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Purposes: Robot-assisted thoracoscopic (RATS) segmentectomy is becoming increasingly common because of the expanded indications for segmentectomy and the widespread adoption of robotic surgery. The precise division of the intersegmental plane is necessary to ensure oncologic margins from the tumor and to preserve the lung function. In this study, we present a strategy for accurately dividing the intersegmental plane using a robotic stapler and review the surgical outcomes. Methods: RATS portal segmentectomy was performed using the Da Vinci Xi system and the intersegmental plane was dissected using a robotic stapler. We evaluated the perioperative outcomes in 92 patients who underwent RATS portal segmentectomy between May 2020 and January 2023. These results were compared with those of 82 patients who underwent complete video-assisted thoracoscopic surgery (CVATS) during the same period. Results: The operative and console times were 162 and 97 min, respectively. No intraoperative complications occurred, and postoperative complications were observed in four cases (4.3%). The operative time, blood loss, postoperative complications, and maximum incision size were significantly lower in the RATS group than in the CVATS group. However, RATS requires a significantly higher number of staplers than CVATS. Conclusions: The division of the intersegmental plane using a robotic stapler in RATS portal segmentectomy was, therefore, found to be safe and effective. [ABSTRACT FROM AUTHOR]

This document provides information on the treatment of pharyngeal pouches, which are herniations of the pharyngeal mucosa that can cause swallowing difficulties and regurgitation. The study suggests that patients should be offered both endoscopic and open approaches to manage these pouches, and that performing either approach under one general anesthesia is a practice that surgeons should consider. The study found that the recurrence rates were 15% for endoscopic procedures, 5.9% for open procedures, and 11.7% overall. The document also emphasizes the importance of informed consent and the duty of doctors to discuss all treatment options with patients. It concludes that pharyngeal pouches should be treated in centers with expertise in both open and endoscopic approaches. [Extracted from the article]

Postoperative complications related to anastomosis, including postoperative anastomotic bleeding and anastomotic leakage, remain a serious issue. The effect of anastomotic devices on suture complications during intestinal anastomosis remains unclear. The present study examined the utility of automated anastomotic devices for reducing anastomotic complication risks. A retrospective cohort study of colorectal cancer surgeries in which an anastomosis device was used at Osaka University Hospital (Suita, Japan) between January 2018 and December 2022 was conducted. Cases of emergency surgery, inflammatory bowel disease and simultaneous surgery for other cancers were excluded. Experienced gastrointestinal surgeons performed manual anastomosis using the ETHICON Circular Stapler CDH or EEA Circular Stapler, and automatic anastomosis using the ECHELON CIRCULAR Powered Stapler, with no observed operator bias. Additionally, a meta-analysis that included other study results was performed. The outcomes included postoperative complications, mainly anastomotic leakage. The study included 414 patients: 231 in the manual circular stapler group and 183 in the powered circular stapler (PCS) group. Although this retrospective study found no statistically significant association between the anastomotic device used and anastomotic complications, an increased risk ratio was observed in the manual group compared with the automatic group when restricted to elderly patients. Similarly, a meta-analysis found a significantly higher anastomotic complication risk in the manual group compared with the automatic group (random-effects model; odds ratio, 0.376; 95% confidence interval, 0.232-0.610; P<0.0001). The findings of the present study suggested that a PCS is useful for reducing the anastomotic complication risk in patients undergoing colorectal cancer surgery. [ABSTRACT FROM AUTHOR]

Background: The majority of the patients with a solitary fibrous tumor (SFT) of the pleura are asymptomatic, and rupture of an SFT with hemothorax is rare. Case presentation: A 48-year-old man was taken by ambulance to our hospital because of sudden onset of left chest pain. Two months before the referral, a tumor was detected in the left upper lobe of the lung by screening computed tomography at another hospital, and further observation was recommended, because the tumor was suspected to be benign. Our contrast-enhanced computed tomography analysis of the chest revealed a solid tumor (5 cm in diameter) with an irregular enhancement effect close to the pericardium and pleural effusion in the left thoracic cavity. Pleural effusion was not detected in the previous imaging analysis. CT number of the pleural effusion was 40 HU, and the pleural effusion was suspected to be hematogenous. Therefore, rupture of the tumor with bleeding was suspected as the cause of the effusion because of the sudden onset. Preoperative diagnosis was a mediastinal tumor, such as a teratoma, because the tumor was close to the pericardium. Thoracoscopic surgery was performed with the patient in the right lateral decubitus position; bloody pleural effusion was observed and drained. The tumor originated from the visceral pleura of the left upper lobe of the lung and was resected with a surgical stapler. Macroscopic analyses of the resected tumor indicated that bleeding were caused by the rupture of the tumor at the defect of the capsule wall. The operation took 63 min. The postoperative pathological diagnosis was a benign SFT. Hemorrhage was observed just under the capsule wall of the tumor. The postoperative course of the patient was uneventful, and he was discharged 2 days after surgery. Conclusions: Even when an SFT is neither huge nor malignant, rupture can occur, and resection should be considered regardless of the size or malignant characteristics. After an SFT rupture, careful follow-up is needed to monitor for the intrathoracic recurrence or dissemination of the tumor. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Single‐port laparoscopic surgical approaches offer improved cosmetic outcomes and enhance recovery following surgery. The purpose of the study was to assess the reliability and efficacy of a single‐port laparoscopic Hartmann's reversal(SPL‐HR) through the colostomy site.Prospective data from consecutive patients who underwent SPL‐HR between 2020 and 2024 was analysed. Once the colostomy was detached from abdominal wall, a single‐port device was introduced through the colostomy site. After mobilizing the rectal stump and afferent colon, colorectal anastomosis was carried out using a circular stapler transanally under laparoscopic vision. Postoperative care and discharge decisions were made following the ERAS protocol. Patient demographics, details of Hartmann's procedure, intraoperative outcomes, and early postoperative outcomes were evaluated.SPL‐HR was successfully performed in 23 of 27 patients (85.1%), with a median operation time of 92 (50–172) min and a median blood loss of 100 (10–360) mL. Five patients (21.7%) experienced a postoperative complication. Two of them experienced grade 3a complications according to Clavien‐Dindo classification: one with an intraabdominal abscess and one with a hematoma at the colostomy site, both requiring drainage under local anaesthesia. Anastomotic leak or mortality wasn't observed in patients. Functional recovery measures such as first flatus time and time to resuming a soft diet were favourable, with a median length of hospital stay of 4 (2–9) days.The SPL‐HR technique is a reliable and efficient method that is easy to perform. It has acceptable complication rates while improving postoperative recovery and reducing the length of hospital stay. [ABSTRACT FROM AUTHOR]

Background: Pancreaticoduodenectomy is a highly difficult and invasive type of gastrointestinal surgery. Prevention of postoperative pancreatic fistula is important, and this may be possible by the stapler method. Methods: STRAP-PD is a single center randomized controlled trial. We compare a method of transecting the pancreatic parenchyma in pancreaticoduodenectomy using a surgical stapler device with a conventional transecting method using energy devices (e.g., scalpel, ultrasonic coagulator and incision devices). Patients with soft pancreas who are scheduled to undergo pancreaticoduodenectomy are randomized to arm A (conventional method) or arm B (stapler method). We aim to examine the safety and usefulness of dissection by the automatic suture device, with attention to the rate of pancreatic fistula ISGPF grade B or C and to postoperative complications. This is a single-center randomized study, which began in September 2023 at Wakayama Medical University Hospital. Discussion: Pancreatic parenchymal transection is typically performed either by direct incision using a scalpel or by employing energy devices such as ultrasonic coagulating cutting devices during pancreaticoduodenectomy. In a prospective pilot study, we conducted pancreatic parenchymal transection in 20 consecutive normal pancreatic cases during pancreaticoduodenectomy, observing postoperative pancreatic fistula grade B in one case (5%). Traditional methods involving scalpel incision or the use of ultrasonic coagulating cutting devices have been historically favored but perceived as technically challenging, and they have been reliant upon the surgeon's skill. Notably, relatively high incidences of postoperative pancreatic fistula among patients with soft pancreas have also been observed. Our proposed stapler method may therefore be a useful method responsible for reducing the development of pancreatic fistula. This method would be as part of minimally-invasive surgery for pancreaticoduodenectomy. It uses an endoscopic linear stapler to cut the pancreatic parenchyma, so it is likely to be more convenient than conventional methods and can be used universally. Trial registration: University Hospital Medical Information Network Clinical Trials Registry, UMIN000052089. the Registration Date on 1st September 2023. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion Anastomotic stricture occurs in up to 30% of colorectal resections; however, evidence on risk factors and preventive measures remains scarce. This study aimed to identify technical factors responsible for increasing the risk for colorectal and coloanal anastomotic strictures.This was a retrospective cohort study of patients with anastomotic stricture who underwent resection and/or redo anastomosis between January 1, 2011 and August 1, 2021 in a tertiary referral centre. Patients with anastomotic stricture were compared with an equal number of randomly selected patients without anastomotic complications, who were operated on during the same time period. The main outcome measures were technical risk factors of anastomotic stricture.Each group included 50 patients who were similar for age, sex, American Society of Anesthesiologists score, distance of anastomosis to the dentate line and indication for surgery. Median follow‐up was significantly longer in the non‐stricture group (38.6 months vs. 12.6 months, p = 0.04). Splenic flexure mobilization [hazard ratio (HR) = 0.18 [2], 95% CI: 0.08–0.39, p < 0.001], high ligation of the inferior mesenteric artery (HR = 0.22, 95% CI: 0.09–0.5, p < 0.001) and high ligation of the inferior mesenteric vein (HR = 0.21, 95% CI: 0.09–0.50, p < 0.001) were associated with a lower likelihood of anastomotic stricture. Conversely, use of a 25‐mm‐diameter circular stapler (HR = 22.69, 95% CI: 2.69‐191.10, p < 0.001), clinically significant anastomotic leak (HR = 3.94, 95% CI: 2.04–7.64, p < 0.001), firing the stapler more than once for rectal division (HR = 24.75, 95% CI: 6.85–89.38, p < 0.001) and diverting stoma (HR = 3.087, 95% CI: 1.736–5.491, p < 0.0001) were predictive of an anastomotic stricture.Failure to mobilize the splenic flexure and to perform high ligation of the inferior mesenteric vessels were associated with higher odds of anastomotic stricture. A small‐diameter circular stapler and multiple distal stapler firings were also associated with anastomotic stricture. These data support routine splenic flexure ligation and high ligation of the inferior mesenteric vessels as well as avoidance of both multiple  stapler firings for rectal transection and a 25‐mm circular stapler for anastomosis.. [ABSTRACT FROM AUTHOR]

