Search Results (169)

Background/Objectives: General anesthesia is the most widely used anesthesia technique for major abdominal surgery, but it may have a longer recovery time, high cost, and environmental impact. In addition, general anesthesia may be contraindicated in some frail patients. Our study aims to evaluate the feasibility and safety of performing colorectal surgery with a minimally invasive technique in frail patients under spinal anesthesia. Methods: From June 2021 to January 2022, 39 consecutive frail patients, undergoing elective laparoscopic colorectal oncological resection surgery under neuraxial anesthesia at the Colorectal Surgery Unit of the Fondazione Policlinico Campus Bio-Medico in Rome, were selected. A retrospective analysis prospectively maintained database of these patients was performed. Results: In all 36 patients, the surgery was successfully completed under spinal anesthesia and laparoscopic technique. Some patients experienced mild abdominal pain between I and II POD (Post Operative Day) (Visual Analogue Scale between 3 and 5) and were treated with oral analgesics as needed. No patients experienced episodes of vomiting or nausea after surgery with gas channeling in I POD. The average hospital stay was about 4 days (range 3–7). No patient required ICU (Intensive Care Unit) admission, and 30-day mortality was 0. Conclusions: Our preliminary data show that performing major surgery with a minimally invasive technique under spinal anesthesia can be feasible and safe, if performed by experienced operators, and can be a viable alternative for the treatment of frail and/or high-risk patients. Full article

Background/Objectives: Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial, which was a multicenter prospective randomized control trial comparing LPPG and laparoscopic distal gastrectomy (LDG), showed an unneglectable incidence of long-term DGE compared to patients who underwent LDG. This study aimed to identify the multifactorial risk factors associated with DGE and to analyze the quality of life (QoL) of patients with DGE following LPPG. Methods: DGE was defined as “nearly normal diet residue” at least once in the endoscopic follow-up at 1, 2, and 3 years after the surgery. Clinicopathological features, surgical outcomes, and QoL were compared between the DGE and non-DGE groups. Results: DGE was observed in 21/124 patients (16.3%) who underwent LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%, p = 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014–0.824, p = 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p = 0.004), constipation (p = 0.04), and a dry mouth (p = 0.005). Conclusions: Despite the strict protocol used to avoid well-known risk factors for DGE, such as damage to the hepatic branch of the vagus nerve, infrapyloric artery and vein, and short antral cuff, the LPPG group of the KLASS-04 trial exhibited a considerable incidence of DGE. No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients. Full article

Background: Laparoscopic antireflux surgery (LARS) is widely used to treat gastroesophageal reflux disease (GERD). Iatrogenic gastroesophageal injuries, when recognized intraoperatively, can be managed without major consequences, whereas undetected injuries presenting as postoperative leaks are associated with high morbidity and mortality. Despite their complexity, research on post-LARS leaks is scant. We aim to describe the diagnosis and management of such injuries at a tertiary referral center. Methods: We describe a single-center case series of patients referred for gastroesophageal perforations after LARS. Patients were identified through the personal records of surgeons at our institution. A narrative literature review was conducted to summarize publications on the topic. Results: Five patients (four female [80%]; median age, 73 years [IQR, 67–74]) were included. The median time between LARS and clinical presentation was 2 (IQR, 1–8) days (range 1–15 days). The most frequent symptoms were shortness of breath (all five patients) and pain (three [60%] patients). All patients presented with hypoxia, and four (80%) patients presented with sepsis. Two (40%) patients underwent primary repair, and three (60%) required limited esophagogastrectomy without immediate reconstruction. All patients required both thoracic and abdominal exploration, and all of them experienced significant postoperative complications (Clavien–Dindo ≥ 3). The median hospital stay was 58 days (IQR, 34–59). At a median follow-up of 14 months (IQR, 6–28), all patients were alive. Conclusions: Although infrequent, gastroesophageal perforation after LARS often requires complex surgical interventions and prolonged hospital stays. Additional efforts should focus on prevention and early recognition. Full article

