have similar weight loss outcomes in the long term. [Extracted from the article]

Background: Recent advances in telecommunication technology and video conferencing systems have opened a new avenue for surgical instruction called "surgical telementoring." This report from the Technology Working Group of the SAGES Project 6 Summit reviews the telementoring technology that currently exists and proposes recommendations for minimum technology requirements and future technology development. While also providing insight in regulatory considerations, this review offers what prospective surgical telementoring participants need to know about the underlying technology with a specific focus on safety, reliability, transmission quality, ease of use, and cost.Methods: Content experts from around the world, in minimally invasive surgery, surgical mentoring and telementoring, surgical education, business development, healthcare innovation, and regulation were invited to attend a 2-day summit in Los Angeles, USA to outline the current state of surgical telementoring and chart the challenges and opportunities going forward. This article summarizes the discussion, conclusions, and recommendation of the technology group with regard to telementoring technology.Results: This article reviews the technical requirements which can be divided into the following categories: (1) safety, (2) reliability, (3) transmission quality, (4) ease of use, and (5) cost.Conclusion: Telementoring applications are technology driven. Given the pace of change of technology, guiding principles in technology design and selection are warranted (Table 4). Telementoring technologies require two basic components, video capturing and display devices at the transmitting and receiving end, and a telecommunication link between them. Many additional features can be added to this basic setup including multiple cameras or video sources, remote camera zoom and pan, recording and storage of videos and images, and telestration capabilities to mention just a few. In general, the cost of these technologies is feature driven. The education framework for each specific application should determine the need for these features (Schlachta in Surg Endosc https://doi.org/10.1007/s00464-016-4988-5 ). [ABSTRACT FROM AUTHOR]

Simple Summary: This paper explores a modern surgical technique called posterior retroperitoneal laparoscopic adrenalectomy (PRLA), which is used to remove the adrenal glands. Unlike traditional open surgery, PRLA uses small incisions in the patient's back, allowing surgeons to access the adrenal glands directly without disturbing other organs in the abdomen. Here, we explain the complex anatomy involved, describe how surgeons perform this procedure step by step, and discuss its benefits and challenges. PRLA can lead to less pain after surgery, shorter hospital stays, and quicker recovery for patients. However, it requires surgeons to have a deep understanding of the body's structure from a different angle than they are used to. This technique is becoming increasingly popular, but it is not suitable for every patient. Our goal is to help surgeons better understand PRLA, potentially improving outcomes for patients who need adrenal gland surgery. Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique "backdoor" approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of the posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. In this paper, the surgical technique is described step by step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Since laparoscopic surgery became the gold standard for colorectal procedures, specific skills are required to achieve good outcomes. The best way to acquire basic and advanced skills and reach the learning curve plateau is by using dedicated simulators: box-trainers, video-trainers and virtual reality simulators. Laparoscopic skills training outside the operating room is cost-beneficial, faster and safer, and does not harm the patient. When compared to box-trainers, virtual reality simulators and cadaver models have no additional benefits. Several laparoscopic trainers available on the market as well as homemade box and video-trainers, most of them using plastic boxes and standard webcams, were described in the literature. The majority of them involve training on a flat surface without any anatomical environment. In addition to their demonstrated benefits, box-trainers which add anatomic details can improve the training quality and skills development of surgeons. Methods: We created a 3D-printed anatomic pelvi-trainer which offers a real-size narrow pelvic space environment for training. The model was created starting with a CT-scan performed on a female pelvis from the Anatomy Museum (Cluj-Napoca University of Medicine and Pharmacy, Romania), using Invesalius 3 software (Centro de Tecnologia da informação Renato Archer CTI, InVesalius open-source software, Campinas, Brazil) for segmentation, Fusion 360 with Netfabb software (Autodesk software company, Fusion 360 with Netfabb, San Francisco, CA, USA) for 3D modeling and a FDM technology 3D printer (Stratasys 3D printing company, Fortus 380mc 3D printer, Minneapolis, MN, USA). In addition, a metal mold for casting silicone valves was made for camera and endoscopic instruments ports. The trainer was tested and compared using a laparoscopic camera, a standard full HD webcam and "V-Box" (INTECH—Innovative Training Technologies, Milano, Italia), a dedicated hard paper box. The pelvi-trainer was tested by 33 surgeons with different qualifications and expertise. Results: We made a complete box-trainer with a versatile 3D-printed pelvi-trainer inside, designed for a wide range of basic and advanced laparoscopic skills training in the narrow pelvic space. We assessed the feedback of 33 surgeons regarding their experience using the anatomic 3D-printed pelvi-trainer for laparoscopic surgery training in the narrow pelvic space. Each surgeon tested the pelvi-trainer in three different setups: using a laparoscopic camera, using a webcam connected to a laptop and a "V-BOX" hard paper box. In the experiments that were performed, each participant completed a questionnaire regarding his/her experience using the pelvi-trainer. The results were positive, validating the device as a valid tool for training. Conclusions: We validated the anatomic pelvi-trainer designed by our team as a valuable alternative for basic and advanced laparoscopic surgery training outside the operating room for pelvic organs procedures, proving that it supports a much faster learning curve for colorectal procedures without harming the patients. [ABSTRACT FROM AUTHOR]

