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Purpose The purpose of this study was to assess the long-term efficacy of hemorrhoidal radiofrequency thermocoagulation (RFT) on bleeding, prolapse, quality of life (QoL), and recurrence. Methods This retrospective, single-center study, with RFT performed using procedure modified via hemorrhoid exteriorization assessed the evolution of hemorrhoidal prolapse rated by Goligher scale; bleeding and discomfort (0–10), feeling of improvement and satisfaction (–5 to +5/5) by analog scales; the impact of hemorrhoids on QoL by HEMO-FISS-QoL score. Results From April 2016 to January 2021, 124 patients underwent surgery and 107 were interviewed in September 2021. The average follow-up was 30 months (range, 8–62 months). The mean work stoppage was 3 days, none in 71.0% of the cases. A mean of 4,334 J was applied. No analgesics were required for 66.4% of patients. External hemorrhoidal thrombosis was the only immediate complication in 9 patients, with no long-term reported complication. Bleeding was completely ceased in 53 out of 102 patients. Of the patients with persistent bleeding, the intensity had dropped greatly (P

Background: Compared with the da Vinci platform, there is limited experience with the Hugo RAS® platform for colorectal surgery in Europe. This difference is especially notable when considering complex procedures such as total colectomy. Aim: To demonstrate the feasibility and safety of using the Hugo RAS® (Medtronic, Minneapolis, MN, USA) platform for total colectomy. Clinical case: An 18-year-old female patient with Familial Adenomatous Polyposis (FAP) and a BMI of 19 underwent a total colectomy with ileorectal anastomosis using the Hugo RAS® platform. The procedure lasted 253 min without complications. The postoperative period was uneventful, and she was discharged from the hospital on the third postoperative day. Conclusion: The Hugo RAS® platform is an emerging minimally invasive robotic that can be used even for total colectomy with proper patient selection. The placement and choice of arms and trocars were crucial to obtaining a similar operative time to the standard laparoscopic approach. The certification of Hugo's new instruments, such as energy devices and staplers, will make this platform even more competitive. [ABSTRACT FROM AUTHOR]

Prostate cancer remains a leading cause of mortality among men globally, necessitating advancements in diagnostic methodologies to improve detection and treatment outcomes. Magnetic Resonance Imaging has emerged as a crucial technique for the detection of prostate cancer, with current research focusing on the integration of deep learning frameworks to refine this diagnostic process. This study employs a comprehensive approach using multiple deep learning models, including a three-dimensional (3D) Convolutional Neural Network, a Residual Network, and an Inception Network to enhance the accuracy and robustness of prostate cancer detection. By leveraging the complementary strengths of these models through an ensemble method and soft voting technique, the study aims to achieve superior diagnostic performance. The proposed methodology demonstrates state-of-the-art results, with the ensemble model achieving an overall accuracy of 91.3%, a sensitivity of 90.2%, a specificity of 92.1%, a precision of 89.8%, and an F1 score of 90.0% when applied to MRI images from the SPIE-AAPM-NCI PROSTATEx dataset. Evaluation of the models involved meticulous pre-processing, data augmentation, and the use of advanced deep-learning architectures to analyze the whole MRI slices and volumes. The findings highlight the potential of using an ensemble approach to significantly improve prostate cancer diagnostics, offering a robust and precise tool for clinical applications. [ABSTRACT FROM AUTHOR]

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Aim: The use of minimally invasive procedures in low-risk congenital heart surgeries has increased recently. Compared to traditional median sternotomy, minimally invasive techniques offer better cosmetic results and provide more satisfaction to both the patient and their parents. Partial anomalous pulmonary venous return (PAPVR) can be safely repaired using these techniques. Material and Methods: The perioperative data of right-sided PAPVR patients who were operated on with minimally invasive approaches in our clinic between March 2019 and January 2023 were reviewed retrospectively. The perioperative data of the patients’ including type of surgery, cardiopulmonary bypass duration, cross-clamp duration, postoperative cardiac rhythm, total operation duration, total drainage, total intensive care unit duration and total hospital stay duration were obtained. The results were compared with the data in the current literature. Results: During the study period, 14 patients underwent surgical repair. Five (36%) of them were female and nine (64%) were male. Patients underwent right infra-axillary vertical thoracotomy (RIAVT) and right anterolateral thoracotomy (RALT) had mean ages of 48±26.6 and 42±18.2 months, respectively. High venosum type atrial septal defect (ASD) was detected in 12 (85.7%) of the patients. The most frequently used surgical treatment was the double patch technique which was used in 12 patients (85.7%). This was followed by single patch repair in one patient (7.1 %). The Warden procedure was used in one patient (7.1%) who was operated on with the RIAVT technique. Patients’ cross-clamp, cardiopulmonary bypass (CPB), and total operation durations were comparable to those reported in the medical literature. Conclusion: RIAVT and RALT are two of the frequently used minimally invasive surgical techniques in congenital heart surgery. After gaining sufficient experience, both of these methods can be safely applied to PAPVR repair. [ABSTRACT FROM AUTHOR]

Purpose: To compare perioperative, functional, and safety outcomes between thulium fiber laser enucleation of the prostate (ThuFLEP) and bipolar enucleation of the prostate performed by a single surgeon with use of propensity score (PS)-matched analysis. Materials and Methods: Data were from 675 patients, 422 of whom underwent ThuFLEP and bipolar enucleation by a single highly experienced surgeon. ThuFLEP was performed with Fiberlase U1 (IRE Polus Ltd.). Perioperative parameters, safety, and functional outcomes, such as International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual volume (PVR), and maximum urinary flow rate (Qmax) were assessed. To control for selection bias, a 1:1 PS-matched analysis was carried out using the following variables as covariates: total prostate volume, preoperative IPSS and early sphincter release. Results: Of 422 patients, 370 (87.7%) underwent ThuFLEP and 52 (12.3%) underwent bipolar enucleation. Operation, enucleation, and morcellation time were comparable between groups before and after PS-matched analysis (p=0.954, p=0.474, p=0.362, respectively). Functional parameters (IPSS, QoL, PVR, Qmax) were also comparable between groups at every time point before and after PS matching. Significant improvements in IPSS, QoL score, Qmax, and PVR were observed during the 24-month follow-up period for both ThuFLEP and bipolar enucleation without any significant differences between groups. Early and late postoperative complications before and after PS-matched analysis were similar. Conclusions: ThuFLEP was comparable to bipolar enucleation in perioperative characteristics, improvement in voiding parameters, and complication rates. Both procedures were shown to be effective and safe in the management of benign prostatic hyperplasia.