Background: Desmoid tumors (DTs) are rare, non-metastatic but locally aggressive connective tissue neoplasms. While standard treatments include surgery, radiation, and ablation, current guidelines advocate active surveillance unless tumors progress or symptoms worsen. Cryotherapy has shown promise in treating DTs; however, its application in rectus abdominis DTs has been limited due to proximity to critical intra-abdominal structures. Methods: This case series describes a novel approach involving laparoscopic-assisted cryoablation in three patients with rectus abdominis DTs. Laparoscopic visualization was employed to improve tumor localization and procedural safety during percutaneous cryoablation. Results: The average tumor size was 7.4 cm, and a mean of 14 cryoprobes were used per case. All patients experienced complete symptom resolution. One patient developed a complication—injury to the inferior epigastric artery—requiring embolization. Follow-up imaging at three months showed significant tumor shrinkage and necrosis in two patients. The third patient had increased lesion volume due to post-procedural hematoma, although radiological markers of cryoablation efficacy were present. Conclusions: Laparoscopic-assisted cryoablation appears to be a feasible and effective technique for treating rectus abdominis DTs, providing symptom relief and favorable early tumor response. Further studies are warranted to evaluate long-term outcomes and validate this approach in broader clinical settings. Full article

Background: Single-port laparoscopic hepatectomy is a minimally invasive modality for the treatment of benign and malignant liver lesions. Due to the method’s technical challenges, it is suitable for experienced hepatobiliary surgeons and selected groups of patients. The aim of this study was to evaluate the results of a single Slovenian center performing single-port laparoscopic hepatectomy with a literature overview. Methods: A single-center retrospective consecutive case series of the twenty-six patients with liver disease operated with the single-port technique from January 2018 to July 2024 at the Department of Abdominal Surgery at the University Medical Centre, Ljubljana, was performed. Lesions were located in easy-to-treat segments. Operative time, conversion rate, length of hospital stay, and surgical complications were recorded and evaluated. Results: We performed twenty-six single-port laparoscopic liver resections (median age 63.5, range 31 to 79 years). The mean operative time was 92 ± 31 min. None of the cases were converted to multi-port laparoscopic or open surgery. Safe resection margins were obtained in cases of malignant disease. The mean hospital stay was 4 days. The post-operative complication rate involving intervention was 7% (2/26). The incisional hernia rate was 11.5% (3/26). No life-threatening surgical complications or morbidity were noted. Conclusions: Single-port laparoscopic hepatectomy is a safe and feasible technique for the resection of benign and malignant liver lesions in the hands of skilled and well-trained hepatobiliary surgeons. Full article

Uterine fibroid is one of the most common benign uterine diseases, affecting up to 70–80% of females of reproductive age. Whilst abdominal myomectomy has traditionally been a major uterine-sparing surgical intervention for its management, this is not without considerable technical challenges and the potential for multiple complications and morbidity. Since the introduction of video-assisted endoscopic surgery by Dr. Camran Nezhat in the 1980s, the development of minimally invasive approaches to myomectomy has accelerated rapidly worldwide. Whilst this offers numerous benefits for patients, laparoscopic myomectomy still carries implications for necessary expertise in surgical skill, intraoperative hemorrhage control, concern for future reproductive potential and risk of occult uterine malignancy. In this review article, we present the latest data regarding such aspects and offer our opinions on widely raised questions and existing contentions regarding myomectomy. We believe that minimally invasive myomectomy is a safe, efficient and beneficial approach to management in the hands of surgeons empowered with advanced knowledge, experience, and refined surgical skills. Full article

Background/Objectives: Colorectal cancer is a significant health problem worldwide. Surgery is the primary curative treatment for most colorectal cancers. Cardiopulmonary exercise testing is now performed widely before surgery, and it is the most objective and precise means of evaluating pre-surgical physical fitness. Also, we can use the 6 min walk test to measure cardiorespiratory fitness before surgery. Methods: We included colorectal patients who were awaiting open abdominal or laparoscopic surgery. After admission to the hospital, patients who signed informed consent forms fulfilled a short questionnaire about health and physical status, preoperative physical activities, and quality of life questionnaire (EORTC QLQ-C30). Patients performed a 6 min walk test (6MWT) 2 days before surgery and 7 days after surgery. 6MWT is a tool for measuring the functional status of fitness. Also, they fulfilled the quality of recovery questionnaire (QoR 15) 7 days after surgery. Results: In a final analysis, we included 72 patients with a mean age of 62.48. We compared the number of steps, walk distance, average and maximal walk speed, and average and maximal heart rate before and after surgery, overall, and by group. Our findings show a statistically significant difference between men and women in the walk distance (F = 4.99, p = 0.02) The number of steps showed a statistically significant difference according to patients’ ages (F = 2.90, p = 0.02). Also, we detected differences in the average and maximum heart rate during walking when comparing body mass index (average heart rate F = 5.72, p = 0.00, maximum heart rate F = 2.52, p = 0.04). Conclusions: Our study provides evidence that average and maximal heart rate during the 6 min walk test was higher in the postoperative period, especially in overweight and obese participants. Full article