This paper presents the development of the hardware and software architecture of a sixdegrees of freedom (DOF) parallel robot (PARA-SILSROB) by illustrating all the stages undertaken to achieve the experimental model of the robot. Based on the experimental model, the control architecture is also presented, which is primarily based on a master–slave control system through which the surgeon controls the robot using the master console composed of commercial peripheral components (two 3D Space Mouse devices, computer, and keyboard) integrated with the solution developed in this study and presented in this paper. The robot was developed also according to the surgical protocol and surgeon's requirements, and for the functionality testing of the mechanical structure, two experimental stands were used. The first stand presented several surgical steps, such as manipulation, resection, and suture of experimental tissues (simulating real-life robot-assisted surgical maneuvers) using commercial instruments. The second stand presented a simulation of an esophagectomy for esophageal cancer and digestive reconstruction through a right intercostal approach. For this testing phase, the organs were created using 3D reconstruction, and their simplified models were 3D printed using PolyJet technology. Furthermore, the input trajectory generated using the master console was compared with the robot actuator's movements and the obtained results were used for validation of the proposed robot control system. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare among patients with high-type anorectal malformations (ARM): (i) short- and long-term outcomes of laparoscopic-assisted anorectoplasty (LAARP) compared to classic posterior sagittal anorectoplasty (PSARP) and (ii) the results of single-stage versus staged PSARP. Methods: Using a defined search strategy, two independent investigators systematically reviewed the English literature. PRISMA guidelines were followed, and meta-analysis was performed using RevMan5.3. Results: Of 567 abstracts screened, 7 papers have been included (254 pts; 121 PSARP, 133 LAARP) in the first systematic review and meta-analysis. The length of hospitalization was shortened in LAARP versus PSARP (10.9 versus 14.4 days; p < 0.0001). PSARP and LAARP were comparable in terms of early postoperative complications (28.9% versus 24.7%; p = ns) and rectal prolapse (21.6% versus 17.5%; p = ns). At long-term follow-up, the presence of voluntary bowel movements (74.0% versus 83.5%; p = ns) and the incidence of soiling (45.5% versus 47.6%; p = ns) were similar in both PSARP and LAARP. Six papers (297 pts) were included in the second systematic review, with three comparative studies included in the meta-analysis (247 pts; 117 one-stage, 130 staged procedures). No significant difference in terms of presence of voluntary bowel movements after single-stage versus staged procedures (72.6% versus 67.3%; p = ns) has been detected. Conclusions: LAARP seems to be a safe and effective procedure, showing short- and long-term outcomes similar to PSARP. One-stage PSARP could be a safe alternative to the classic three-stage procedure, even for those infants with high-type ARM. Further and larger comparative studies would be needed to corroborate these partial existing data. [ABSTRACT FROM AUTHOR]

In their letter, Talebpour et al. cite and debate various articles from the literature and reference their experience to support the use of laparoscopic gastric plication (LGP) for class II obesity. A cost consideration and review of laparoscopic gastric plication versus laparoscopic sleeve gastrectomy. Response to Letter to the Editor by Talebpour M. et al. in Regard to our Recently Published Paper Titled 'How Bad is "Bad"?. [Extracted from the article]

