Search Results (1,299)

Background: The peritoneal dialysis (PD) catheter is commonly placed using an open surgery approach. However, mechanical peritoneal catheter-related complications are common causes of peritoneal dialysis technical failure. In recent years, laparoscopic procedures have been recommended because of less invasiveness and high effectiveness in reducing catheter dysfunction; however, this approach is burdened by higher costs and higher risks related to general anesthesia. Methods: We have developed a new advanced video-laparoscopy (ALS) approach with a simple technique that does not require general anesthesia. By using an ultrasound-guided procedure it is possible to place a PD catheter by regional anesthesia (Transversus Abdominis Plane (TAP) block associated with bilateral quadratus lumborum (QLB) block). Results: We here report the outcomes of 20 patients who underwent ALS implantation of straight-neck, double-cuffed Tenckhoff catheters using cutaneous anesthesia with TAP and QLB block. No major complications, including bleeding, were reported. No patient needed intravenous treatment for pain control, and all procedures were well tolerated. During a median follow-up of 21 months [IQR, 15–35] no mechanical complication was reported. Conclusions: ALS without general anesthesia is a simple and well-tolerated technique that can be used in patients at high risk. It therefore allows recruiting a greater number of patients for PD and ensuring well-performing catheters with lower risk of mechanical complications. Full article

Background and Objectives: Perforated gastro-duodenal ulcers (PGDUs) are life-threatening surgical emergencies with high morbidity and mortality. This study aimed to evaluate surgical strategies, outcomes, and prognostic factors in patients treated for PGDUs in a tertiary Eastern European center. Materials and Methods: We conducted a retrospective cross-sectional analysis of 156 patients admitted with PGDUs between 2020 and 2024. Data on demographics, risk factors, ulcer location, type of surgical approach, operative details, hospital stay, and mortality were collected. Statistical analysis included chi-square, Mann–Whitney U, and multivariate logistic regression. Results: The mean age was 57.6 ± 15.9 years (range 18–91), with men accounting for 64.7% of cases. Alcohol use was significantly associated with male sex (p = 0.012), while NSAID use was equally distributed. Open surgery was the mainstay of treatment (85.9%), with laparoscopy performed in 12.8% and conversion in 1.9%. Median hospital stay was shorter after laparoscopic repair (7.5 vs. 9 days, p = 0.039. On multivariate analysis, both age and comorbidity burden were independent predictors of mortality (p < 0.01). Conclusions: PGDU management in Eastern Europe remains dominated by open surgery. Laparoscopy, though underutilized, is associated with shorter recovery. Age is the strongest determinant of mortality, highlighting the need for early risk stratification, wider adoption of minimally invasive techniques, and preventive measures targeting modifiable risk factors. Full article

Background/Objectives: Urinary incontinence (UI) remains a common and distressing complication following radical prostatectomy (RP). This prospective observational study aimed to assess the effectiveness of structured pelvic floor rehabilitation and to identify clinical and surgical predictors of continence recovery. Methods: A total of 182 patients undergoing RP received standardized physiotherapist-guided pelvic floor muscle training (PFMT), including supervised sessions before and after surgery, as well as individualized home exercise programs. UI severity was evaluated using a 1 h pad test and a four-level UI stage classification at three time points. The primary outcomes were changes in UI stage and the achievement of full continence, defined as a pad test result ≤2 g. Results: Following three rehabilitation sessions, 80.2% of patients regained full continence. Preoperative PFMT (β = −1.27, p = 0.0061) and shorter time to rehabilitation (β = −0.04, p = 0.0026) were associated with greater improvement in continence outcomes. Patients treated with robot-assisted RP showed a higher probability of continence recovery compared to those undergoing laparoscopic RP, particularly in the presence of moderate to severe baseline incontinence. Higher baseline urinary leakage significantly decreased the odds of treatment success (β = −0.01, p = 0.0001). ISUP grade and extraprostatic extension were not independently associated with outcomes. Conclusions: Despite the absence of a control group, this study demonstrates the effectiveness of structured and personalized pelvic floor rehabilitation in improving post-RP continence. Early initiation and preoperative training should be prioritized to optimize recovery in routine clinical practice. Full article