Purpose: This study aimed to assess the clinical outcome and safety of holmium laser enucleation of the prostate (HoLEP) following transrectal ultrasound-guided prostate biopsy (TR biopsy) in the treatment of benign prostate hyperplasia. Materials and Methods: We retrospectively analyzed data from 556 patients who underwent HoLEP between 2014 and 2021. The patients were categorized into six groups: Group 1-A (n=45) underwent HoLEP within four months post TR biopsy. Group 1-B (n=94) underwent HoLEP more than four months post TR biopsy. Group 1-C (n=120) underwent HoLEP after a single TR biopsy. Group 1-D (n=19) underwent HoLEP after two or more TR biopsies. Group 1-total (n=139, group 1-A+group 1-B or group 1-C+group 1-D) underwent HoLEP post TR biopsy. Group 2 (control group, n=417) underwent HoLEP without prior TR biopsy. We examined perioperative parameters, safety, and functional outcomes. Results: The age, body mass index, International Prostate Symptom Score (IPSS), uroflowmetry, and comorbid diseases between group 1-total and group 2 were comparable. However, group 1-total exhibited significantly elevated prostate-specific antigen levels and larger prostate volumes (p

Objective Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years. Methods We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type. Results Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar results were observed in cancer-only and benign-only cohorts. Conclusion Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years.

Introduction and objective: Magnetic-assisted robotic surgery (MARS) has been developed to maximize patient benefits of minimally invasive surgery while enhancing surgeon control and visualization. MARS platform (Levita Magnetics) comprises two robotic arms that provide control to an external magnetic controller and an off-the-shelf laparoscopic camera. Our aim was to evaluate the safety and efficacy of the MARS platform in laparoscopic renal and adrenal procedure for the first time. Methods: This is a prospective, single-arm, open-label study (Clinical Trials Identifier: NCT05353777) including patients with renal or adrenal pathology analysis, submitted to laparoscopic procedure between April and June 2022. Patients were followed up to 30 days postoperatively. Preoperative, intraoperative, and postoperative data were recorded. Polynomial regression was used to determine the learning curve for docking time. Results: Fifteen cases were performed using the MARS platform (three partial nephrectomies, five total nephrectomies for benign pathology analysis, four radical nephrectomies, and three adrenalectomies) corresponding to 10 women and 5 men (mean age, 55 years [18–77]; average body mass index, 29 cm/m2 [22–39]). No cases required conversion to open procedure and all patients were discharged on the first or second postoperative day. No complications or re-admissions were reported within the first 30 days. All oncologic cases had negative margins. Learning curve was achieved by the fourth case, diminishing docking time from 5.22 (2.6–11.5) to 2.68 minutes (2.1–3.8) (p = 0.002). The learning curve was fitted to a cubic regression (R2 = 0.714). Conclusion: This is the first clinical study demonstrating the safety and versatility of the MARS platform in urologic procedures. The robot was especially useful for tissue retraction, avoiding additional incisions and the need for a surgical assistant while increasing surgeon control and visualization. The learning curve was rapid, achieving a short docking time. MARS is a promising new technology that could be successfully evaluated in other surgeries. [ABSTRACT FROM AUTHOR]

Purpose: To compare perioperative, functional, and safety outcomes between thulium fiber laser enucleation of the prostate (Thu-FLEP) and bipolar enucleation of the prostate performed by a single surgeon with use of propensity score (PS)-matched analysis. Materials and Methods: Data were from 675 patients, 422 of whom underwent ThuFLEP and bipolar enucleation by a single highly experienced surgeon. ThuFLEP was performed with Fiberlase U1 (IRE Polus Ltd.). Perioperative parameters, safety, and functional outcomes, such as International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual volume (PVR), and maximum urinary flow rate (Qmax) were assessed. To control for selection bias, a 1:1 PS-matched analysis was carried out using the following variables as covariates: total prostate volume, preoperative IPSS and early sphincter release. Results: Of 422 patients, 370 (87.7%) underwent ThuFLEP and 52 (12.3%) underwent bipolar enucleation. Operation, enucleation, and morcellation time were comparable between groups before and after PS-matched analysis (p=0.954, p=0.474, p=0.362, respectively). Functional parameters (IPSS, QoL, PVR, Qmax) were also comparable between groups at every time point before and after PS matching. Significant improvements in IPSS, QoL score, Qmax, and PVR were observed during the 24-month follow-up period for both ThuFLEP and bipolar enucleation without any significant differences between groups. Early and late postoperative complications before and after PS-matched analysis were similar. Conclusions: ThuFLEP was comparable to bipolar enucleation in perioperative characteristics, improvement in voiding parameters, and complication rates. Both procedures were shown to be effective and safe in the management of benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

In the open‐label, phase III CheckMate 816 study (NCT02998528), neoadjuvant nivolumab plus chemotherapy demonstrated statistically significant improvements in event‐free survival (EFS) and pathological complete response (pCR) versus chemotherapy alone in patients with resectable non‐small‐cell lung cancer (NSCLC). Here we report efficacy and safety outcomes in the Japanese subpopulation. Patients with stage IB–IIIA, resectable NSCLC were randomized 1:1 to nivolumab plus chemotherapy or chemotherapy alone for three cycles before undergoing definitive surgery within 6 weeks of completing neoadjuvant treatment. The primary end‐points (EFS and pCR) and safety were assessed in patients enrolled at 16 centers in Japan. Of the Japanese patients randomized, 93.9% (31/33) in the nivolumab plus chemotherapy arm and 82.9% (29/35) in the chemotherapy arm underwent surgery. At 21.5 months' minimum follow‐up, median EFS was 30.6 months (95% confidence interval [CI], 16.8–not reached [NR]) with nivolumab plus chemotherapy versus 19.6 months (95% CI, 8.5–NR) with chemotherapy; hazard ratio, 0.60 (95% CI, 0.30–1.24). The pCR rate was 30.3% (95% CI, 15.6–48.7) versus 5.7% (95% CI, 0.7–19.2), respectively; odds ratio, 7.17 (95% CI, 1.44–35.85). Grade 3/4 treatment‐related adverse events were reported in 59.4% versus 42.9% of patients, respectively, with no new safety signals identified. Neoadjuvant nivolumab plus chemotherapy resulted in longer EFS and a higher pCR rate versus chemotherapy alone in Japanese patients, consistent with findings in the global population. These data support nivolumab plus chemotherapy as a neoadjuvant treatment option in Japanese patients with resectable NSCLC. [ABSTRACT FROM AUTHOR]

no abstract

This article provides information on the use of minimally invasive percutaneous plate osteosynthesis (MIPPO) for treating pilon fractures, which are fractures of the distal tibia. The article explains that pilon fractures are often caused by high-energy traumatic events and discusses the goals of treatment, including limb alignment and secure fixation. The article presents a case study and highlights the advantages of the MIPPO technique, such as reduced surgical trauma and improved fracture healing. Other treatment options, such as intramedullary nailing and external fixation, are also mentioned. The article compares different techniques for treating distal tibia fractures and recommends MIPPO as the primary option due to its minimally invasive nature and potential biological benefits. The drawbacks of open reduction and internal fixation methods are also discussed. [Extracted from the article]