Simple Summary: Some large-breed dogs are at high risk of a life-threatening gastric dilatation and volvulus (GDV) when the stomach twists and cuts off the blood supply. This must be treated surgically with gastropexy. Gastropexy can be also performed before GDV occurs through open surgery or laparoscopically (keyhole). Laparoscopic gastropexy can be performed in various ways, and one of the newer trends is the use of semi-robotic instruments, such as the FlexDex device (Infiniti Medical, Brighton (US). This paper reports on a learning curve of a specialist surgeon with prior expertise starting to use the FlexDex device. Because this novel tool offers great range of movement, laparoscopic suturing is much easier with it, and within 12 cases, the operating time dropped by 73%, from 52 to 14 min. This is significant because many surgeons shy away from keyhole procedures due to the lengthy time to gain sufficient skills. Reducing surgical time also represents shorter, therefore, safer anaesthesia as well as lower costs of anaesthetic drugs and agents. Using advanced instruments decreases the technical difficulties related with keyhole surgery and laparoscopic suturing in particular. Objectives: Keyhole gastropexy is becoming increasingly popular, and the new development facilitates shorter surgical times. This paper reports on the learning curve in two-port laparoscopic gastropexy using FlexDex in a specialist's hands. FlexDex is a novel tool combining aspects of robotic surgery without requiring an expensive robot theatre setting. Methods: Cohort of 16 dogs >25 kg and at high risk of gastric volvulus and dilatation (GDV) undergoing elective laparoscopic gastropexy were enrolled in the study consecutively from 5/2022 to 9/2023. All patients were operated on by one surgeon (FM), and surgical time was recorded to assess learning curve. Competence was defined as plateauing surgical time. Detailed follow-up at 1 day, 7 days, 14 days, 2 months, 6 months, and long-term was recorded for success rate and complications. Ultrasound examination was scheduled at 4–6-month review to confirm lasting success of the gastropexy. Results: All 16 patients were operated on successfully without any significant complications, as confirmed on the ultrasound. The surgical time of laparoscopic gastropexy reduced from 52 to 14 min (reduction of 38 min/73%) and reached plateau after the 12th case of the 16, making it a very steep learning curve in specialist hands. There were no serious complications, and success rate was 100% at the 6-month ultrasound assessment. Clinical Significance: This is the first paper to report on the learning curve with the FlexDex device in a two-port laparoscopic gastropexy setting. It effectively halves the operating time to 30 min, making the surgery safer for the patient and more cost-efficient, without compromising the result. [ABSTRACT FROM AUTHOR]

The article presents several medical research papers. Topics include evaluating the safety and feasibility of laparoscopic surgery for locally recurrent rectal cancer (LRRC), using PI3K/AKT/mTOR inhibition pathways for anal cancer, and discussing the role of primary tumor resection in colorectal cancer patients with asymptomatic and synchronous unresectable metastasis.

Objective. Endometriosis, affecting about 10% of individuals assigned female at birth, is challenging to diagnose and manage. Diagnosis typically involves the identification of various signs of the disease using either laparoscopic surgery or the analysis of T1/T2 MRI images, with the latter being quicker and cheaper but less accurate. A key diagnostic sign of endometriosis is the obliteration of the pouch of Douglas (POD). However, even experienced clinicians struggle with accurately classifying POD obliteration from MRI images, which complicates the training of reliable AI models. Approach. In this paper, we introduce the H uman– AI Co llaborative M ulti-modal M ulti-rater Learning (HAICOMM) methodology to address the challenge above. HAICOMM is the first method that explores three important aspects of this problem: (1) multi-rater learning to extract a cleaner label from the multiple 'noisy' labels available per training sample; (2) multi-modal learning to leverage the presence of T1/T2 MRI images for training and testing; and (3) human–AI collaboration to build a system that leverages the predictions from clinicians and the AI model to provide more accurate classification than standalone clinicians and AI models. Main results. Presenting results on the multi-rater T1/T2 MRI endometriosis dataset collected for validating the methodology, the proposed HAICOMM model outperforms an ensemble of clinicians, noisy-label learning models, and multi-rater learning methods by a large margin. Significance. The HAICOMM methodology offers a novel solution to the long-standing problem of accurately diagnosing endometriosis from MRI images, specifically in relation to the key diagnostic sign of POD obliteration. By leveraging multi-rater, multi-modal, and human–AI collaborative learning, it has the potential to improve the accuracy of endometriosis diagnosis, which could have far-reaching implications for the better management of this challenging medical condition that affects a significant proportion of the female population. [ABSTRACT FROM AUTHOR]