Background: Since the introduction of powered circular staplers in colorectal surgery, there has been growing interest in their impact on reducing complications, particularly anastomotic leakage. This study compared short-term postoperative outcomes between powered and manual circular staplers. Methods: This retrospective study included colorectal cancer patients at the tertiary referral center from April to October 2023 who underwent anterior or low anterior resection (LAR) using a circular stapler. According to energy source, patients were divided into powered and manual groups, which used two powered and four types of manual staplers, respectively. All open, laparoscopic, and robotic approaches were included. Propensity score matching (PSM) analysis was used to reduce selection bias. Postoperative complications within 30 days, especially for anastomosis-related complications, were compared between the groups. Results: Among 511 patients, the powered group was 161 (32%). After PSM, 143 pairs of 286 patients were analyzed. The proportions of LAR were 53.8% and 51.0%, and initial diverting stoma rates were 23.1% and 22.4% for the Powered and Manual groups, respectively. Comprehensive complication rates were similar between the Powered group and the Manual group, without statistical significance (13.3% vs. 21.0%, P = 0.063). Anastomotic leakage was not different between the Powered and Manual groups (4.2% vs. 4.9%, P = 0.782). There was no significant difference in other complications, including anastomotic bleeding, ileus, surgical site infection, and intra-abdominal hematoma. Conclusions: The study implies that powered circular staplers may not significantly reduce postoperative complications, including anastomotic leakages, compared to manual staplers in colorectal surgery of high-volume centers. [ABSTRACT FROM AUTHOR]

Purpose: Anastomotic leak (AL) remains the most important complication after left-sided colic anastomoses and technical complications during anastomotic construction are responsible of higher leakage incidence. Powered circular stapler (PCS) in colorectal surgery has been introduced in order to reduce technical errors and post-operative complications due to the manual circular stapler (MCS). Methods: A systematic review and meta-analysis were performed. An electronic systematic search was performed using Web of Science, PubMed, and Embase of studies comparing PCS and MCS. The incidence of AL, anastomotic bleeding (AB), conversion, and reoperation were assessed. PROSPERO Registration Number: CRD42024512644. Results: Five observational studies were eligible for inclusion reporting on 2379 patients. The estimated pooled Risk Ratios for AL and AB rates following PCS were significantly lower than those observed with MCS (0.44 and 0.23, respectively; both with p < 0.01). Conversion and reoperation rate did not show any significant difference: 0.41 (95% CI 0.09–1.88; p = 0.25) and 0.78 (95% CI 0.33–1.84; p = 0.57); respectively. Conclusion: The use of PCS demonstrates a lower incidence of AL and AB compared to MCS but does not exhibit a discernible influence on reintervention or conversion rates. The call for future randomized clinical trials aims to definitively clarify these issues and contribute to further advancements in refining surgical strategies for left-sided colonic resection. [ABSTRACT FROM AUTHOR]

This document contains summaries of several videos on colorectal surgery techniques. The videos cover a range of topics including rectal cancer surgery, pelvic exenteration, diagnostic tests, and surgical procedures for various conditions. The summaries provide information on the safety, feasibility, and efficacy of these techniques, as well as the importance of understanding anatomical variations. These videos offer valuable insights for researchers and library patrons interested in colorectal surgery. [Extracted from the article]

Background: In the landscape of thoracic surgery, innovation continually drives progress, offering novel approaches to address complex pathologies while prioritizing patient well-being. Dual-port robotic-assisted thoracic surgery (DRATS) represents a new frontier in this evolution. In this report, we describe our experience with the fully dual-port robotic-assisted thoracic surgery (F-DRATS) approach for segmentectomy with the indocyanine green intersegmental plane identification. Methods: We define as F-DRATS the robotic thoracic surgery performed by two intercostal incisions without rib spreading, using the robotic camera, robotic dissecting instruments, and exclusively robotic staplers. We herein describe our F-DRATS approach in lingulectomy and lymphadenectomy of stations 5, 6, 7, and 10 using the da Vinci Surgical System. Results: The patient's postoperative course was uneventful with the chest tube removed on the second postoperative day. The final pathological analysis confirmed a low-grade malignant potential adenocarcinoma, with a main diameter of 1.1 cm, at 3 cm from the lung margins. Conclusions: This is the first description in the literature of a F-DRATS lingulectomy with ICG intersegmental plane identification. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite improvements, survival rates for gastric cancer remain low, even in developed countries, confirming the role of primary and secondary prevention. OBJECTIVE: This study aims to demonstrate the role of additional suspension sutures on the esophagojejunal anastomosis (EJA) to strengthen the anastomosis, i.e., relieve the mechanical suture. METHODS: A retrospective cohort study was conducted from 2011 to 2022 at the Clinic for Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina. The experimental group consisted of patients placed with a suspension suture at the esophagojejunal anastomosis (EJA) site after total gastrectomy. The control group was patients without a suspension suture. The clinical and laboratory parameters available from the medical history were analyzed, X-ray passage, surgical complications, non-surgical complications, the length of hospitalization, the postoperative course, time of onset of postoperative complications, postoperative radiological follow-up and endoscopic postoperative follow-up were then analyzed. RESULTS: A total of 212 patients were included in the study: 87 in the experimental group with suspension sutures on the EJA and 125 in the control group without suspension sutures on the EJA. The two cohorts did not differ in other clinicopathologic parameters except perineural invasion, which was more prevalent in the control group. Patients in both groups were anemic and elevated values of C reactive protein (CRP) and decreased levels of proteins, albumin and globulin, with no significant difference between the two groups. The most common general complication was pleural effusion (28%), followed by pneumonia (∼ 22%). The most common complication in the experimental group was an intraabdominal abscess, while in the control group, it was a surgical wound infection. CONCLUSION: Our study did not show a statistically significant difference between the two analyzed EJA techniques created with a circular stapler, when it comes to postoperative course and outcome in patients with gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the use of laparoscopic staplers in robotic procedures (bedside stapling, BS). This study aims to evaluate the effectiveness of BS compared with robotic staplers (RS) in bariatric robotic procedures. Methods: Patients who underwent robotic sleeve gastrectomy or gastric bypass elective procedures between 1/1/2021 and 12/31/2021 were extracted from PINC AI™ Healthcare Data. The following clinical outcomes were compared: blood transfusion, bleeding, anastomotic leak, intensive care unit (ICU) visit, and 30-day readmission, operating room (OR) time, inpatient costs, and length of stay. We evaluated baseline balance in BS and RS and bivariate association between covariates and outcomes using Chi-square or Fisher exact test and t-test or ANOVA. Multivariable general linear mixed models (GLMMs) with respective gamma or binomial distribution and log-link function were used to obtain adjusted outcomes variations between BS and RS. Results: Total of 7268 discharges were included with 1603 (22.1%) BS and 5665 (77.9%) RS cases. RS cases consisted of a higher number of patients who were Hispanic (17.0% vs. 9.4%), had Medicaid (26.9% vs. 19.4%) and underwent sleeve gastrectomy (68.4% vs. 53.5%). Higher proportions of RS cases were done by providers in Northeast region (35.5% vs. 24.3%), smaller size (< 500 beds; 71.1% vs. 52.3%), and teaching hospitals (59.4% vs. 39%). The adjusted outcomes variations demonstrated that patients that had RS were significantly more likely to have blood transfusions, ICU stays, increased ORT (19 min) and costs ($1273). Sensitivity analysis showed similar results, except no significant differences in blood transfusion rates in both groups. Conclusions: Bedside staplers significantly reduce healthcare resource utilization with equivalent effectiveness and fewer ICU stays compared to robotic staplers. [ABSTRACT FROM AUTHOR]