Hui Wang,1,* Xiaonan Zhou,2,* Xingyu Li,1,* Zeng Xu,1,* Qingbing Meng,3 Jianxi Wang,1 Xiaolong Shen,1 Huajiang Chen,1 Wen Yuan,1 Xiaodong Wu1 1Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China; 2Department of Anesthesiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China; 3Department of Orthopedics, Shanghai Zhongshan Hospital, Fudan University Shanghai School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huajiang Chen; Xiaodong Wu, Email chenhuajspine@163.com; wuxiaodongspine@163.comIntroduction: Low back pain following transforaminal endoscopic lumbar discectomy (TELD) is prevalent (15– 25% incidence). Modifying TELD techniques to avoid excessive disc removal has been suggested to reduce such pain. Facet injury, re-herniation, and disc space collapse might contribute. This retrospective study aimed to explore factors linked to post-TELD low back pain.Methods: A total of 351 patients with L3/4, L4/5, and L5/S1 intervertebral lumbar disc herniations, who underwent TELD at two spine centers, were included. Patients were followed for one year. Low back and leg pain visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Pfirrmann grade, and disc height were measured at 3 months and 1 year. Correlation analyses examined links between postoperative low back pain VAS scores, age, sex, disc/vertebrae height ratio (D/V H ratio), Pfirrmann grade, cannula position grade, re-herniation grade, high-intensity zone (HIZ), disc calcification, surgical grade, and other factors. Significant variables were identified using partial least square tests, with variable importance in projection (VIP) values quantifying their impact on low back pain.Results: Univariate analysis indicated that surgical grade correlated with long-term postoperative low back pain (P = 0.023), while re-herniation (P = 0.008, P = 0.000), disc height (P = 0.001, P = 0.034), and sex (P = 0.025, P = 0.003) correlated with both short- and long-term postoperative low back pain. Trephine/cannula position is correlated with short-term low back pain (P = 0.036). Worsening low back pain was associated with female sex, improper trephine/cannula position, re-herniation, and post-surgical disc space collapse. Intradiscal irrigation was linked to decreased low back pain.Discussion: This study highlights factors influencing low back pain after TELD. Loss of disc height, extent of re-herniation, quality of trephine/cannula position, and sex were associated with low back pain at both 3 months and 1-year post-TELD. Proper techniques, like minimizing disc height loss and re-herniation, may help mitigate postoperative low back pain.Keywords: spine, endoscopy, radiology, minimally invasive surgical procedure, postoperative low back pain

Background: The purpose of this study was to clarify the oncological safety of reduced-port laparoscopic surgery (single-incision plus one port) (RPS) for patients with rectal cancer. Methods: The clinicopathological data of 63 selected patients with clinical Stage I-III (T1-3 and N0-2) rectal cancer who underwent RPS of radical anterior resection between 2012 and 2017 were retrospectively analyzed. The median distance of tumor from anal verge was 11 cm. Ordinarily, a multiport platform with three channels was placed in the 3-cm umbilical incision, and another 5- or 12-mm port was placed in the right lower abdomen. Results: The median operative time, amount of intraoperative bleeding, number of harvested lymph nodes, and length of distal margin were 272 min, 10mL, 22 nodes, and 4.0 cm, respectively, and there was one (2%) patient with involvement of the radial margin. There were eight patients (13%) who required additional ports, and one patient (2%) who converted to open surgery. Intra- and postoperative complications occurred in one (2%) and 12 patients (19%), respectively. The median length of postoperative hospital stay was 8 days. The median follow-up period was 79 months, and incisional hernia was observed in 3 (5%) patients at the platform site not the port site, and cancer recurrence occurred in four patients (6%). The 5-year relapse-free and overall survival rates were 100% and 100% in the patients with pathological Stage I disease, 94% and 100% in the patients with pathological Stage II disease, and 83% and 89% in the patients with pathological Stage III disease, respectively. Conclusion: RPS in the selected patients with rectal cancer, performed by an expert laparoscopic surgeon, may be technically safe and oncologically acceptable as well as multiport laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Background: Over the past 20 years, surgeons involved in soft tissue minimally invasive surgery have experienced the pros and cons of both conventional and tele-robotic laparoscopic approaches. The Maestro System, developed by Moon Surgical (Paris, France) aims to overcome the challenges inherent to both approaches thanks to a new concept that augments the surgeon's performance at the bedside during a laparoscopic procedure. Methods: The current study aims to present the first human experience with laparoscopic cholecystectomy with the Maestro system on 10 patients. Results: All ten procedures were completed successfully. No significant complications related to the use of the Maestro system werenoted. Conclusion: Our preliminary observations appear to support the benefits of the Maestro system in non-emergent laparoscopic cholecystectomies. It goes without saying that further research is necessary to demonstrate the safety of this approach in other procedures. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of the Optilume BPH Catheter System for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Methods: This open-label, single-arm study enrolled eighty subjects with LUTS secondary to BPH who were treated with the Optilume BPH Catheter System. Symptoms were recorded utilizing the International Prostate Symptom Score (IPSS) and Benign Prostatic Hyperplasia Impact Index (BPH-II). Functional improvement was measured utilizing peak urinary flow rate (Qmax) and post-void residual urine volume (PVR). Adverse events were systematically captured and reported at each follow-up visit. Results: Subjects treated with the Optilume BPH Catheter System experienced a significant improvement in LUTS from baseline through 2 years of follow-up, as measured by IPSS (22.3 vs 8.2, p < 0.001) and BPH-II (6.9 vs 2.3, p < 0.001). Functional improvement was also significant, with Qmax improving from an average of 10.9 mL/s at baseline to 17.2 mL/s at the 2-year follow-up and PVR improving from 63.1 to 45.0 mL. Treatment-related adverse events were typically minor, with none occurring between 1- and 2-year post-treatment. Conclusions: The Optilume BPH Catheter System is a unique minimally invasive surgical therapy that combines mechanical and pharmaceutical aspects for the treatment of BPH. The functional and symptomatic improvements seen after treatment are significant and have been sustained through 2 years in this early feasibility study. Registration: NCT03423979, registered February 6, 2018. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the clinical outcomes of safety and efficacy of a minimally invasive, meshless anchoring system-the EnPlace® SSL fixation for apical POP repair in 581 patients. Materials and Methods: The patients follow-up exams and questionnaires were performed and completed first day after surgery, one and four months after. Anatomical and functional cure rates, post-operative complication rate and severity, as well as urine and bowel symptoms, post-operative pain and dyspareunia levels, were all used as outcome measures. Results: The mean age of the study population (n=581) was 63.5±10.7 years. Fifty-two (9.9%) patients had a previous hysterectomy and 117 (22.3%) patients had urinary stress incontinence (USI) symptoms. All women had a prolapse in a minimum of two compartments and at least one compartment was at stage III. Preoperative C point pelvic organ prolapse (POP)-quantification showed a mean of 1.44 (-2-12). 99.2% of patients had concomitant anterior and posterior colporrhaphy. 20% of patients had an addition of a midurethral sling due to USI symptoms. POPs, USI and overactive bladder symptoms were all found to be reduced significantly. However, the prevalence of de novo dyspareunia among sexually active women was 1.7% (0.7% increase). The patient's satisfaction rates at the 4 months follow-up was 92.1%. Conclusions: SSL fixation is made simple to execute with the EnPlace® device, which prevents mesh and dissection-related issues by allowing quick and a suspending suture being safely inserted through the SSL. The EnPlace® operation, done weather with or without concomitant colporrhaphy, produced positive objective and subjective results and low recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Fracture reduction and fixation of distal femur fractures are technically demanding. Postoperative malalignment is still commonly reported after minimally invasive plate osteosynthesis (MIPO). We evaluated the postoperative alignment after MIPO using a traction table with a dedicated femoral support. Methods: The study included 32 patients aged 65 years or older with distal femur fractures of all AO/OTA types 32 (c) and 33 (except 33 B3 and C3) and peri-implant fractures with stable implants. Internal fixation was achieved with MIPO using a bridge-plating construct. Bilateral computed tomography (CT) scans of the entire femur were performed postoperatively, and measurements of the uninjured contralateral side defined anatomical alignment. Due to incomplete CT scans or excessively distorted femoral anatomy, seven patients were excluded from analyses. Results: Fracture reduction and fixation on the traction table provided excellent postoperative alignment. Only one of the 25 patients had a rotational malalignment of more than 15° (18°). Conclusions: The surgical setup for MIPO of distal femur fractures on a traction table with a dedicated femoral support facilitated reduction and fixation, resulting in a low rate of postoperative malalignment, despite a high rate of peri-implant fractures, and could be recommended for surgical treatment of distal femur fractures. [ABSTRACT FROM AUTHOR]