Background: CT image guidance and navigation, although routinely used in complex endovascular procedures, is an unexplored territory in evolving vascular robotic procedures. In robotic surgery, it promises the better localization of vasculature, the optimization of port placement, less inadvertent tissue damage, and increased patient safety during the dissection of retroperitoneal structures. However, unknown tissue displacement resulting from induced pneumoperitoneum and positional changes compared to the preoperative CT scan can pose significant limitations to the reliability of image guidance. We aimed to study the displacement of retroperitoneal organs and vasculature due to factors such as increased intra-abdominal pressure (IAP) due to CO₂ insufflation and patient positioning (PP) using intraoperative CT imaging in a cadaveric model. Methods: A thawed, fresh-frozen human cadaveric model was positioned according to simulated procedural workflows. Intra-arterial, contrast-enhanced CT scans were performed after the insertion of four laparoscopic ports in the abdomen. CT scans were performed with 0–5–15–25 mmHg IAPs in supine, left lateral decubitus, right lateral decubitus, Trendelenburg, and reverse Trendelenburg positions. Euclidean distances between fixed anatomical bony and retroperitoneal vascular landmarks were measured and compared across different CT scans. Results: Comparing the effects of various IAPs to the baseline (zero IAP) in the same PP, an average displacement for retroperitoneal vascular landmarks ranged from 0.6 to 3.0 mm (SD 1.0–2.8 mm). When changing the PPs while maintaining the same IAP, the average displacement of the retroperitoneal vasculature ranged from 2.0 to 15.0 mm (SD 1.7–7.2 mm). Conclusions: Our preliminary imaging findings from a single cadaveric model suggest minimal (~3 mm maximum) target vasculature displacement in the retroperitoneum due to elevated IAP in supine position and higher displacement due to changes in patient positioning. Similar imaging studies are needed to quantify procedural workflow-specific and anatomy-specific deformation, which would be invaluable in developing and validating advanced tissue deformation models, facilitating the routine applicability and usefulness of CT image guidance for target delineation during robotic vascular procedures. Full article

Background/Objectives: Laparoscopic hysterectomy is commonly performed for benign gynecologic conditions, and the choice of uterine manipulation technique may influence surgical outcomes. The Boztosun technique, a modification of the classical Rein technique, enables intra-abdominal manipulation of the uterus without requiring transvaginal instruments. This study aimed to compare the Boztosun technique with a conventional vaginal uterine manipulator in terms of surgical efficiency and perioperative outcomes. Methods: This retrospective study included 30 patients who underwent laparoscopic hysterectomy for benign indications at Akdeniz University Hospital between March 2022 and March 2024. Fifteen patients underwent surgery using the Boztosun technique, and fifteen with a vaginal uterine manipulator. Operative time, colpotomy time, manipulator placement time, hospital stay, uterine weight, hemoglobin change, and complications were compared. Results: The Boztosun technique was associated with significantly shorter operative time (81.67 ± 11.02 min vs. 109 ± 10.85 min, p < 0.001), colpotomy time (4.13 ± 0.92 min vs. 8.87 ± 0.92 min, p < 0.001), manipulator placement time (0.81 ± 0.27 min vs. 8.07 ± 1.22 min, p < 0.001), and hospital stay (2.13 ± 0.35 days vs. 3.53 ± 0.92 days, p < 0.001). No significant differences were found in uterine weight, hemoglobin decrease, or complication rates. All procedures were completed laparoscopically without conversion to open surgery. Conclusions: The Boztosun technique may serve as a safe, efficient, and cost-effective alternative to vaginal uterine manipulators in laparoscopic hysterectomy. Its simplified intra-abdominal approach offers advantages in surgical workflow and recovery. Further prospective studies are needed to validate these findings and assess their applicability in broader clinical settings. Full article