Background: Excessive tension at the anastomosis contributes to anastomotic leakage (AL) in low anterior resection (LAR). However, the specific tension has not been measured. We assessed whether "Bridging," characterized by the proximal colon resembling a suspension bridge above the pelvic floor, is a significant risk factor for AL following LAR for rectal cancer. Methods: This retrospective study reviewed the medical records and laparoscopic videos of 102 patients who underwent laparoscopic LAR using the double stapling technique at Yachiyo Hospital between January 2014 and December 2023. Patients were classified based on whether they had Bridging (tight or sagging) or were in a Resting state of the proximal colon, and the association between Bridging and AL was examined. Results: AL occurred in 31.3% of the Tight Bridging group, 20% of the Sagging Bridging group, and 2.2% of the Resting group (P = 0.002). The incidence of AL was significantly higher in patients with Bridging than in those without (23.2% vs. 2.2%, P = 0.003). Multivariate analysis revealed that Bridging is an independent risk factor for AL (odds ratio = 6.97; 95% confidence interval: 1.45–33.6; P = 0.016). Conclusions: The presence of Bridging is a significant risk factor for AL following LAR for rectal cancer, suggesting the need for implementing preventive measures in patients with this condition. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery performed worldwide. The Titan stapler aims to standardize the sleeve gastrectomy by eliminating inconsistencies and simplifying the procedure. Methods: A retrospective chart review was performed on all patients > 18 years of age undergoing LSG using the Titan. Pre-operative demographics, perioperative findings, and post-operative complications were all abstracted from the MBSAQIP database. Results: A total of 807 LSG have been performed using the latest iteration of the Titan stapler since November 2022. Data from these patients was compared to 3829 patients who underwent LSG using a sequential staple firing technique from September 2016–September 2021. The median age of Titan patients was 42 years (IQR 33–52) compared to 44 years (IQR 35–54) for sequential firing. The median pre-operative BMI was 47.1 (IQR 43.5–52.1) for Titan versus 47.6 (IQR 43.1–53.3) for sequential staple firing. After propensity matching, operative duration was significantly less for the Titan. Titan patients had decreased hospital length of stay, experienced fewer 30-day readmissions, and had less post-operative nausea/vomiting. Post-op bleed rates were similar between the two cohorts. Weight loss at 6 months favored the sequential fire arm, but our preliminary data shows this difference diminishes at 1 year. Conclusions: Here we report our data on patients undergoing LSG using the latest Titan stapler. We show the device is safe, effective, and has resulted in an improvement in length of stay, readmissions, and post-operative nausea/vomiting. We also noted reduced operative time with this technique. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) is a commonly performed type of bariatric surgery. Early complications of LSG include bleeding, leakage, pulmonary embolism, and surgical site infections. Most surgeons try to implement preventive methods, such as omentopexy. Staple line-imbrication, which has a difficult learning curve, often prevents complications. This study aimed to evaluate the effect of omentopexy on patients with imbricated LSG. Material and Methods: The study applied a retrospective data analysis design to patients who underwent LSG between 2020 and 2023. All patients' staple lines were imbricated, and patients were then divided into two groups: omentopexy group and control group. Patients' demographic features, such as age, gender, height, weight, body mass index(BMI), bleeding, leakage, and reoperations, were recorded and examined retrospectively. Results: A total of 1356 patients were included in the study (540 in omentopexy, 816 in control), of which the mean age was 37.9 ± 10.5 years, 82.3% were women, and mean BMI was 40.9 ± 5.8 kg/m2. The mean bleeding rate was 1.0% (1.3–0.7%), the mean leakage rate was 0.2% (0.2–0.2%, respectively), and the mean reoperation rate was 0.6% (0.7% and 0.5%, respectively). No statistically significant differences were observed. Conclusion: Omentopexy is a technique that is widely used to prevent staple line complications. According to our study, omentopexy applied to an imbricated stapler line increased the operation time but did not affect bleeding or leakage ratios. This is the first study to evaluate the effect of omentopexy on imbricated staple lines. The findings of the study indicate that omentopexy has no additional benefit on early complications when using staple-line imbrication. [ABSTRACT FROM AUTHOR]

Purpose: To assess the risk factors for thrombosis in the pulmonary vein stump (PVT) and the efficacy of proximal ligation in preventing PVT after lobectomy. Methods: In total, 649 surgical patients with lung cancer were retrospectively reviewed. To compare the clinical effectiveness of PV proximal ligation, the simple stapler group (290 patients) and the proximal ligation group (359 patients who underwent thread ligation at the pericardial reflection with/without a stapler) were analyzed. Results: In the simple stapler group, 12 of 290 patients (4.1%) developed PVT. Among these, 9 of 58 underwent left upper lobectomy (LUL). In contrast, 5 of the 359 patients (1.4%) in the proximal ligation group developed PVT. All five patients received LUL. The incidence of PVT in the proximal ligation group was significantly lower than that in the simple stapler group (p = 0.0295) as well as in the analysis by LUL alone (p = 0.0263). A logistic regression analysis indicated that higher BMI and LUL were associated with the development of PVT (p = 0.0031, p < 0.0001), and PV proximal ligation reduced PVT (p = 0.0055). Conclusion: Proximal ligation of the PV has the potential to prevent PVT, especially after LUL. [ABSTRACT FROM AUTHOR]

Face transplantation (FT) has emerged as a critical intervention for patients with complex facial deformities unsuitable for conventional reconstructive methods. It aims to restore essential functions such as facial expression, mastication, and speech, while also improving psychosocial health. The procedure utilizes various surgical principles, addressing unique challenges of craniofacial complexity and diverse injury patterns. The integration of Computerized Surgical Planning (CSP) leverages computer-aided technologies to enhance preoperative strategy, intraoperative navigation, and postoperative assessment. CSP utilizes three-dimensional computed tomography, printing, angiography, and navigation systems, enabling surgeons to anticipate challenges and reduce intraoperative trial and error. Through four clinical cases, including a groundbreaking combined face and bilateral hand transplant, CSP's role in FT is highlighted by its ability to streamline operative processes and minimize surgical revisions. The adoption of CSP has led to fewer cadaveric rehearsals, heightened operative precision, and greater alignment with preoperative plans. Despite CSP's advancements, it remains complementary to, rather than a replacement for, clinical expertise. The demand for technological resources and multidisciplinary teamwork is high, but the improved surgical outcomes and patient quality of life affirm CSP's value in FT. The technology has become a staple in reconstructive surgery, signaling a step forward in the evolution of complex surgical interventions. [ABSTRACT FROM AUTHOR]

When a mass occurs at the staple line following lung resection, it can be difficult to distinguish between local cancer recurrence and granuloma. We present a case of a staple‐line granuloma with 18F‐fluorodeoxyglucose‐positron emission tomography uptake and elevated serum carbohydrate antigen 19–9 (CA19‐9) in a patient with ovarian cancer lung metastasis. After granuloma resection, serum CA19‐9 levels normalized, and CA19‐9 positive cells were identified in the resected tumor. Therefore, serum CA19‐9 elevation does not rule out a staple‐line granuloma. Whereas granulomas on computed tomography (CT) scans tend to show smooth shadows along the staple line unilaterally, detailed CT evaluation may help diagnostic differentiation. Differentiation based on imaging and tumor markers has limitations. However, core needle biopsy has the risk of misdiagnosis and tumor cell dissemination, therefore surgical resection should be considered when comprehensive findings indicate a potential recurrence. [ABSTRACT FROM AUTHOR]