Simple Summary: Laparoscopy represents the gold standard surgical approach for adrenalectomies. Although the robotic platform has been reported to overcome the innate shortcomings of laparoscopic surgery, its use in adrenalectomies remains debated. The aim of this paper is to compare the surgical and postoperative outcomes of robotic adrenalectomy (RA) and laparoscopic adrenalectomy (LA) for adrenal tumors by the inclusion of the largest number of studies. With respect to the mean intraoperative blood loss, conversion to open surgery rate, time to first flatus and length of hospital stay, the RA group showed slightly statistically significant lower rates than the laparoscopic approach. However, the overall costs of hospitalization were significantly higher in the RA group than the LA group. In the near future, RA could represent a promising complementary approach to LA for benign and small malignant adrenal masses, particularly in high-volume referral centers specializing in robotic surgery. Background: Minimally invasive surgery (MIS) for adrenal glands is becoming increasingly developed worldwide and robotic surgery has advanced significantly. Although there are still concerns about the generalization of outcomes and the cost burden, the robotic platform shows several advantages in overcoming some laparoscopic shortcomings. Materials and Methods: A systematic review and meta-analysis were conducted using the PubMed, MEDLINE and Cochrane library databases of published articles comparing RA and LA up to January 2024. The evaluated endpoints were technical and post-operative outcomes. Dichotomous data were calculated using the odds ratio (OR), while continuous data were analyzed usingmean difference (MD) with a 95% confidence interval (95% CI). A random-effects model (REM) was applied. Results: By the inclusion of 28 studies, the meta-analysis revealed no statistically significant difference in the rates of intraoperative RBC transfusion, 30-day mortality, intraoperative and overall postoperative complications, re-admission, R1 resection margin and operating time in the RA group compared with the LA. However, the overall cost of hospitalization was significantly higher in the RA group than in the LA group, [MD USD 4101.32, (95% CI 3894.85, 4307.79) p < 0.00001]. With respect to the mean intraoperative blood loss, conversion to open surgery rate, time to first flatus and length of hospital stay, the RA group showed slightly statistically significant lower rates than the laparoscopic approach. Conclusions: To our knowledge, this is the largest and most recent meta-analysis that makes these comparisons. RA can be considered safe, feasible and comparable to LA in terms of the intraoperative and post-operative outcomes. In the near future, RA could represent a promising complementary approachto LA for benign and small malignant adrenal masses, particularly in high-volume referral centers specializing in robotic surgery. However, further studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Postoperative adhesions represent a major medical challenge and are associated with serious health and economic consequences. 4DryField® PH (PlantTec Medical GmbH, Lueneburg, Germany) is a starch-based medical device designed both to prevent adhesions and for hemostasis. This paper explores methods to successfully apply it in gynecological surgery, leveraging the authors' extensive clinical experience. We provide detailed insights into best practices that benefit most patients with conditions such as endometriosis, along with practical tips and guidance on optimizing application and dosage. Our real-world clinical experience across various indications, supported by published data, demonstrates significant patient benefits: reduced adhesion formation, better recovery, less pain, and improved fertility. Patient acceptance and satisfaction are notably high. The device can be applied to surgical wounds as a powder for hemostasis and transformed into a gel in situ or as a premixed gel when adhesion prevention is prioritized. Specific advantages for each method are demonstrated by case studies. When used correctly, 4DryField PH is safe and effective, especially for larger wound areas with a high risk of reoperation and adhesion formation and when pregnancy is desired. It offers great versatility due to its use as either in situ gel or premixed gel with different viscosities. Despite some remaining gaps in clinical evidence and ongoing studies, our personal clinical experience suggests significant benefits with minimal risks. Therefore, we have no concerns regarding the broad use of 4DryField PH in gynecology and other surgical disciplines. Future research should focus on patient-reported outcomes and health economic benefits to support reimbursement efforts. [ABSTRACT FROM AUTHOR]