Background/Objectives: Laparoscopic surgery plays a central role in the management of abdominal trauma, particularly in patients with hemodynamic stability. Recently, single-port laparoscopic surgery (SPLS) has emerged as a technique that further reduces access-related trauma while preserving the benefits of conventional laparoscopy. Thus, this review aimed to examine the current landscape of SPLS in trauma care, summarizing available clinical data and highlighting practical considerations for its use. Despite the limited experience, early evidence suggests that SPLS can achieve diagnostic and therapeutic outcomes comparable to those achieved by multi-port approaches in selected cases. Particular attention is given to a hybrid method that combines intracorporeal assessment with extracorporeal small bowel examination and repair through a single umbilical incision. This technique offers a pragmatic balance between thorough exploration and minimal invasiveness. Methods: We searched PubMed, Scopus, Web of Science, and Google Scholar through December 2023 using the terms “single-port laparoscopy”, “single-incision laparoscopic surgery”, “trauma laparoscopy”, and related phrases. Case reports, case series, comparative studies, and reviews describing single-incision laparoscopic surgery in trauma were included in this narrative analysis. Results: SPLS may offer advantages in terms of postoperative pain, wound complications, and cosmetic outcomes, especially in younger patients. As familiarity with the approach increases and dedicated instrumentation becomes more accessible, its role in trauma protocols may expand. Conclusions: Further prospective research is needed to define long-term outcomes, refine patient selection, and integrate SPLS more systematically into trauma care protocols. Full article

Background: Laparoscopic surgery for endometriosis presents unique challenges due to the complexity of and variability in lesion appearances within the abdominal cavity. This study investigates the application of deep learning models for object detection in laparoscopic videos, aiming to assist surgeons in accurately identifying and localizing endometriosis lesions and related anatomical structures. A custom dataset was curated, comprising of 199 video sequences and 205,725 frames. Of these, 17,560 frames were meticulously annotated by medical professionals. The dataset includes object detection annotations for 10 object classes relevant to endometriosis, alongside segmentation masks for some classes. Methods: To address the object detection task, we evaluated the performance of two deep learning models—FasterRCNN and YOLOv9—under both stratified and non-stratified training scenarios. Results: The experimental results demonstrated that stratified training significantly reduced the risk of data leakage and improved model generalization. The best-performing FasterRCNN object detection model achieved a high average test precision of 0.9811 ± 0.0084, recall of 0.7083 ± 0.0807, and mAP50 (mean average precision at 50% overlap) of 0.8185 ± 0.0562 across all presented classes. Despite these successes, the study also highlights the challenges posed by the weak annotations and class imbalances in the dataset, which impacted overall model performances. Conclusions: In conclusion, this study provides valuable insights into the application of deep learning for enhancing laparoscopic surgical precision in endometriosis treatment. The findings underscore the importance of robust dataset curation and advanced training strategies in developing reliable AI-assisted tools for surgical interventions. The latter could potentially improve the guidance of surgical interventions and prevent blind spots occurring in difficult to reach abdominal regions. Future work will focus on refining the dataset and exploring more sophisticated model architectures to further improve detection accuracy. Full article

Following the U.S. Food and Drug Administration’s warning against power morcellators due to potential cell dissemination of occult malignancy, there has been a shift away from minimally invasive approaches. This concern also overshadows the well-documented advantages of minimally invasive surgery in benign gynecology. Objectives: To evaluate whether intraperitoneal cell dissemination during laparoscopic surgery for uterine fibroids can be reduced by (i) the choice of morcellation method and/or (ii) copious irrigation after the procedure. Methods: This prospective multicenter comparative pilot study included 72 women undergoing laparoscopic myomectomy (LM) or total laparoscopic hysterectomy (TLH) for benign conditions. Women were divided into four groups in order to compare different types of morcellation, including a reference group without morcellation: (i) LM with power morcellation (n = 21, Group A), (ii) TLH with en-bloc transvaginal tissue removal without morcellation (n = 17, Group B), (iii) TLH with manual vaginal morcellation (n = 19, Group C), and (iv) TLH with contained manual vaginal morcellation (n = 15, Group D). Patients receiving cold knife morcellation were randomized into Groups C or D. In order to assess cell spread before surgery, after surgery but before morcellation, after morcellation, and after abdominal irrigation with a total of 3000 mL saline solution, peritoneal washings were collected at six timepoints. Results: After specimen removal (TP3), cell spread was significantly higher in cases with power morcellation [13/19 (68%) in Group A] compared to transvaginal cold knife morcellation, both contained and uncontained [Group C 1/14 (7%) and Group D 1/19 (9%)] (p < 0.001), or to TLH with en bloc removal [Group B 1/17 (6%)]. Saline irrigation reduced the positive cytologies. After 3000 mL (TP6), the difference between Group A and the TLH groups was not significant [4/18 (22%) vs. 3/45 (7%), p = 0.079]. Conclusions: Our study shows that (i) transvaginal cold knife morcellation results in significantly less peritoneal cell dissemination than power morcellation, and (ii) peritoneal irrigation with 3000 mL of saline significantly reduces residual cell presence. These findings could support maintaining minimally invasive approaches while addressing safety concerns. Full article