Background: Although functional end-to-end anastomosis (FEEA) using a stapler in the colorectal field has been recognised worldwide, the technique varies by surgeon, and the safety of anastomosis using different techniques is unknown. Methods: This multicentre prospective observational cohort study was conducted by the KYCC Study Group in Yokohama, Japan, and included patients who underwent colonic resection at seven centres between April 2020 and March 2022. This study compared the incidence of surgery-related abdominal complications (SAC: anastomotic leakage [AL], anastomotic bleeding, intra-abdominal abscess, enteritis, ileus, surgical site infection, and other abdominal complications) between two different methods of FEEA (one-step [OS] method: simultaneous anastomosis and bowel resection; two-step [TS] method: anastomosis after bowel resection). Complications of Clavien–Dindo classification grade 2 or higher were assessed. Results: Among 293 eligible cases, the OS and TS methods were used in 194 (66.2%) and 99 (33.8%) patients, respectively. The baseline characteristics were similar between the groups. The OS method used fewer staplers (three vs. four staplers, p < 0.00001). There were no significant differences in SAC rate between the OS (19.1%) and the TS (16.2%) groups (p = 0.44). The OS group had four cases (2.1%) of AL (two patients; grade 3, two patients; grade 2) while the TS group had one case (1.0%) of grade 2 AL (p = 0.67). Multivariate logistic regression analysis showed that male sex (odds ratio [OR] 3.95; p < 0.00001), an open surgical approach (OR 2.36; p = 0.03), and longer operative duration (OR,2.79; p = 0.002) were independent predictors of complications, whereas the OS method was not an independent predictor (OR 1.17; p = 0.66). Conclusions: The OS and the TS technique for stapled colonic anastomosis in a FEEA had a similar postoperative complication rate. Trial registration number: UMIN000039902 (registration date 23 March 2020). [ABSTRACT FROM AUTHOR]

Background: Colorectal anastomotic leakage causes severe consequences for patients and healthcare system as it will lead to increased consumption of hospital resources and costs. Technological improvements in anastomotic devices could reduce the incidence of leakage and its economic impact. The aim of the present study was to assess if the use of a new powered circular stapler is cost-effective. Method: This observational study included patients undergoing left-sided circular stapled colorectal anastomosis between January 2018 and December 2021. Propensity score matching was carried out to create two comparable groups depending on whether the anastomosis was performed using a manual or powered circular device. The rate of anastomotic leakage, its severity, the consumption of hospital resources, and its cost were the main outcome measures. A cost-effectiveness analysis comparing the powered circular stapler versus manual circular staplers was performed. Results: A total of 330 patients were included in the study, 165 in each group. Anastomotic leakage rates were significantly different (p = 0.012): 22 patients (13.3%) in the manual group versus 8 patients (4.8%) in the powered group. The effectiveness of the powered stapler and manual stapler was 98.27% and 93.69%, respectively. The average cost per patient in the powered group was €6238.38, compared with €9700.12 in the manual group. The incremental cost-effectiveness ratio was − €74,915.28 per patient without anastomotic complications. Conclusion: The incremental cost of powered circular stapler compared with manual devices was offset by the savings from lowered incidence and cost of management of anastomotic leaks. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of new staple-line reinforcement (SLR) in pulmonary resection through a prospective study and to compare the results of this study with historical control data in an exploratory study. Methods: The subjects of this study were 48 patients who underwent thoracoscopic lobectomy. The primary endpoint was air leakage from the staple line. The secondary endpoints were the location of air leakage, duration of air leakage, and postoperative pulmonary complications. Results: The incidence of intraoperative air leakage from the staple line was 6.3%. Three patients had prolonged air leakage as a postoperative pulmonary complication. No malfunction was found in patients who underwent SLR with the stapling device. When compared with the historical group, the SLR group had a significantly lower incidence of air leakage from the staple line (6.3% vs. 28.5%, P < 0.001) and significantly shorter indwelling chest drainage time (P = 0.049) and length of hospital stay (P < 0.001). Conclusions: The use of SLR in pulmonary resection was safe and effective. When compared with conventional products, SLR could control intraoperative air leakage from the staple line and shorten time needed for indwelling chest drainage and the length of hospital stay. [ABSTRACT FROM AUTHOR]

Living-donor liver transplantation (LDLT) is an established treatment for patients with end-stage liver disease or acute liver failure, and outflow reconstruction is considered one of the most vital techniques in LDLT. To date, many strategies have been reported to prevent outflow obstruction, which can be refractory to liver dysfunction and can cause life-threatening graft loss or mortality. In addition, in this era of laparoscopic hepatectomy in donor surgery, especially LDLT using a left liver graft, it has been predicted that cutting the hepatic vein with automatic linear staplers will lead to more outflow-related problems than with conventional open hepatectomy because of the short neck of the anastomosis orifice. We herein review 10 cases of venoplasty performed with a novel venous cuff system using a donor's round ligament around the hepatic vein in LDLT with a left lobe graft, which makes anastomosis of the hepatic vein sterically easy for postoperative venous patency. [ABSTRACT FROM AUTHOR]

Background: Research on anastomotic leakage (AL) in colonic procedures within an Enhanced Recovery After Surgery (ERAS) protocol has not yet been conducted. The aim of this study was to identify risk factors for AL after colonic surgery. Methods: The study included all consecutively recorded patients operated with colonic resection surgery in the Swedish part of the international ERAS® Interactive Audit System (EIAS) between September 2009 and June 2022. The cohort was analyzed and evaluated regarding risk factors for AL. Results: Altogether 10,632 patients were included, 10,219 were without AL and 413 (3.9%) were with AL. After adjusted analysis, male sex (4.6% AL), OR: 1.49; 95% CI (1.16–1.90), obesity (4.8% AL), OR: 1.62; 95% CI (1.18–2.24), previous surgery (4.4% AL), OR: 1.45; 95% CI (1.14–1.86), open surgery (4.4% AL), OR: 1.36; 95% CI (1.02–1.83), anastomosis between small bowel and rectum (13.1% AL), OR: 3.97; 95% CI (2.23–7.10), stapled anastomosis (5.3% AL), OR: 2.46; 95% CI (1.79–3.38), inhalation anesthesia (4.2% AL), OR: 1.80; 95% CI (1.26–2.57), and conversion to open surgery (5.5% AL), OR 1.49; 95% CI (1.02–2.19) were significant risk factors for AL. Although pre and intraoperative compliance to the ERAS‐protocol was similar, excess of fluids day 0 was an independent predictor for AL. Conclusion: Male sex, obesity, previous surgery, open surgery, stapled anastomotic technique, anastomosis between small bowel and rectum, inhalation anesthesia, conversion to open surgery, and among ERAS interventions, excess of fluids day 0, were significant risk factors for AL. [ABSTRACT FROM AUTHOR]

• To review on development of magnesium and its alloys. • To investigate multiple biomedical applications of magnesium-based materials including orthopedic implants, cardiovascular implants, biodegradable surgical wires, staplers, and their anti-tumor activity. • To explore magnesium alloys functional properties such as biocompatibility, density, mechanical properties, corrosion resistance in biomedical environment, ductility, nontoxicity, host tissue response, and various anti-microbial strategies. • To peruse different surface modification and advanced manufacturing technologies of magnesium and its alloy to improve biomedical properties. • To survey magnesium and its alloy for biomedical applications and future direction. Magnesium (Mg) and its alloys have recently gained increasing attention in the biomedical field as promising biodegradable materials with harmless degradation products. Magnesium-based alloys have a wide range of biomedical applications because of their outstanding biocompatibility and unique mechanical properties. Widespread use of Mg-based biomedical devices eliminates the need for post-healing biomaterial removal surgery and minimizes the negative consequences of the implantation of permanent biomaterials, including stress shielding and undesired metal ion release in the body. This paper provides a literature review on the properties and manufacturing methods of Mg-based alloys for biomedical applications, including orthopedic implants, cardiovascular applications, surgical wires and staplers, and antitumor activities. Each application of Mg-based biomaterials is investigated from a biological perspective, including matching functional properties, biocompatibility, host tissue responses, and anti-microbial strategies, along with potential additive manufacturing technologies for these applications. Finally, an outlook is presented to provide recommendations for Mg-based biomaterials in the future. [Display omitted] [ABSTRACT FROM AUTHOR]

Background/Aim: The present study examined the impact of circular stapler size on anastomotic complications, including leakage and stricture in patients undergoing double-stapling technique (DST) anastomosis for left-sided colon or rectal cancer. Patients and Methods: A total of 403 patients were enrolled in this study, with circular stapler sizes of 25, 28, and 29 mm. Results: A small circular stapler (25 mm) was used in 170 cases (42.2%), and a medium-sized circular stapler (28/29 mm) was used in 233 cases (57.8%). After propensity score matching, there was no marked difference in the incidence of anastomotic leakage/stricture between the groups (13.9% vs. 10.9%, 3.0% vs. 1.0%, respectively). Conclusion: The size of the circular stapler was not associated with the incidence of anastomotic leakage or stricture in this cohort. [ABSTRACT FROM AUTHOR]