In this retrospective study, our aim was to investigate a novel treatment strategy guideline for vaginal cuff dehiscence after hysterectomy based on the mode of operation and time of occurrence in patients who underwent hysterectomy at Severance Hospital between July 2013 and February 2019. We analyzed the characteristics of 53 cases of vaginal cuff dehiscence according to the mode of hysterectomy and time of occurrence. Out of a total of 6530 hysterectomy cases, 53 were identified as vaginal cuff dehiscence (0.81%; 95% confidence interval: 0.4–1.6%). The incidence of dehiscence after minimally invasive hysterectomy was significantly higher in patients with benign diseases, while malignant disease was associated with a higher risk of dehiscence after transabdominal hysterectomy (p = 0.011). The time of occurrence varied significantly based on menopausal status, with dehiscence occurring relatively earlier in pre-menopausal women compared to post-menopausal women (93.1% vs. 33.3%, respectively; p = 0.031). Surgical repair was more frequently required in cases of late-onset vaginal cuff dehiscence (≥8 weeks) compared to those with early-onset dehiscence (95.8% vs. 51.7%, respectively; p < 0.001). Patient-specific factors, such as age, menopausal status, and cause of operation, may influence the timing and severity of vaginal cuff dehiscence and evisceration. Therefore, a guideline may be indicated for the treatment of potentially emergent complications after hysterectomy. [ABSTRACT FROM AUTHOR]

Open esophagectomy is considered to be the main surgical procedure in the world for esophageal cancer treatment. Implementing a new surgical technique is associated with learning curve morbidity. The objective of this study is to determine the learning curve based on anastomotic leakage (AL) after implementing minimally invasive Ivor Lewis esophagectomy (MI-ILE) in January 2015. All 257 patients who underwent MI-ILE in a single high-volume center between January 2015 and December 2020 were retrospectively included in this study. The learning curve was evaluated using the standard CUSUM analysis with an expected AL rate of 11%. Secondary outcome parameters were postoperative complications, textbook outcome, and lymph node yield divided by the year of operation. Hierarchical binary logistic regression analysis was used to check for potential confounding variables. The CUSUM analysis showed a learning curve of 179 cases. The mean AL rate decreased from 33.3% in 2015 to 9.5% in 2020 (P  = 0.007). There was an increase in the mean lymph node yield from 21 in 2018 to 28 in 2019 (P  < 0.001) and textbook outcome from 37.3% in 2015 to 66.7% in 2020 (P  = 0.005). A newly implemented MI-ILE has a learning curve of 179 patients based on a reference AL rate of 11% using the CUSUM method. Whether future generation surgeons will show similar learning curve numbers, implicating continuous development of different introduction programs of new techniques, will have to be the focus of future research. [ABSTRACT FROM AUTHOR]

Background: Valvuloplastic esophagogastrostomy (VEG) using the double flap technique (DFT) after proximal gastrectomy (PG) represents a promising procedure for the prevention of reflux oesophagitis. We aimed to retrospectively investigate the efficacy of minimally invasive PG followed by VEG-DFT in preventing reflux oesophagitis among patients who require intra-mediastinal anastomosis. Methods: A total of 80 patients who underwent reconstruction with DFT after LPG from November 2013 to January 2021 were enrolled in the present study. Data were obtained through a review of our prospectively maintained database. At 1 year after surgery, multivariate analyses were performed to identify risk factors for gastroesophageal reflux disease of Los Angeles (LA) classification grade B or higher. Results: The incidence of LA grade B or higher reflux oesophagitis 1 year after surgery was 10%. Multivariate analyses revealed that the longitudinal length of the resected oesophagus of > 20 mm was the only significant risk factor for reflux oesophagitis. Patients with a longitudinal length of the resected oesophagus > 20 mm (group-L, n = 35) had a significantly longer total operative time and a higher rate of complications within 30 days of surgery than those with a length of ≤ 20 mm (group-S, n = 45). LA grade B or higher reflux oesophagitis was significantly higher in group-L than in group-S (20% vs. 2.2%; P = 0.011). Conclusions: There is a need for surgical procedures with improved efficacy for the prevention of reflux oesophagitis in patients requiring oesophageal resection of > 20-mm. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the clinical relevance of vaginal cuff dehiscence following a hysterectomy. Data were prospectively collected from all patients who underwent hysterectomies at a tertiary academic medical center between 2014 and 2018. The incidence and clinical factors of vaginal cuff dehiscence after minimally invasive versus open hysterectomy were compared. Vaginal cuff dehiscence occurred in 1.0% (95% confidence interval [95% CI], 0.7–1.3%) of women who underwent either form of hysterectomy. Among those who underwent open (n = 1458), laparoscopic (n = 3191), and robot-assisted (n = 423) hysterectomies, vaginal cuff dehiscence occurred in 15 (1.0%), 33 (1.0%), and 3 (0.7%) cases, respectively. No significant differences in cuff dehiscence occurrence were identified in patients who underwent various modes of hysterectomies. A multivariate logistic regression model was created using the variables indication for surgery and body mass index. Both variables were identified as independent risk factors for vaginal cuff dehiscence (odds ratio [OR]: 2.74; 95% CI, 1.51–4.98 and OR: 2.20; 95% CI, 1.09–4.41, respectively). The incidence of vaginal cuff dehiscence was exceedingly low in patients who underwent various modes of hysterectomies. The risk of cuff dehiscence was predominantly influenced by surgical indications and obesity. Thus, the different modes of hysterectomy do not influence the risk of vaginal cuff dehiscence. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic techniques have been used for hiatal hernia repair. Robotic-assisted repairs have been increasingly used with unproven benefits. The aim of this study was to compare outcomes between laparoscopic and robotic-assisted hiatal hernia repair. Methods: The Nationwide Readmissions Database (NRD) was used to identify hospitalizations for laparoscopic or robotic hiatal hernia repair from 2010 to 2019. Primary outcomes included post-operative complications and 30- and 90-day readmission rates. Secondary outcomes included in-hospital death, length of stay, and inflation-adjusted hospital cost. Multivariable models were estimated for overall complication and readmission rates. Results: Approximately 517,864 hospitalizations met inclusion criteria with 11.3% including robotic repairs. Robotic repair was associated with a higher overall complication rate (9.2% vs. 6.8%, odds ratio [OR]: 1.4, 95% CI: 1.3–1.5, p <.001); however, the trend showed more similar complication rates across years. The higher overall complication rate remained after adjusting for patient and facility characteristics (adjusted OR [aOR]: 1.3, 95% CI: 1.2–1.4, p <.001). Robotic repairs were associated with higher 30-day (6.1% vs. 7.4%, aOR: 1.2, 95% CI: 1.2–1.3, p <.001) and 90-day readmission rates (9.4% vs. 11.2%, aOR: 1.2, 95% CI: 1.2–1.3, p <.001). In-hospital mortality and length of stay were similar, although, higher hospital costs were associated with robotic repairs. Both complications and readmission rates were lower as annual procedural volume increased. Conclusion: Robotic repairs had higher unadjusted and adjusted complication and readmission rates. The overall complication rate has shown a trend towards improvement which may be a result of increasing experience with robotic surgery. [ABSTRACT FROM AUTHOR]