Background: Intramural pregnancy is a very rare type of ectopic pregnancy, which is surrounded by uterine myometrium layer and separates from endometrium. To our knowledge, this abnormal location site of ectopic pregnancy remains likely under-recognized and under-reported. Through this paper, we aim to underscore the role of minimally invasive surgery in this uncommon condition where applicable, especially in low-middle income countries. Case presentation: A 34-year-old Vietnamese female patient (gravida 3 parity 1) was hospitalized due to a diagnosis of intramural pregnancy. Rapidly, the patient underwent laparoscopy for a removal of ectopic pregnancy mass corresponding to 5–6 weeks of gestation, taking into consideration the possibility of conservative surgery. This surgical intervention was carefully performed under ultrasound guidance at operating room. The surgical management resulted in a favorable outcome, though a hysterectomy and laparotomy could be avoided intentionally in this case. Conclusion: This case report emphasizes the timely detection of intramural pregnancy involving the successful outcome. Moreover, in an early term of intramural pregnancy, uterine conservative management under laparoscopic surgery combined with ultrasound could be a reliable management for this extreme rarity at tertiary center. Further data is required to strengthen this finding. [ABSTRACT FROM AUTHOR]

In laparoscopic liver surgery, image-guided navigation systems provide crucial support to surgeons by supplying information about tumor and vessel positions. For this purpose, these information from a preoperative CT or MRI scan is overlaid onto the laparoscopic video. One option is performing a registration of preoperative 3D data and 3D reconstructed laparoscopic data. A robust registration is challenging due to factors like limited field of view, liver deformations, and 3D reconstruction errors. Since in reality various influencing factors always intertwine, it is crucial to analyze their combined effects. This paper assesses registration accuracy under various synthetically simulated influences: patch size, spatial displacement, Gaussian deformations, holes, and downsampling. The objective is to provide insights into the required quality of the intraoperative 3D surface patches. LiverMatch serves as the feature descriptor, and registration employs the RANSAC algorithm. The results of this paper show that ensuring a large field of view of at least 15-20% of the liver surface is necessary, allowing tolerance for less accurate depth estimation. [ABSTRACT FROM AUTHOR]

Introduction: Accurate disclosure of conflicts of interest (COI) is critical to interpretation of study results, especially when industry interests are involved. We reviewed published manuscripts comparing robot-assisted cholecystectomy (RAC) and laparoscopic cholecystectomy (LC) to evaluate the relationship between COI disclosures and conclusions drawn on the procedure benefits and safety profile. Methods: Searching Pubmed and Embase using key words "cholecystectomy", laparoscopic" and "robotic"/"robot-assisted" retrieved 345 publications. Manuscripts that compared benefits and safety of RAC over LC, had at least one US author and were published between 2014 and 2020 enabling verification of disclosures with reported industry payments in CMS's Open Payments database (OPD) (up to 1 calendar year prior to publication) were included in the analysis (n = 37). Results: Overall, 26 (70%) manuscripts concluded that RAC was equivalent or better than LC (RAC +) and 11 (30%) concluded that RAC was inferior to LC (RAC–). Six manuscripts (5 RAC + and 1 RAC–) did not have clearly stated COI disclosures. Among those that had disclosure statements, authors' disclosures matched OPD records among 17 (81%) of RAC + and 9 (90%) RAC– papers. All 11 RAC- and 17 RAC + (65%) manuscripts were based on retrospective cohort studies. The remaining RAC + papers were based on case studies/series (n = 4), literature review (n = 4) and clinical trial (n = 1). A higher proportion of RAC + (85% vs 45% RAC–) manuscripts used data from a single institution. Authors on RAC + papers received higher amounts of industry payments on average compared to RAC– papers. Conclusions: It is imperative for authors to understand and accurately disclose their COI while disseminating scientific output. Journals have the responsibility to use a publicly available resource like the OPD to verify authors' disclosures prior to publication to protect the process of scientific authorship which is the foundation of modern surgical care. [ABSTRACT FROM AUTHOR]

The article presents abstracts of studies on surgical endoscopy including post-oesophagectomy diaphragmatic hernia repair techniques, laparoscopic management of acute intra-thoracic gastric volvulus, and hybrid robotic posterior pelvic clearance.