Introduction: With a rising number of bariatric procedures, the absolute number of postoperative complications is increasing, too. Postoperative bleeding, particularly along the staple line, is a recognized challenge. Numerous strategies including reinforcement of the staple line (SLR) have been proposed to improve bleeding rates, but no single technique has shown superiority over the others. In our bariatric center, we have implemented intraoperative blood pressure regulation alone, without SLR, to reduce hemorrhagic complications postoperatively. Methods: This retrospective observational analysis compares the incidence of postoperative bleeding in two groups of consecutive patients (total n = 438 patients), one with and one without intraoperative blood pressure elevation to 150 mmHg systolic without the additional use of staple line reinforcement. This intervention was integrated into our standard bariatric surgical procedure, no randomization or matching was conducted. Significant postoperative bleeding was defined as drop of hemoglobin of more than 2.5 mg/dl in 48 h and one of the following symptoms: lactate ≥ 2 mmol/L, bloody drainage, quantity of drainage more than 200 ml and/or radiological signs. Results: Defined postoperative bleeding occurred in 33 (7.5%) patients. We observed a decrease in bleeding rates from 10% to 5% (n = 22 vs. n = 11) after introducing intraoperative blood pressure increase (p = 0.034). The rate of revisional surgery for bleeding also decreased from 2.7% to 0.5% (n = 6 vs. n = 1). In multivariate analysis, the intervention with blood pressure elevation showed a significant decrease on bleeding rates (p = 0.038). Conclusion: The use of increased intraoperative blood pressure alone, without staple line reinforcement, appears to be an effective and suitable method for reducing post-bariatric hemorrhagic complications. [ABSTRACT FROM AUTHOR]

Background: Sigmoid volvulus (SV) is an acute abdominal condition characterized by torsion of the sigmoid colon around the mesentery, and often results in intestinal obstruction that may progress to bowel ischemia, necrosis, or perforation. Although SV commonly occurs due to predisposing factors like anatomic variations, age-related motility disorders, chronic constipation, and neurologic diseases, its incidence following sigmoid colon cancer surgery has rarely been reported. Herein, we report a rare case of recurrent SV following laparoscopic sigmoidectomy, which was successfully treated by laparoscopic redo surgery. Case presentation: The patient was a 77-year-old man who had previously undergone laparoscopic sigmoidectomy for sigmoid colon cancer. Sixteen months postoperatively, he developed an incisional hernia at the umbilical site, which was treated with a laparoscopic repair using an intraperitoneal onlay mesh. After the hernia surgery, the patient had no anastomotic leakage or stenosis on regular follow-ups. However, 65 months after the first surgery, he presented with abdominal pain and distension. A computed tomography revealed that the remnant sigmoid colon was distended in a twisting manner around the anastomosis, leading to the diagnosis of SV. Although endoscopic de-torsion was successful, the SV recurred 2 months later, requiring elective laparoscopic redo surgery. The procedure involved resection of the sigmoid colon including the prior anastomosis with a left pararectal incision and DST re-anastomosis using a 25-mm circular stapler. The operation lasted 165 min with minimal bleeding and no complications. The postoperative course was uneventful. Pathological analysis confirmed fibrosis without malignancy. The patient remains well without recurrence of SV and anastomotic stenosis more than 5 years after surgery. Conclusion: SV following sigmoid colon cancer surgery has rarely been reported. This case illustrates the potential need for prophylaxis against postoperative SV, especially in patients with long sigmoid colon undergoing laparoscopic surgery for colorectal cancer. Further, laparoscopic redo surgery following initial laparoscopic surgery for colorectal cancer can be performed with minimal invasiveness, especially if patient selection is properly managed. [ABSTRACT FROM AUTHOR]

Introduction: Various techniques and reinforcements have been proposed over the years in order to prevent leaks and bleeding after sleeve gastrectomy (LSG). The aim of this study was to retrospectively compare the staple line complication (SLC) rate in patients who underwent LSG with the use of bioabsorbable membrane (GORE® SEAMGUARD®, GoR) for staple line versus those who received no reinforcement. Methods: Data on all consecutive patients undergoing LSG between 1 January 2014 and 31 December 2018 were retrospectively reviewed. Patients were divided into two groups: the GoR+ group if the SeamGuard (GoR) was used and the GoR− group if no reinforcement was applied on the staple line. Preoperative demographics and rate of SLC were compared between groups. All cases of SLC coming from other centers were also reviewed. Results: A total number of 626 LSGs were performed at our institution during the study period. GoR was applied in 450 (71.9%) cases (GoR+ group), while NR was used in 176 (28.1%) patients (GoR− group). Two (1.13%) cases of leaking and two (1.13%) cases of bleeding occurred in the GoR− group, while no SLC was recorded in patients who received GoR (p < 0.05). Thirteen cases of SLC coming from other institutions were treated at our hospital; all these cases were performed without any SLR. Conclusion: In our case series, the use of GoR reduced the rate of SLC after LSG. In all cases of SLC coming from other institutions, no reinforcement had been applied on the staple line during LSG. [ABSTRACT FROM AUTHOR]

The article focuses on describing an innovative approach using staples to complement CT imaging for identifying an intrathecal access point for nusinersen administration in a pediatric patient with severe spinal deformity. Topics include the challenges faced due to the patient's severe scoliosis and the decision to switch to a CT-guided approach, which was well-tolerated and showed a high success rate in recent reports.

Background: Thromboembolic occlusion of the superior mesenteric artery (SMA) is a grave complication in individuals diagnosed with atrial fibrillation (AF). This condition often necessitates extensive bowel resection, culminating in short bowel syndrome, which presents challenges for anticoagulant administration and/or antiarrhythmic therapy. Case presentation: Presented here are findings of two patients, aged 78 and 72 years, respectively, who underwent comprehensive thoracoscopic AF surgery subsequent to extensive small bowel resection following SMA embolization. In each, onset of AF precipitated an embolic event, while the concurrent presence of short bowel syndrome complicated anticoagulation management. Total thoracoscopic AF surgery, comprised stapler-closure of the left atrial appendage (LAA) and bilateral epicardial clamp-isolation of the pulmonary veins, an operative modality aimed at addressing AF rhythm control and mitigating embolic events such as cerebral infarction, led to favorable outcomes in both cases. Additionally, computed tomography (CT) conducted one month post-surgery revealed the absence of residual tissue in the LAA, with the left atrium demonstrating a well-rounded, spherical shape. At the time of writing, the patients have remained asymptomatic following surgery regarding thromboembolic and arrhythmic manifestations for 29 and 10 months, respectively, notwithstanding the absence of anticoagulant or antiarrhythmic pharmacotherapy. Additionally, electrocardiographic surveillance has revealed persistent sinus rhythm. Conclusions: The present findings underscore the feasibility and efficacy of a total thoracoscopic AF surgery procedure for patients presented with short bowel syndrome complicating SMA embolization, thus warranting consideration for its broader clinical application. [ABSTRACT FROM AUTHOR]

Background: Intracorporeal mechanical gastrogastrostomy (IMG) techniques have recently been developed and their short-term safety was presented in their initial evaluation. However, whether they are comparable to extracorporeal hand-sewing gastrogastrostomy (EHG) remains unclear. The aim of the study is to establish the safety of IMG in totally laparoscopic pylorus-preserving gastrectomy (TLPPG) compared to EHG in laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG). Methods: We retrospectively analyzed the short-term outcomes of patients with middle-third early gastric cancer who underwent LAPPG or TLPPG between 2005 and 2022. The primary objective of this study was to evaluate the non-inferiority of IMG to EHG in terms of safety, with the primary endpoint being the risk difference in anastomosis-related complications (ARCs). The sample size required to achieve a statistical power of 80% for the non-inferiority test was 971 with a one-sided alpha level of 5% and non-inferiority of 5%. Results: The analysis included a total of 1,021 patients who underwent LAPPG or TLPPG during the study period. Among them, 488 patients underwent EHG, while 533 underwent IMG. The incidences of ARCs were 11.3% and 11.4% in EHG and IMG, respectively. The observed difference in incidence was 0.0017 (90% confidence interval − 0.0313 to 0.0345), which statistically demonstrated the non-inferiority of IMG to EHG in the incidence of ARCs. Among other complications, the incidence of wound infection in IMG was lower than that in EHG. Conclusion: IMG is safe regarding ARCs compared with EHG. These results will encourage surgeons to introduce IMG for patients with early middle gastric cancer. [ABSTRACT FROM AUTHOR]