Background: Modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) and external oblique intercostal plane block (EOIB) provide abdominal analgesia by blocking thoracoabdominal nerves. Our aim was to compare the analgesic efficacy of M-TAPA vs. EOIB on the quality of recovery and pain scores in patients who underwent laparoscopic cholecystectomy surgery (LC). Methods: Patients with American Society of Anesthesiologists status I-II, aged between 18 and 65 years, and scheduled for elective LC under general anesthesia were enrolled in the study. The patients were randomized into two groups: Group M-TAPA (n = 30) and Group EOIB (n = 30). The blocks were performed with 40 mL 0.25% bupivacaine in total. The primary outcome of the study was the global quality of recovery score, and the secondary outcomes were the pain scores, rescue analgesic requirement, and adverse effects during the 24-h postoperative period. Results: The global quality of recovery scores at 24 h were similar in both groups. There was a reduction in the median static and dynamic numerical rating scale (NRS) in the first 2 h postoperatively for M-TAPA compared to the EOIB (p < 0.001). The need for rescue analgesia was significantly lower in the M-TAPA group compared to the EOIB group (p < 0.005). Conclusions: Opioid consumption was lower in the M-TAPA group, and the pain scores of the two groups were similar, with the exception of the first 2 h postoperatively. Both the M-TAPA block and EOIB are effective for analgesia following laparoscopic abdominal surgeries. Full article

Background: Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing bleeding across various surgical procedures. However, its role in bariatric surgery remains underexplored. This study aimed to evaluate the effectiveness of TXA in mitigating hidden blood loss following laparoscopic sleeve gastrectomy (SG). Methods: A single-center, single-blind, randomized, controlled trial was conducted at the University Clinical Center, Medical University of Gdańsk, Poland, between July 2022 and June 2023. A total of 238 patients undergoing SG were randomized to receive either TXA or no pharmacological intervention. The primary outcome was hemoglobin concentration in abdominal drainage post-surgery. Secondary outcomes included total blood loss, drainage volume, the need for blood transfusion, and postoperative complications. Statistical analyses were conducted using intention-to-treat and per-protocol strategies. Results: A statistically significant reduction in hemoglobin concentration in abdominal drainage samples was observed in the TXA group (p = 0.011). No significant differences were found in total blood loss, drainage volume, necessity for blood transfusions, or extended hospital stay between groups. Conclusions: While TXA administration may reduce the hidden blood loss effect, its general clinical significance appears questionable. Nonetheless, intraoperative TXA may be beneficial for a selected patient group with multiple preoperative disorders and risk factors. Further research is necessary to comprehensively assess the risks and benefits of TXA administration in bariatric surgery. Full article

Background: Upper abdominal surgeries exceeding two hours and operated in a lateral decubitus position present an “intermediate” risk for pulmonary complications. The objectives of this study were to observe the sonographic and clinical changes during and after surgeries with one recruitment maneuver (RM) performed intraoperatively before extubation. Methods: Laparoscopic nephrectomy patients were randomized into pre-extubation single RM (Group RM) and control (Group NoRM) groups. The LUS (Lung Ultrasound Score) was evaluated after intubation (T1), at the end of surgery before the RM (T2), after the RM but before extubation (T3), and 30 min after arrival to the Post-Anesthesia Care Unit (T4) in Group RM; in Group NoRM, it was evaluated at the T1, T2, and T4 time points. The primary outcome was the effect on the pre-extubation LUS (T2 in Group NoRM versus T3 in Group RM). The secondary outcomes included the effects on the T4 LUS, PPC occurrence, and PaO₂/FiO₂ ratios, and the sensitivity and specificity of the LUS in predicting PPCs. Results: The data of 54 patients were analyzed. The pre-extubation LUS was significantly lower in Group RM (16 (12.5, 17) vs. 18 (17, 20), p < 0.001). The T4 LUS was only different in the upper zones in the dependent lung (2 (1, 3.5) in Group RM vs. 4 (3, 4.5) in Group NoRM, p = 0.01). The perioperative PaO₂/FiO₂ ratios were similar (p > 0.05). The pre-extubation LUS exhibited 91% sensitivity (p = 0.04), whereas the T4 LUS sensitivity was 82% (p = 0.01). The PPC risk was 10-fold higher in patients with a pre-extubation LUS exceeding 19. Conclusions: A pre-extubation single RM instantly increases the LUS. However, this does not persist postoperatively or diminish respiratory complications. More importantly, the LUS was found to be a sensitive tool for predicting PPCs when performed just before extubation. Full article