Operative site wound infection is one of the most frequent infections in surgery. A variety of studies have shown that the results of laparoscopy might be superior to those of an open procedure. Nevertheless, there is still a lack of clarity as to whether there is a difference between open and laparoscopy with respect to the occurrence of wound infections in different paediatric operations. In this review, we looked at randomized, controlled studies that directly measured the rate of wound infection following an appendectomy with a laparoscope. We looked up four main databases for randomized, controlled studies that compare the treatment of paediatric appendicitis with laparoscopy. The surgeries included appendectomy. Through our search, we have determined 323 related papers and selected five qualified ones to be analysed according to the eligibility criteria. Five trials were also assessed for the quality of the documents. In the 5 trials, there were no statistically significant differences in the incidence of post‐operative wound infection among the paediatric appendectomy and the open‐access group (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.34–1.15, p = 0.13). The four trials did not show any statistically significant difference in abdominal abscesses among the laparoscopic and open‐access treatment groups (OR, 1.64; 95% CI, 0.90–3.01, p = 0.11). The four trials did not reveal any statistically significant difference in operating time (mean difference, −4.36; 95% CI, −17.31 to 8.59, p = 0.51). In light of these findings, the use of laparoscopy as compared with the open‐approach approach in paediatric appendectomies is not associated with a reduction in the risk of wound infection. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including imaging modalities in pediatric oncology, role of minimally invasive surgery in solid tumor treatment and surgical approach to neuroblastoma.

Purpose: We present surgical techniques and operative results of laparoscopic reconstruction for patients with retrocaval ureter (RCU) and review similar papers. Materials and Methods: Ten patients with RCU were enrolled in this study from April 2005 to January 2017. The mean age of 7 males and 3 females was 40.5 years old. The chief complaint was flank pain in 6 patients; the remaining patients were detected incidentally. All patients showed hydronephrosis and typical S-shaped deformity of the ureter on imaging studies. Five patients showed obstructed patterns on the renal scans. Two surgeons performed laparoscopic ureteroureterostomies with transperitoneal approaches including excision of the compressed ureter. Double-J ureteral stents were inserted intraoperatively. The operative and follow-up results were checked and compared with published papers. Results: All laparoscopic reconstructions were successfully completed without conversion to open surgery. The mean operative time was 199.6 minutes. The estimated blood loss was 154.4 mL. No operative complications were encountered. There were no obstruction and symptom after the mean follow-up of 40.7 months. We found 7 papers from PubMed, which had more than five cases of laparoscopic reconstruction of RCU. We reviewed and summarized the clinical and operative parameters. Conclusions: Our results show that transperitoneal laparoscopic ureteroureterostomy with excision of the compressed ureter is a safe and effective treatment for RCU. Data from published papers and ours summarize clinical parameters of RCU, and suggest that the laparoscopic reconstruction can be considered as the standard treatment for it. [ABSTRACT FROM AUTHOR]

The article presents abstracts on veterinary medicine which include a standing laparoscopic ovariectomy technique with intraabdominal ovarian dissection inside a specimen retrieval bag for removal of large pathologic ovaries through small incisions, the association between results of endoscopic evaluation of arytenoid function (AF) and epiglottic structure (ES) in Thoroughbred yearlings, and assessment of superficial digital flexor tendonitis treatments in the Thoroughbred racehorse.