Male circumcision (mc) was among the first surgeries done by mankind. This method has the ability to reduce the risk of sexually transmitted illnesses such human papillomavirus (HPV), genital ulcer disease, and HIV infection. The Problems such as haemorrhage, edoema, and poor cosmetic outcomes remain prevalent in individuals who have traditional mc. Furthermore, traditional mc is time-consuming. Objective: The objective of this study was to compare the clinical results of adult male circumcision using a circular stapler to traditional methods. Primary and secondary outcomes were used to conduct a comparative assessment. Methods: We used a comparative randomised control to examine numerous characteristics and results of male circumcision using a circular stapler vs traditional male circumcision in adults in Central India. The surgical time, pain score, blood loss volume, healing time, treatment expenses, and postoperative complications were compared in the two groups. Results: The stapler group had a considerably shorter operation time and lower blood loss volume compared to the traditional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; P<0.01). The stapler group had substantially lower intraoperative and postoperative pain levels than the traditional group (0.8 ± 0.5 vs 2.4 ± 0.8 and 4.0 ±0.9 vs 5.8 ± 1.0, respectively; P<0.01). Furthermore, the stapler group had considerably less problems than the traditional group (2.7% vs 7.8%, respectively; P<0.01). However, the stapler group had significantly greater treatment expenses than the traditional group (8000 ± 500.20 vs 1000.50 ± 125.00, respectively; P<0.01). Conclusion: Overall, the current research demonstrated that stapler circumcision is a time-saving and safe male circumcision procedure. [ABSTRACT FROM AUTHOR]

Introduction: Parastomal hernia repair is a real surgical challenge because of the high rate of recurrence. The Stapled Mesh Stoma Reinforcement Technique (SMART) is a keyhole-like technique in which the mesh is stapled to the fascia using a circular mechanical stapler. Methods: A prospective study from January 2021 to February 2023 was conducted including all patients operated with the SMART technique. Primary endpoint was the recurrence rate during the follow-up. Secondary endpoints were reoperation, Surgical site Occurrence (SSO) and deep (mesh) surgical site infection (SSI) within 30 days postoperatively. Results: Sixteen patients operated on SMART procedures were included. The mean follow-up was 11.3 ± 9.2 months. The SSO rate was 18.7% (n = 3). A seroma was drained radiologically (IIIa), one haematoma was evacuated surgically (IIIb) and one patient presented a postoperative lesion of a ureter after a parastomal Bricker's hernia repair. In addition, there was one death due to multiple organ failure (V). There was no SSI. The recurrence rate was 57.1% during the follow-up. Conclusion: This study shows disappointing results for this SMART technique, with a high recurrence rate. [ABSTRACT FROM AUTHOR]

Bioadhesive materials and patches are promising alternatives to surgical sutures and staples. However, many existing bioadhesives do not meet the functional requirements of current surgical procedures and interventions. Here, we present a translational patch material that exhibits instant adhesion to tissues (2.5-fold stronger than Tisseel, an FDA-approved fibrin glue), ultra-stretchability (stretching to >300% its original length without losing elasticity), compatibility with rapid photo-projection (<2 min fabrication time/patch), and ability to deliver therapeutics. Using our established procedures for the in silico design and optimization of anisotropic-auxetic patches, we created next-generation patches for instant attachment to tissues while conforming to a broad range of organ mechanics ex vivo and in vivo. Patches coated with extracellular vesicles derived from mesenchymal stem cells demonstrate robust wound healing capability in vivo without inducing a foreign body response and without the need for patch removal that can cause pain and bleeding. We further demonstrate a single material-based, void-filling auxetic patch designed for the treatment of lung puncture wounds. Bioadhesive materials and patches are promising alternatives to surgical sutures and staples but many existing bioadhesives do not meet the functional requirements of current surgical procedures. Here the authors present a tissue adhesive, stretchable and rapid photo-projection compatible translational patch material which is able to deliver therapeutics. [ABSTRACT FROM AUTHOR]

The article discusses the challenges of performing laparoscopic sigmoidectomy for colorectal cancer in patients with situs inversus totalis (SIT), a rare congenital anomaly. The surgical procedure is complicated by the mirrored anatomical view and trocar placement required for patients with SIT. The article presents a case study of successful laparoscopic surgery for sigmoid cancer in a patient with SIT, highlighting the importance of anatomical knowledge and careful planning for safe surgery in this specific patient group. [Extracted from the article]

To demonstrate the anatomical and technical highlights of nerve-sparing deep endometriosis (DE) surgery with rectal discoid resection using a newer single-port robotic system. Step-by-step demonstration of this method was provided with narrated video footage. The surgery was performed at an urban general hospital. Single-port laparoscopic surgery is a useful surgical approach in gynecology because of the excellent cosmetic results but shows challenges including reduced intracorporeal triangulation and conflict with nonarticulating instruments. The range of indications is thus limited. A 46-year-old woman was referred with severe pelvic pain, dysmenorrhea, and pain on defecation. Magnetic resonance imaging revealed uterine adenomyosis, bilateral ovarian endometriomas, and 3 cm of rectal endometriosis. Computed tomography colonography confirmed 38% stenosis of the rectum. A newer single-port robotic system was used. The main outcome measures were technical safety and feasibility of intrapelvic complex DE surgery using a newer single-port robotic platform. The procedure was performed using nine steps with a da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, California). Importantly, the surgical steps were completely identical to conventional multiport laparoscopic or robotic surgery. This suggests that conventional laparoscopic or robotic skills are highly transferrable to the newer system. The surgical steps are as follows: • Step 1: adhesiolysis and adnexal surgery • Step 2: separation of the nerve plane • Step 3: dissection of the ureter • Step 4: reopening of the pouch of Douglas • Step 5: complete removal of DE lesions while avoiding injury to the nerve plane • Step 6: hysterectomy (if the patient desires non–fertility-sparing surgery) • Step 7: rectal discoid resection with circular stapler • Step 8: checking for rectal injury using an air leakage test and tissue perfusion • Step 9: application of barrier agents for adhesion prevention The newer single-port system offered several advantages, including high-resolution three-dimensional visualization, articulating instruments (intracorporeal instrument triangulation), and improved dexterity and range of motion. These advantages allow precise dissection even in difficult situations such as DE. This appears to be the first reported use of the da Vinci SP for nerve-sparing DE surgery or rectal discoid resection. The newer single-port robotic system can provide the same quality of surgery as conventional multiport laparoscopic and robotic platforms with cosmetic advantages for the treatment of complex pelvic pathologies. [ABSTRACT FROM AUTHOR]

Background: DaVinci® single-port (SP) robotic surgery offers several benefits compared to traditional multiport laparoscopic or robotic surgeries. One of the main advantages is that it allows for a minimally invasive approach, resulting in a single, smaller incision and reduced trauma to the patient's body, leading to less postoperative pain, faster recovery, and reduced risk of complications. The cosmesis of a single port with minimal visible scarring is also an attractive aspect to the patients; however, many surgeons use an additional port for energy device, stapler use, and drain insertion. Pure single-port surgery with one incision is still rare. Here, we share our experience of our first 10 cases using the SP robotic platform in colorectal surgery. Methods: From May 2023 to December 2023, colorectal patients who underwent SP robotic surgery were analyzed. Placement of the incision was the umbilicus for eight patients, and right lower quadrant for two patients, through which ileostomy maturation was performed. Data on perioperative parameters and postoperative outcomes were analyzed, with a median follow-up of 4.6 months (range 0.6–7.4 months). Results: A total of 10 colorectal patients underwent DaVinci® single-port robotic colorectal surgery at our institution during this period. The patient demographic was four males (40%) and six females (60%) with a median age of 63.5 years (range 50–75 years). Median body mass index (BMI) was 22.89 kg/m2 (range 19.92–26.84 kg/m2). Nine patients were diagnosed with colorectal cancer, and one patient was diagnosed with a rectal gastrointestinal tumor. One patient underwent anterior resection and cholecystectomy simultaneously. Mean operation time was 222 min (range 142–316 min), and mean wound size was 3.25 cm (range 2.5–4.5 cm). Nine patients underwent surgery with single incision through which a single-port trocar was inserted, and one patient had one additional port for drain insertion. Mean hospital stay was 6 days (range 4–8 days) with one postoperative complication of bleeding requiring transfusion, but there was no readmission within 30 days. Conclusions: Overall, our experience with single-port robotic colorectal surgery has been promising. With only one patient with additional port for drain insertion, all nine patients underwent SP-robotic surgery with single incision for colon as well as rectal surgeries. Compared to an average postoperative length of stay of 6.5-8 days in laparoscopic colorectal surgeries reported in literature, SP-robotic surgery 33showed faster recovery of 6 days highlighting its benefits in patient recovery and satisfaction. [ABSTRACT FROM AUTHOR]