Background: MRI-guided transurethral ultrasound ablation (TULSA) is under investigation for whole-gland ablation of low- and intermediate-risk prostate cancer. The ideal method for post-TULSA bladder drainage through postoperative suprapubic tube (SPT) vs indwelling urethral catheter (UC) has not been established. The objective of this study was to evaluate urinary outcomes after whole-gland TULSA, comparing postoperative SPT with UC. Materials and Methods: Two-institution retrospective analysis of whole-gland TULSA for men with grade group 1 and 2 prostate cancer. One institution placed SPT at the time of TULSA with clamp trials (day 10) and removal once voiding. The second placed UC until void trial (day 7). Outcomes included the International Prostate Symptom Score (IPSS), urinary bother score, catheter reinsertion, stricture, clean intermittent catheterization (CIC), and incontinence. Results: Forty-five patients (median age 67) were analyzed. The UC cohort (N = 26) was older (p = 0.007) than the SPT cohort (N = 19) but with similar baseline prostate volumes, IPSS, and urinary bother scores. Patients receiving UC had fewer days with catheter (p = 0.013). Although UC patients suffered more lower urinary tract symptoms at 1-month post-TULSA, there was no significant difference between IPSS scores at baseline and 6 months after surgery regardless of urinary management strategy, although the UC group noted significantly decreased urinary bother. Rates of infection were similar between groups. Six strictures were observed overall, with more in the SPT group, although the difference was not significant (4/19 [21.1%] SPT; 2/26 [7.7%] UC). At 6 months, incontinence rates were low and similar between groups (2/19 [10.5%] SPT; 4/26 [15.4%] UC) and only one patient (UC) required CIC. Conclusions: Our overall findings suggest that SPT and UC are both acceptable options for postoperative bladder drainage after whole-gland TULSA, with statistically similar rates of urinary complications but a slightly different side effect profile. [ABSTRACT FROM AUTHOR]

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

Objectives: Single direct right axillary artery cannulation is uncommon in minimally invasive cardiac surgery; however, the risk of cerebral infarction due to retrograde perfusion using the femoral artery remains high in patients with thoracoabdominal aortic atheroma. In our institution, we perform right axillary artery cannulation using a modified Seldinger technique in patients with atherosclerotic disease. This study aimed to evaluate the safety and effectiveness of this technique in minimally invasive cardiac surgery. Methods: Data of all peripheral cannulation cases in patients who underwent minimally invasive cardiac surgery between March 2014 and December 2019 were obtained from our institutional database. Right axillary artery cannulation was successfully performed in 175 patients, 112 of whom underwent magnetic resonance imaging. Results: Procedures comprised single-valve 86.3% (n = 151, 86.3%), double-valve (n = 21, 12%), and triple-valve (n = 3, 1.7%) surgeries. In-hospital mortality rate was 1.7% (n = 3). Stroke rate was 1.1% (n = 2); these 2 patients developed stroke at 3 and 5 days postoperatively. Forty-one (36.9%) patients were diagnosed with silent brain infarction on postoperative magnetic resonance imaging. There were no instances of intraoperative local axillary arterial injury, dissection, rupture, or surgical wound infection. Two patients had axillary wound hematoma and 2 had temporary right limb neuropathy, which resolved before discharge. No cases of pseudoaneurysm were found at the cannulation site. Limb ischemia and compartment syndrome were not reported. Conclusions: There were no complications of postoperative symptomatic cerebral infarction following minimally invasive cardiac surgery with single direct right axillary artery cannulation using a modified Seldinger technique, even though patients had significant atherosclerotic vascular disease. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical outcomes of percutaneous endoscopic cervical discectomy with lamina-hole approach for cervical radiculopathy. Methods A retrospective case series study was conducted to analyze clinical data of 30 patients with cervical radiculopathy admitted in our department from May 2018 to December 2019. All patients underwent percutaneous endoscopic cervical discectomy with lamina-hole approach. The operative time, intraoperative blood loss, intraoperative complications were collected and analyzed. Neck disability index (NDI) and visual analogue scale (VAS) of neck and arm were used preoperatively, postoperatively and at the end of follow-up. Results All patients successfully completed the operation. Their operation time was 30~200 (84.5±36.5) min, and the intraoperative blood loss was 5~50 (20.5±11.8) mL. No neurovascular injury was observed intra-operatively and post-operatively. The follow-up time was 9~23 (14.3±4.0) months. The NDI scores were decreased from 61.3±13.2 pre-operatively to 26.6±7.4 post-operatively (P < 0.01), and further reduced to 9.8±3.5 at the last follow-up (P < 0.01). The VAS scores of the neck and arm were 5.2±0.7 and 6.5±1.1 before operation, and decreased to 3.1±0.7 and 2.8±0.7 (P < 0.01) after operation, respectively. At the last follow-up, the values were further reduced to 0.6±0.8 and 0.5±0.6 (P < 0.01), respectively. Conclusion Percutaneous endoscopic cervical discectomy with lamina-hole approach is a new option for cervical radiculopathy, and can achieve the decompression of nerve root with preserving facet joint integrally.