Surgical training in medical school residency programs has followed the apprenticeship model. The learning and assessment process is inherently subjective and time-consuming. Thus, there is a need for objective methods to assess surgical skills. Here, we use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to systematically survey the literature on the use of Deep Neural Networks for automated and objective surgical skill assessment, with a focus on kinematic data as putative markers of surgical competency. There is considerable recent interest in deep neural networks (DNNs) due to the availability of powerful algorithms, multiple datasets, some of which are publicly available, as well as efficient computational hardware to train and host them. We have reviewed 530 papers, of which we selected 25 for this systematic review. Based on this review, we concluded that DNNs are potent tools for automated, objective surgical skill assessment using both kinematic and video data. The field would benefit from large, publicly available, annotated datasets representing the surgical trainee and expert demographics and multimodal data beyond kinematics and videos. [ABSTRACT FROM AUTHOR]

Background: The celiac trunk represents an unpaired visceral branch of the abdominal aorta, which detaches at the level of the 12th cervical vertebra. It has a trajectory of 1-2 cm and a caliber of 5-8 mm, having relations with the parietal peritoneum, the vestibule of the omental bursa, the diaphragmatic lymph nodes and the diaphragmatic pillar muscles, the caudate lobe of the liver, the vertical portion of the small gastric curvature and the median arcuate ligament. The celiac trunk trifurcates into three terminal branches: the left gastric artery, the common hepatic artery and the splenic artery. Each of these branches has a specific trajectory and relations, vascularizing the corresponding organs. Given its importance as a source of vascularization, any anatomical variation is eloquent and necessary to be known for the diagnosis and treatment of conditions at this level. Methods: The selection of articles that were included in this paper was made using the PubMed database, where the following keywords were used: variation of celiac trunk, celiac trunk and laparoscopic surgery, clinical implications of celiac trunk, celiac trunk and oncologic extensive surgery. Entering the mentioned keywords generated an initial number of 5428 references. They were subjected to a filtering process: duplicates were removed, only free full-text articles were selected, and inclusion and exclusion criteria were applied. Subsequently, the most appropriate articles for the topic of the paper were chosen, according to the Web of Science Impact Factor and suitability criteria, resulting in a final number of 28 articles. Literature review: These 28 articles were reviewed based on the criteria: anatomical variants in the branching of the celiac trunk, implications of anatomical variations of the celiac trunk in: laparoscopic surgery - treatment of median arcuate ligament syndrome, abdominal oncological surgery, liver transplant and interventional radiology. Conclusions: The anatomical variations of the celiac trunk have a significant impact on abdominal surgery, whether oncological or not, liver transplant, as well as minimally invasive radiological procedures. A correct knowledge of the up-mentioned variations significantly decreases the rate of intra- and post-interventional complications, accompanied by a smaller recovery time in the possible event of a complication, and also the general healing time following surgery. [ABSTRACT FROM AUTHOR]

Background: Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. Methods: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. Results: A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. Conclusions: The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma. [ABSTRACT FROM AUTHOR]

Duodenal perforation consequent to prior surgery is a rare but severe complication carrying serious consequences if not promptly managed. This study aims to identify the best treatment pathway available to date. This is a systematic review registered to PROSPERO. The literature research was conducted on Ovid Medline, Embase, and Cochrane up to February 2022 to identify all papers reporting surgical-related duodenal perforations. Twelve articles were included. Most of these studies were case reports or case series. The most common cause of perforation was laparoscopic cholecystectomy (72.7%). The median time to symptom appearance was 2 days. Most of these perforations were severe injuries located in the first portion of the duodenum. Only one patient was treated with a non-interventional conservative management, which failed. Five patients were managed with interventional non-surgical treatments: 4 with endoscopy (50% failure) and one with a percutaneous occluder. Different surgical treatments were reported: direct suture (100% failure), direct suture and T-tube duodenostomy (75% failure), simple abdominal drainage, and suture with pyloric exclusion. Further extensive surgeries were also reported. The overall mortality rate was 13.6%, with a median hospital stay of 38.5 days. This review shows a wide spectrum of managements for patients with duodenal perforation related to prior surgery. The decision on which treatment to adopt must consider patient's clinical setting and duodenal defect characteristics (size, site, and time to diagnosis). A tentative treatment flowchart is provided, although larger sample size studies are needed to obtain a treatment pathway based on evidence. [ABSTRACT FROM AUTHOR]

The article announces that the Best Original Paper Award for the year 2012 has been given to researcher Alex L.H. Leung and colleagues for their research titled "Emergency Laparoscopic Repair for Strangulated Groin Hernias-a single centre experience."