Background: Surgical staplers have been widely used to facilitate surgeries, and this study aimed to examine the real-world effectiveness of a new powered stapling system with Gripping Surface Technology (GST) on intraoperative outcomes of gastrectomy for gastric cancer. Method: The data were extracted from the Fourth Hospital of Hebei Medical University's (FHHMU) medical records system. Participants (N = 121 patients) were classified into the GST (n = 59) or non-GST group (n = 62), based on the use of the GST system. The intraoperative outcomes such as bleeding were assessed by reviewing video records. T-tests, Chi-square tests, and Mann–Whitney-U tests were used to compare the baseline characteristics between groups. Multivariate logistic regression was conducted for adjusting outcomes to study the effect of variables. Results: Compared with the non-GST group, the GST group had significantly lower risks for intraoperative bleeding, intraoperative anastomosis intervention rate, intraoperative suture, and intraoperative pression (aORs: 0.0853 (p < 0.0001), 0.076 (p = 0.0003), 0.167 (p = 0.0012), and 0.221 (p = 0.0107), respectively). The GST group also consumed one fewer cartridge than the non-GST group (GST:5 vs non-GST: 6, p = 0.0241). Conclusion: The use of the GST system was associated with better intraoperative outcomes and lower cartridge consumption in Chinese real-world settings. [ABSTRACT FROM AUTHOR]

Summary: Background: Incisional complications following ventral midline celiotomy represent a challenge for equine surgeons. Preventative measures to minimise risks of incisional complications are continuously being investigated. This includes the search for an ideal surgical closure method. Objective: To compare the incidence of incisional complications after skin closure with nylon sutures versus stainless‐steel skin staples (SSS) following ventral midline celiotomy for colic surgery in horses and to assess additional risk factors for incisional complications. Study design: Prospective blinded randomised study (2012–2014). Methods: One hundred and twenty‐three horses that underwent colic surgery between May 2012 and May 2014 and survived for >2 weeks were included in the study. Horses were allocated randomly to two groups—65 horses were closed with skin staples, and 58 horses were closed with skin sutures (nylon‐0). Patient records and a follow‐up questionnaire were used to record incisional complications that occurred during hospitalisation and after discharge. Results: Follow‐up information was available in 119 of 123 horses. Four horses without follow‐up were excluded. With strict inclusion criteria, incisional drainage was recorded in 43% (49/115) of the horses, including 40% (25/63) of the surgical staples skin closure group and 46% (24/52) of the nylon suture skin closure group. Pregnancy and large colon intestinal lesions were risk factors for incisional complications. Surgeon 3 was found to decrease the incidence of incisional infection. No association was detected between incisional complications and hernia development. Main limitations: The non‐uniformity of the follow‐up examination; reliance on owners or caregiver of the horse for follow‐up information, horses lost to follow‐up, incomplete data. Another limitation was the single‐centre design of the study. Conclusions: Although not significantly superior, the use of staples may serve as a valid alternative for ventral midline abdominal incision skin closure. [ABSTRACT FROM AUTHOR]

Background: Bowel resection and anastomosis are commonly performed surgeries in general surgery for various causes like gangrene bowel, perforation, carcinomas. Bowel anastomosis can be done by hand sewen technique or using staplers. There are various factors that affect anastomosis healing are poor nutritional status, diabetes mellitus, anaemia, smoking etc. most common complications of bowel anastomosis are anastomotic leak, bleeding, stricture, obstruction The main aim of the study is 1. To study the outcome of anastomosis performed through hand-sewn Versus stapler. 2. To study the outcome of anastomosis done in elective surgeries versus Emergency surgeries. 3. To study various factors affecting the outcome of bowel anastomosis. Methods: The study is a prospective cross-sectional study of 50 cases who Attended Surgical OPD and casualty (emergency department), Andhra Medical College, King George Hospital, Visakhapatnam and underwent bowel resection and anastomosis over two years.A detailed history and physical examination after taking informed Consent. Investigations like erect x-ray abdomen, Ultrasonogram abdomen, Routine blood investigations like complete blood picture, blood sugar, Renal function tests, liver function tests, and contrastenhanced Computerized tomography (CECT) abdomen if necessary. Results: -The incidence of AL in the present study is 11%. 63.6% of the AL is seen In males. -The majority of them are seen in the 7th decade, followed by the 4thDecade. - Smoking, anemia, and hypoalbuminemia are significant risk factors for AL. -Diabetes mellitus, as such, is not a significant risk factor for AL. - 40% of the patients having sepsis developed AL. -8 out of 11 AL are of emergency, which is statistically significant. -AL is not significantly associated with either hand-sewn or stapler in Whichever circumstance used. -CRP is significantly associated with the development of AL (p<0.01). CONCLUSIONS: There is no significant difference between hand sewen and stapler anastomosis. Preoperative factors like anemia, hypoalbunemia, smoking are the risk factors for anastomotic leak. Serum c reactive protein is a predictor of anastomotic leak. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal anastomosis is a regularly carried out surgical technique to set up communication between two distant portions of the intestine since the era of Sushruta. There exist different methods of intestinal anastomosis. The newer techniques are Stapling devices over to conventional hand-sewn method of anastomosis. It is proved that a key to a successful anastomosis is accurate anastomosis of two viable ends of the bowel maintaining good vascularity and less tension. Due to consistency, stapler's can be used at difficult locations. Aims and Objectives: The objective of present study was to compare the outcome of hand-sewn versus stapler anastomosis in elective gastrointestinal surgeries. Materials and Methods: We conducted a prospective and randomized study including 30 study participants each in stapler's method and hand-sewn method at surgery outpatient department of Kempegouda Institute of Medical Sciences Hospital and Research Center. Results: Stapling procedure took less days to get restored, less time to return of bowel sounds, shorter duration of hospital stays, and less time to resume for oral feeds compared to hand-sewn method and which were statistically significant (P<0.05). Complications such as anastomotic leaks accounted for 3.3% in stapler group and 13.3% in hand-sewn anastomosis, which was not significant statistically. Conclusion: We concluded that time for anastomosis during the procedure, restoration of the gastrointestinal function, oral feeding resumption, and post-operative hospital stay took significantly less time in stapling technique than hand-sewn anastomosis and the staplers looked technically easy compared to hand-sewn method. Complications related to procedure did not show significant differences which helped us to conclude that one can use staplers with similar safety and accuracy as hand suturing method. [ABSTRACT FROM AUTHOR]

Background: Anastomosis configuration is an essential step in treatment to restore continuity of the gastrointestinal tract following bowel resection in patients with Crohn's disease (CD). However, the association between anastomotic type and surgical outcome remains controversial. This retrospective study aimed to compare early postoperative complications and surgical outcome between stapler and handsewn anastomosis after bowel resection in Crohn's disease. Methods: Between 2001 and 2018, a total of 339 CD patients underwent bowel resection with anastomosis. Patient characteristics, intraoperative data, early postoperative complications, and outcomes were analyzed and compared between two groups of patients. Group 1 consisted of patients with stapler anastomosis and group 2 with handsewn anastomosis. Results: No significant difference was found in the incidence of postoperative surgical complications between the stapler and handsewn anastomosis groups (25% versus 24.4%, p = 1.000). Reoperation for complications and postoperative hospital stay were similar between the two groups. Conclusion: Our analysis showed that there were no differences in anastomotic leak, nor postoperative complications, mortality, reoperation for operative complications, or postoperative hospital stay between the stapler anastomosis and handsewn anastomosis groups. [ABSTRACT FROM AUTHOR]

Background: A stapler is usually used for transection and closure of the pancreas in distal pancreatectomy (DP) or central pancreatectomy (CP). When the pancreas is transected to the right of the portal vein, it is difficult to use a stapler and clinically relevant postoperative pancreatic fistula (CR-POPF) frequently occurs. We report on the efficacy of pancreaticojejunostomy (PJ) of the pancreatic stump for patients in whom stapler use is difficult. Methods: Patients who underwent DP or CP were enrolled in this study. The pancreas was usually transected by a stapler, and ultrasonic coagulating shears (UCS) were used depending on the tumor situation. When using UCS, hand-sewn closure or PJ was performed for the pancreatic stump. The relationship between clinicopathological factors and the methods of pancreatic transection and closure were investigated. Results: In total, 164 patients underwent DP or CP, and the pancreas was transected with a stapler in 150 patients and UCS in 14 patients. The rate of CR-POPF was higher and the postoperative hospital stay was longer in the UCS group than in the stapler group. PJ of the pancreatic stump, which was performed for 7 patients, did not worsen intraoperative factors. CR-POPF was not seen in these 7 patients, which was significantly less than that with hand-sewn closure. Conclusions: PJ of the pancreatic stump during DP or CP reduces CR-POPF compared with hand-sewn closure and may be useful especially when the pancreas is transected to the right of the portal vein. [ABSTRACT FROM AUTHOR]