Background: Retroperitoneal lymph node dissection (RPLND) is a treatment option for men with stage 1 or 2 testis cancer and the standard of care for men with postchemotherapy retroperitoneal residual disease. Given the morbidity of RPLND, four important surgical modifications have been proposed: minimally invasive access, nerve-sparing resection, template resection, and en-bloc resection. Objective: To describe the surgical steps and perioperative outcomes of robotic nerve-sparing unilateral template RPLND with en-bloc resection (roboRPLND-NS+). Design, setting, and participants: From 2017 to 2019, five patients with suspicion of retroperitoneal metastatic testicular cancer on abdominopelvic computed tomography underwent roboRPLND-NS+ at a single referral center. All surgeries were carried out by a single surgeon who has performed more than 500 extended and more than 50 super-extended robot-assisted lymph node dissections. Surgical procedure: A lateral transperitoneal robotic approach with a da Vinci Xi Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in six-arm configuration was used. The sympathetic chains, postganglionic sympathetic fibers, and hypogastric plexus were preserved as much as possible to ensure a nerve-sparing procedure. The template borders consisted of the renal vein cranially, the ureter laterally, the interaortocaval space medially, the common iliac artery caudally, and the psoas muscle dorsally for the right and left modified RPLND templates. Lymph nodes and the surrounding fatty tissue were progressively resected from the common iliac vessels and the abdominal aorta using the split-and-roll technique, and all of the template tissue was resected as a single specimen. Intraoperative and postoperative complications were recorded. Measurements: Lymph node yield and perioperative and postoperative oncological and functional outcomes were measured. Results and limitations: The median patient age was 38 yr (interquartile range [IQR] 32–41) and the median operative time was 274 min (IQR 238–280). Node metastases were pathologically confirmed in three patients. The median number of lymph nodes removed was 19 (IQR 18–21), and the median number of positive lymph nodes was 2 (IQR 1–3). No patient experienced intraoperative or postoperative complications. The postoperative hospital stay was either 3 or 4 d. Maintenance of antegrade ejaculation was achieved in all patients. After median follow-up of 15 mo (IQR 14–30), all patients were alive and no recurrence was observed. Limitations include the low number of patients and the single surgeon experience. Conclusions: RoboRPLND-NS+ is a safe and feasible technique that allows removal of a high number of lymph nodes with good functional outcomes. Short-term survival outcomes were excellent, with no recurrences or deaths recorded. Patient summary: We describe a feasible and safe robot-assisted surgical procedure for removal of lymph nodes in patients with testicular cancer. Our technique has potential to decrease the medical problems arising as side effects of the surgery while achieving good cancer control.

El tratamiento curativo del hiperparatiroidismo primario (HPP) es quirúrgico y hoy en día puede realizarse mediante cirugía mínimamente invasiva (CMI) y además ser radioguiado (RG) si se inyecta un radiofármaco con afinidad por el tejido paratiroideo que puede ser detectado con sondas gammadetectoras o con una gammacámara portátil (GCP). El objetivo es valorar si la gammagrafía intraoperatoria (GGio) con GCP puede sustituir a la anatomía patológica intraoperatoria (APio) para determinar si la pieza extirpada es una paratiroides anormal. Se intervienen 92 pacientes mediante CMI-RG-HPP con GCP tras la administración de una dosis de 99mTc-MIBI. Se compara cualitativamente (captación sí/no) la información aportada por la GCP en el análisis de las piezas extirpadas con el resultado de la anatomía patológica intraoperatoria (APio). El gold standard es la histología definitiva. Se evalúan con GGio y APio 120 piezas extirpadas. Hubo 110 concordancias (95 VP y 15 VN) y 10 discordancias (3 FP y 7 FN). De las 120 lesiones, 102 correspondían a paratiroides y 18 eran no paratiroides. Hubo una buena concordancia entre la imagen por gammagrafía intraoperatoria (GGio) y la AP, del 70,1% según el índice kappa de Cohen. La GGio presentó los siguientes valores de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, razón de verosimilitud positiva, razón de verosimilitud negativa y valor global de la prueba (93,1%, 83,3%, 96,9%, 68,2%, 5,59, 0,08 y 0,92, respectivamente). La GGio es una técnica de ayuda quirúrgica rápida y eficaz para confirmar/descartar la posible naturaleza paratiroidea de las lesiones extirpadas en la cirugía del HPP, pero no puede reemplazar al estudio histológico. The curative treatment of primary hyperparathyroidism (PPH) is surgical and today it can be performed by minimally invasive surgery (MIS) and also be radioguided (RG) if a radiopharmaceutical with affinity for the parathyroid tissue that can be detected with gamma-detector probes or with a portable gamma camera (PGC) is injected. The objective is to assess whether intraoperative scintigraphy (GGio) with PGC can replace intraoperative pathological anatomy (APio) to determine if the removed specimen is an abnormal parathyroid. Ninety-two patients underwent CMI-RG-HPP with PGC after administration of a dose of 99mTc-MIBI. The information provided by the PGC in the analysis of the excised specimens is qualitatively compared (capture yes/no) with the result of the intraoperative pathological anatomy (APio). The gold standard is the definitive histology. One hundred twenty excised pieces are evaluated with GGio and APio. There were 110 agreements (95 TP and 15 TN) and 10 disagreements (3 FP and 7 FN). Of the 120 lesions, 102 were parathyroid and 18 were non-parathyroid. There was good agreement between intraoperative scintigraphy imaging (GGio) and PA, 70.1% according to Cohen's Kappa index. The GGio presented the following values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and overall value of the test (93.1%, 83.3%, 96.9%, 68.2%, 5.59, 0.08 and 0.92 respectively). GGio is a rapid and effective surgical aid technique to confirm/rule out the possible parathyroid nature of the lesions removed in PPH surgery, but it cannot replace histological study. [ABSTRACT FROM AUTHOR]

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

Abstract Background Pancreatic resections are complex and technically challenging surgical procedures. They often come with potential limitations to high-volume centers. Distal pancreatectomy is a relatively simple procedure in most cases. It facilitates the development of up-to-date minimally invasive surgical procedures in pancreatic surgery including laparoscopic distal pancreatectomy and robot-assisted distal pancreatectomy. Main body To obtain a desirable long-term prognosis, R0 resection and adequate lymphadenectomy are crucial to the surgical management of pancreatic cancer, and they demand standard procedure and multi-visceral resection if necessary. With respect to combined organ resection, progress has been made in evaluating and determining when and how to preserve the spleen. The postoperative pancreatic fistula, however, remains the most significant complication of distal pancreatectomy, with a rather high incidence. In addition, a safe closure of the pancreatic remnant persists as an area of concern. Therefore, much efforts that focus on the management of the pancreatic stump have been made to mitigate morbidity. Conclusion This review summarized the historical development of the techniques for pancreatic resections in recent years and describes the progress. The review eventually looked into the controversies regarding distal pancreatectomy for tumors in the body and tail of the pancreas.