This article provides a comprehensive overview of the wound healing process, emphasising the critical role of surgical staples in primary intention healing. It outlines the four distinct phases of wound healing including haemostasis, inflammation, proliferation, and maturation – and discusses the mechanisms by which surgical staples enhance this natural biological process. Special focus is given to the aseptic non-touch technique (ANTT), which is crucial in preventing infections during the staple removal procedure. The article further explores the procedural steps involved in the removal of surgical staples and highlights the holistic aspects of patient care that need to be considered. This includes strategies for effective pain management, ensuring informed consent, and maintaining a sterile environment. By integrating clinical skills with a thorough understanding of wound care, this article aims to improve nursing practices in surgical settings, promoting better patient outcomes and recovery. [ABSTRACT FROM AUTHOR]

Objective: The Dermabond™ Prineo™ Skin Closure System (DP; Ethicon, Somerville, NJ) combines the effectiveness of cyanoacrylate with a self-adhering mesh. DP is used for orthopedic surgery, abdominoplasty, excisional body-contouring procedures, mastopexy, reduction mammoplasty, spine surgery, and obstetrics. Many studies compared DP–type systems with conventional wound-closure methods and found numerous advantages and some complications for the newer system. Methods: This review covers 22 studies reporting side-effects of DP or comparing this skin-closure system with others. Results: Superficial- or deep-wound complications, surgical-site infections, cellulitis, delayed wound healing, dehiscence, allergic contact dermatitis, prolonged discharge from wounds, or necrosis were the main side-effects reported. Conclusions: DP is safe, according to various studies. It has many advantages, such as cost and operating-time reduction, better cosmetic results, and-more-hygienic management of wounds. Several studies claim that there are no significant differences from conventional wound closure in terms of complications. However, there is a potential risk for a type IV hypersensitivity reaction, which is one of the most-important complications related to the DP-type skin-closure system. More research is needed to analyze the adverse outcomes thoroughly, plus analyses of costs, operating times, and cosmetic results of various types of wound-closure system, including this one, to and tailor the best choice of wound closure for each patient following surgery. (J GYNECOL SURG 40:123) [ABSTRACT FROM AUTHOR]

Aim: Total mesorectal excision with adequate free margins is the gold standard for rectal surgery. Applying a linear stapler in a narrow pelvis can be challenging and the proper distal margin difficult to assess. In selected cases the colorectal eversion technique combined with single‐stapled double‐purse‐string anastomosis (SSDP) can be a practical solution. Method: Eleven patients, six men and five women, mean body mass index 27 ± 1.3 kg/m2, underwent total mesorectal excision with the colorectal eversion technique combined with modified SSDP between September 2022 and January 2023. Results: The mean operative time was 190 min. The mean hospital stay was 4 days. There were no postoperative complications. The final histology showed complete mesorectal resection, circumferential resection margin negative, free distal resection margin, anastomotic doughnuts negative. At 7 ± 3 months follow‐up there was no evidence of local recurrence or distant metastasis. Conclusion: The colorectal eversion technique combined with modified SSDP is a reproducible and safe technique in selected patients. Prospective randomized trials with large patient series are needed to confirm our preliminary results. [ABSTRACT FROM AUTHOR]

Aim: Natural orifice specimen extraction (NOSE) in left‐sided colorectal surgery requires application of the circular stapler anvil to the proximal bowel without exteriorization through an additional abdominal incision. We describe an intracorporeal method to secure the stapler anvil, termed the intracorporeal antimesenteric ancillary trocar (IAAT) technique. Method: The ancillary trocar is attached to the stapler anvil before introduction into the abdominal cavity through the anal or vaginal orifice. The colon is incised before the trocar spike is brought out through the antimesenteric surface 3–4 cm within the cut edge. A linear stapler is used to seal the bowel end. The ancillary trocar is detached and retrieved via the NOSE conduit. Following the NOSE procedure, a side‐to‐end colorectal anastomosis is performed with the transanal circular stapler. Results: Ten consecutive patients underwent elective left‐sided colorectal resection with IAAT for NOSE (seven transanal, three transvaginal) from January to June 2023. Median age and body mass index were 66 (range 47–74) years and 24.3 (range 17.9–30.8) kg/m2 respectively. Two (20%) patients underwent sigmoid colectomy for sigmoid volvulus while eight (80%) underwent anterior resection for colorectal cancer. Median operating time, operative blood loss and postoperative length of hospital stay were 170 (range 140–240) min, 20 (range 10–40) mL and 1 (range 1–3) day respectively. There were no postoperative complications, readmissions or reoperations. Median follow‐up duration was 3 (range 1–6) months. Conclusion: The IAAT double‐stapling side‐to‐end anastomotic technique is safe and feasible for patients undergoing left‐sided colorectal resection with NOSE, resulting in good outcomes. [ABSTRACT FROM AUTHOR]

Introduction: In minimally invasive esophagectomy, a circular stapled anastomosis is common, but no evidence exists investigating the role of the specific localization of the anastomosis. The aim of this study is to evaluate the impact of an esophagogastrostomy on the anterior or posterior wall of the gastric conduit on the postoperative outcomes. Material and methods: All oncologic minimally invasive Ivor Lewis procedures, performed between 2017 and 2022, were included in this study. The cohort was divided in two groups: a) intrathoracic esophagogastrostomy on the anterior gastric wall of the conduit (ANT, n = 285, 65%) and b) on the posterior gastric wall (POST, n = 154, 35%). Clinicopathological parameters and short-term outcomes were compared between both groups by retrieving data from the prospective database. Results: Overall, 439 patients were included, baseline characteristics were similar in both groups, there was a higher proportion of squamous cell carcinoma in ANT (22.8% vs. 16.2%, P = 0.043). A higher rate of robotic-assisted procedures was observed in ANT (71.2% vs. 49.4%). Anastomotic leakage rate was similar in both groups (ANT 10.4% vs. POST 9.8%, P = 0.851). Overall complication rate and Clavien–Dindo > 3 complication rates were higher in POST compared to ANT: 53.2% vs. 40% (P = 0.008) and 36.9% vs. 25.7% (P = 0.014), respectively. The rate of delayed gastric emptying (20.1% vs. 7.4%, P < 0.001) and nosocomial pneumonia (22.1% vs. 14.8%, P = 0.05) was significantly higher in POST. Conclusion: Patients undergoing minimally invasive Ivor Lewis esophagectomy with an intrathoracic circular stapled anastomosis may benefit from esophagogastrostomy on the anterior wall of the gastric conduit, in terms of lower rate of delayed gastric emptying. [ABSTRACT FROM AUTHOR]

Background: Approach to enteric anastomotic technique has been a subject of debate, with no clear consensus as to whether handsewn or stapled techniques are superior in trauma settings, which are influenced by unique perturbances to important processes such as immune function, coagulation, wound healing and response to infection. This systematic review and meta‐analysis compares the risk of anastomotic complications in trauma patients with gastrointestinal injury requiring restoration of continuity with handsewn versus staples approaches. Methods: A comprehensive computer assisted search of electronic databases Medline, Embase and Cochrane Central was performed. Comparative studies evaluating stapled versus handsewn gastrointestinal anastomoses in trauma patients were included in this review. All anastomoses involving small intestine to small intestine, small to large intestine, and large intestine to large intestine were eligible. Anastomosis to the rectum was excluded. Outcomes evaluated were (1) anastomotic leak (AL) (2) a composite anastomotic complication (CAC) end point consisting of AL, enterocutaneous fistula (ECF) and deep abdominal abscess. Results: Eight studies involving 931 patients were included and of these patients, data from 790 patients were available for analysis. There was no significant difference identified for anastomotic leak between the two groups (OR = 0.77; 95% CI 0.24–2.45; P = 0.66). There was no significant improvement in composite anastomotic complication; defined as a composite of anastomotic leak, deep intra‐abdominal abscess and intra‐abdominal fistula, in the stapled anastomosis group (OR = 1.05; 95% CI 0.53–2.09; P = 0.90). Overall, there was limited evidence to suggest superiority with handsewn or stapled anastomosis for improving AL or CAC, however this was based on studies of moderate to high risk of bias with poor control for confounders. Discussion: This meta‐analysis demonstrates no superiority improvement in anastomotic outcomes with handsewn or stapled repair. These findings may represent no effect in anastomotic outcome by technique for all situations. However, considering the paucity of information on potential confounders, perhaps there is a difference in outcome with overall technique or for specific subgroups that have not been described due to limited sample size and data on confounders. Currently, there is insufficient evidence to recommend an anastomotic technique in trauma. [ABSTRACT FROM AUTHOR]