Introduction: Intracorporeal esophagojejunostomy is a technically demanding procedure, with many challenges. This study presents the anastomotic and technical complications associated with the mis‐insertion of a linear stapler into the esophageal submucosal layer and the recovery procedure for this complication. Materials and Surgical techniques: Of 100 intracorporeal esophagojejunostomy cases from 2017 to 2020, this complication occurred in three cases—one during functional end‐to‐end anastomosis and two during the overlap method. To recover, the residual esophageal mucosa was incised from the entry point to the top of the incomplete staple line, which was then reinforced by suturing in full thickness, including the incised mucosa. After reinforcement, the common stab incision was closed by the linear stapler or handsewn. As a result, none of the patients developed anastomotic leakage or stenosis. Discussion Mucosal dissection and suturing for recovery for the anastomotic site may be an option to address cases of mis‐insertion of a linear stapler into the submucosal layer. [ABSTRACT FROM AUTHOR]

Background: Pancreatoduodenectomy (PD) is the only curative therapy for distal cholangiocarcinoma (dCC). There has been no study to compare outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for dCC. The aim of the study is to compare the two operation types for dCC in terms of postoperative and oncologic outcomes. Methods: Data from 426 patients who underwent MIPD (n = 91) or OPD (n = 335) for dCC from January 2012 to December 2019 at two tertiary hospitals were retrospectively reviewed. After 1:2 propensity score matching, postoperative and oncologic outcomes were compared. Results: Minimally invasive pancreatoduodenectomy group showed more favorable results than OPD group in terms of blood loss (MIPD vs OPD, 250 [150‐400] vs 400 [200‐600], mL, P <.001), and length of hospital stay (19.8 ± 11.3 vs 26.6 ± 14.3 days, P <.001). OPD group showed more favorable results than MIPD group in terms of operation time (MIPD vs OPD, 457 ± 70 vs 398 ± 85 min, P <.001) and harvested lymph nodes (14.9 ± 7.8 vs 20.7 ± 11.5, P <.001). There was no statistical difference between the two groups in the R0 resection rate and complications. In long‐term survival analysis, there was no significant difference between the two groups. Conclusion: Minimally invasive pancreatoduodenectomy showed comparable postoperative complications and long‐term oncologic survival with OPD in the treatment of dCC. [ABSTRACT FROM AUTHOR]

Introduction: Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach is a novel minimally invasive surgical technique for total hip arthroplasty (THA). This meta-analysis was conducted to evaluate the outcomes following THA via the SuperPATH approach in elderly patients with femoral neck fractures (FNFs), compared with those via traditional surgical approaches. Methods: Eligible studies were retrieved through searching 7 electronic databases and manually screening related references. Objectives were surgical-related parameters, functional outcomes, and incidence of postoperative complications. Results: 9 comparative studies were included. Pooled results suggested that at the cost of longer operative time (WMD: 14.25, 95% CI: 3.25 to 25.25), the SuperPATH technique was superior to traditional approaches regarding incision length (WMD: (4.51, 95% CI: (6.46 to (2.56), intraoperative blood loss (WMD: (80.47, 95% CI: (122.36 to (38.57), and hospital stays (WMD: (3.35, 95% CI: (5.05 to (1.65). SuperPATH groups exhibited significantly increased Harris Hip Scores within 1 month after surgery (7d, WMD: 9.85, 95% CI: 6.40 to 13.30; 14d, WMD: 10.68, 95% CI: 8.29 to 13.08; 1 month, WMD: 6.17, 95% CI: 3.56 to 8.78) and had a reduced incidence of overall complications (OR: .19, 95% CI: .09 to .41). No significant differences were found between the 2 groups regarding postoperative pain relief. Conclusion: Elderly patients with FNFs are potential candidates for THA treatment via the SuperPATH technique, which is associated with improved surgical outcomes, better short-term functional recovery, and lower risk of total complications as compared to traditional approaches. Additional studies are needed to further confirm our conclusions and validate the long-term efficacy of SuperPATH. [ABSTRACT FROM AUTHOR]

Background and Objectives Treatment choice for fungal ball is endoscopic endonasal removal. However, it is not easy to remove fungal elements from the maxilla using only an endonasal approach. To overcome this difficulty, we introduced a cotton pledget technique and evaluated its efficacy through a cadaveric study and clinical research. Materials and Method A cadaveric study was performed using 10 half heads of seven cadavers. The ease and safety of the cotton pledget technique were compared to those of a previously reported technique. In clinical research, we enrolled 52 patients who underwent surgery with the cotton pledget technique and 36 patients who underwent surgery using the conventional endoscopic approach. Demographic factors, preoperative Lund-Mackay (LM) score, sinonasal outcome test (SNOT) score, surgical morbidity, and incomplete removal rate were analyzed. Results The cadaveric study showed that the cotton pledget technique was easier (p=0.011) than the conventional technique. In addition, clinical evaluation showed that the cotton pledget group had significantly lower incomplete removal rate than that of the control group (p=0.010). Conclusion The cotton pledget technique is an easy and safe method that enables fungal ball removal more effectively than the conventional technique without need for inferior meatal antrostomy (IMA) or the Caldwell-Luc (CL) approach.

Background: Long-segment, grade IV suprastomal tracheal stenosis is rare and difficult to treat (Carpenter et al., 2022 [1]). Patients with grade IV stenosis have significant quality of life impairments since they are tracheostomy dependent and aphonic. Open airway surgery is often needed to improve tracheal patency, restore the patient's voice, and progress towards decannulation (Abouyared et al., 2017 [2]). However, not all patients are candidates for upfront open surgery (Abouyared et al., 2017; Shamji, 2018 [2,3]). Therefore, it is important to develop and refine endoscopic interventions to improve quality of life for these patients., Methods: We describe a step-by-step endoscopic approach to the recannulation of long-segment, grade IV suprastomal tracheal stenosis. Briefly, our approach utilizes dual (proximal & distal) visualization of the stenosis prior to passing a 25 gauge needle through the stenosis to identify the proper trajectory for recannulation. Then a 16 gauge needle is passed in the same manner, and a wire is placed through the needle and into the distal airway. Once the airway is recannulated, the initial pinpoint opening is gradually widened in Seldinger fashion over the wire with Savary dilators followed by balloon dilation. Finally, a suprastomal L-stent (modified Montgomery T-Tube) is placed to reduce the risk of restenosis (Edwards et al., 2023 [4])., Case Discussion: A 39-year-old woman with a past medical history significant for poorly controlled type I diabetes mellitus and polysubstance abuse presented with tracheostomy dependence and aphonia. She was diagnosed with a long-segment, grade IV suprastomal tracheal stenosis and initially underwent endoscopic recannulation. This intervention restored her voice and allowed for optimization of her medical conditions before open airway surgery., Conclusion: Most patients experience a significant improvement in their quality of life as their voice is typically restored following this procedure. Additionally, individuals who eventually require open airway surgery gain additional time for medical optimization. In our experience, this procedure represents a safe and effective means of extending the utility of traditional endoscopic airway interventions for the management of patients with grade IV stenosis., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The curative treatment of primary hyperparathyroidism (PPH) is surgical and today it can be performed by minimally invasive surgery (MIS) and also be radioguided (RG) if a radiopharmaceutical with affinity for the parathyroid tissue that can be detected with gamma-detector probes or with a portable gamma camera (PGC) is injected., Aim: The objective is to assess whether intraoperative scintigraphy (GGio) with PGC can replace intraoperative pathological anatomy (APio) to determine if the removed specimen is an abnormal parathyroid., Material and Method: 92 patients underwent CMI RG--HPP with PGC after the administration of a dose of 99 mTc-MIBI. The information provided by the PGC in the analysis of the excised specimens is qualitatively compared (capture yes/no) with the result of the intraoperative pathological anatomy (APio). The Gold standard is the definitive histology., Results: 120 excised pieces are evaluated with GGio and APio. There were 110 agreements (95TP and 15TN) and 10 disagreements (3FP and 7FN). Of the 120 lesions, 102 were parathyroid and 18 were non-parathyroid. There was good agreement between intraoperative scintigraphy imaging (GGio) and PA, 70.1% according to Cohen's Kappa index. The GGio presented the following values ​​of Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, Positive Likelihood Ratio, Negative Likelihood Ratio and Overall Value of the Test (93.1%, 83.3%, 96.9%, 68.2%, 5.59, 0.08 and 0.92 respectively)., Conclusion: GGio is a rapid and effective surgical aid technique to confirm/rule out the possible parathyroid nature of the lesions removed in PPH surgery, but it cannot replace histological study., (Copyright © 2024 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: We investigated the current practices and perceptions of colorectal surgeons in South Korea regarding intracorporeal ileocolic anastomosis (IIA) in minimally invasive right hemicolectomy (RHC)., Methods: Members of the Korean Society of Coloproctology (KSCP) participated in an online survey encompassing demographic information, surgical experiences, methods for IIA, and advantages, barriers, and perceptions of IIA. We performed a statistical analysis of survey results., Results: Among the 1,074 KSCP members contacted, 178 responded to the survey. Most respondents were males aged 40-49 years with >10 years of experience who were affiliated with a tertiary healthcare facility. One hundred fifty-six respondents had performed <100 colorectal cancer surgeries annually. Fifty-nine respondents reported experiences of the IIA technique in minimally invasive RHC. Most respondents favored the isoperistaltic side-to-side (S-S) anastomosis and stapled S-S anastomosis, hand-sewn closure for the common channel, and the periumbilical area for primary specimen extraction. Respondents with IIA experience emphasized the reduction in postoperative complications as the primary reason for performing IIA, whereas respondents without IIA experience cited the lack of benefits as the main deterrent. Respondents commonly cited concerns regarding anastomotic leakage and intraabdominal contamination as the primary reasons for not performing IIA. Respondents with IIA experience demonstrated a more positive response towards attempting or transitioning to IIA than those without. Respondents with IIA experience prioritized self-sufficiency, whereas respondents without IIA experience prioritized proctorship and discussions of the initial cases., Conclusion: Measures to standardize the IIA technique and appropriate training programs must be implemented to enhance its use in minimally invasive RHC., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2024, the Korean Surgical Society.)

Background: Oral floor ranulas are pseudocysts located in the floor of the mouth that result from the extravasation of mucus from a sublingual gland. Historically, there has been little consensus on the ideal first-line treatment. Currently, definitive treatment involves sublingual gland excision, which can injure the lingual nerve and submandibular duct. Minimally invasive surgical techniques have been proposed, but so far have been associated with a high rate of recurrence. Methods: The so-called piercing–stretching suture technique was performed in 14 naïve adult and paediatric patients (6 females, with a mean age of 20.3 years (range, 7–55 years)). Clinical and ultrasonographic evaluations were performed in all patients; post-operative sialendoscopy was conducted in two paediatric patients. Results: The surgical procedure was successful in all patients, and complete recovery of the ranula was seen in all but one of the patients who underwent suture replacement. No major or minor complications were encountered. Conclusion: This minimally invasive procedure may be considered a reliable and first-line treatment for management of simple oral floor ranulas. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to provide an interim safety analysis of the first 30 surgical procedures performed using the Versius Surgical System. Background: Robot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. The new system is currently undergoing a first-in-human prospective clinical trial to confirm the safety and effectiveness of the device when performing minimal access surgery (MAS). Methods: Procedures were performed using Versius by a lead surgeon supported by an operating room (OR) team. Male or female patients aged between 18 and 65 years old and requiring elective minor or intermediate gynaecological or general surgical procedures were enrolled. The primary endpoint was the rate of unplanned conversion of procedures to other MAS or open surgery. Results: The procedures included nine cholecystectomies, six robot-assisted total laparoscopic hysterectomies, four appendectomies, five diagnostic laparoscopy cases, two oophorectomies, two fallopian tube recanalisation procedures, an ovarian cystectomy and a salpingo-oophorectomy procedure. All procedures were completed successfully without the need for conversion to MAS or open surgery. No patient returned to the OR within 24 h of surgery and readmittance rate at 30 and 90 days post-surgery was 1/30 (3.3%) and 2/30 (6.7%), respectively. Conclusions: This first-in-human interim safety analysis demonstrates that the Versius Surgical System is safe and can be used to successfully perform minor or intermediate gynaecological and general surgery procedures. The cases presented here provide evidence that the Versius clinical trial can continue to extend recruitment and begin to include major procedures, in alignment with the IDEAL-D Framework Stage 2b: Exploration. [ABSTRACT FROM AUTHOR]

More than 120 surgical methods for the correction of hallux valgus deformities have been reported. For the correction of moderate to severe hallux valgus deformities with aesthetic demands, minimally invasive surgery at the proximal area can be considered. This paper reports a case of moderate hallux valgus deformity treated by a minimally invasive proximal transverse metatarsal osteotomy followed by intramedullary plate fixation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this retrospective study was to evaluate a revised classification system for predicting the difficulty of laparoscopic partial liver resection. Methods: Patients who had undergone initial laparoscopic partial liver resection for a solitary lesion from January 2012 to February 2021were classified into two groups according to the type of procedure performed, "scooping-out" versus "cutting." The participants were then further divided into "small" and "large" subgroups according to the tumor's depth and diameter. Finally, they were categorized into two groups, namely "standard" and "advanced." Operative outcomes were compared between the two groups and the proposed revised system for classifying difficulty of laparoscopic partial liver resection compared with the existing scoring system. Results: Of the 65 procedures assessed, 40 were categorized as standard and 25 as advanced. Tumor size (P < 0.001), operation time (P < 0.001), volume of intraoperative blood loss (P = 0.001), rate of the Pringle maneuver (P = 0.044), and resected liver weight (P < 0.001) were significantly greater in the advanced than in the standard group. Differences in operation time and intraoperative blood loss were not identified by the existing difficulty scoring system. Conclusion: The proposed revised classification is useful for predicting the difficulty of laparoscopic partial liver resection. [ABSTRACT FROM AUTHOR]