Background/Objective: Percutaneous transhepatic gallbladder drainage (PTGBD) is commonly used in patients with acute cholecystitis (AC) who are unfit for early laparoscopic cholecystectomy (LC). However, the efficacy, safety and long-term role of PTGBD remain debated. We aimed to evaluate the effectiveness and safety of PTGBD in managing AC, focusing on infection control, procedure-related complications, and need for secondary surgical intervention. Methods: We performed a single-center retrospective study including all patients who underwent PTGBD for AC from January 2018 to December 2023 at a tertiary care hospital. Patients were identified through an institutional database. Relevant clinical, procedural, and outcome data were extracted from electronic medical records. The primary outcome was infection control, defined as clinical and biochemical resolution of AC without the need for additional interventions beyond antibiotic therapy. Secondary outcomes included PTGBD-related complications, 30-day mortality, length of hospital stay, readmission rate, and the rate of subsequent LC. Results: A total of 105 patients were included (mean age 69.9 years; 63.8% male). Infection control was observed in 92.4% of patients following PTGBD. PTGBD-related complications occurred in 36.2%, mainly drain dislodgement and recurrent cholecystitis. Mortality was 4.8%. Delayed LC was performed in 80.9% of patients, with a 10.6% conversion rate and 16.5% postoperative complication rate. Conclusions: PTGBD is effective for infection control in high-risk AC patients unfit for immediate surgery. However, the complication rate and the frequent need for delayed LC underscore the importance of careful patient selection and standardized management strategies. Full article

Background/Objectives: Minimally invasive surgical techniques require precise psychomotor skills distinct from those used in traditional surgery. Simulation-based training is essential for skill acquisition without patient risk. This study compared two prevalent training methodologies: the Origami-Box-Folding Exercise (OBFE) and Outside-the-Box Knot-Tying Exercise (OBTKE). Methods: In this prospective cohort study, 84 surgical residents (34 OBFE, 50 OBTKE) from General Surgery, Obstetrics–Gynecology, and Urology underwent pre- and post-intervention assessments. Performance metrics included completion times for surgical and square knots, out-of-visual-field instrument instances, needle drops, tissue lesions, and self-assessment via 5-point Likert scales. Behavioral Observation Research Interactive Software quantified performance objectively. Data were analyzed using paired Wilcoxon signed-rank tests for within-group comparisons and Wilcoxon rank-sum tests for between-group differences. Results: Both methodologies significantly improved surgical knot-tying performance. Surgical knot completion time decreased by 316.65 s (OBFE) and 360 s (OBTKE) with no significant between-group difference (p = 0.96). For square knots, OBFE exhibited significantly greater improvement with a 278 s reduction versus 169 s for OBTKE (p = 0.02). Technical errors decreased similarly in both groups. OBFE showed greater improvement in self-rated surgical knot knowledge (p = 0.03) and larger effect sizes for self-assessment measures (0.84–0.87 vs. 0.77–0.85). Conclusions: Both OBFE and OBTKE effectively improve laparoscopic skills in surgical residents. OBFE is particularly beneficial for square knot efficiency and self-rated knowledge enhancement, while OBTKE focuses on targeted knot-tying training. These findings support the implementation of both methodologies in surgical education, potentially in sequence—OBFE for foundational skills and OBTKE for advanced refinement. Full article

Introduction: Robotic splenectomy has emerged as a promising alternative to laparoscopic surgery, offering potential advantages in precision, ergonomics, and individualized surgical planning. In the context of personalized medicine, robotic technology may enable tailoring of surgical strategies to patient-specific anatomy, spleen size, and comorbid hematologic conditions. However, its clinical superiority remains uncertain due to limited and heterogeneous evidence. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines, utilizing PubMed, CINAHL, Web of Science, and EMBASE databases to locate studies on robotic splenectomies in children. This review was prospectively registered in PROSPERO (CRD420251104285). Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Random-effects models were fitted using restricted maximum likelihood (REML), and confidence intervals were adjusted using either Knapp–Hartung (HKSJ) or modified Knapp–Hartung (mKH) methods when appropriate. 95% prediction intervals were calculated, and the certainty of evidence for each outcome was assessed using the GRADE approach. Results: This review included 272 pediatric patients from 16 studies conducted between 2003 and 2025, of which five were included in the meta-analysis. No statistically significant differences were observed between robotic and laparoscopic splenectomy for operative time, intraoperative blood loss, conversion to open surgery, blood transfusions, or complications. However, the direction of effect estimates consistently favored the robotic approach. A statistically significant reduction in hospitalization days (−0.93 days; 95% CI: −1.61 to −0.24; p = 0.01) was found, though this became marginally significant after HKSJ adjustment (p = 0.06). Intraoperative blood loss showed significance in the primary model (−63.88 mL; 95% CI: −120.38 to −7.38; p = 0.03), but not after mKH correction (p = 0.16). Heterogeneity was substantial-to-extreme for several outcomes and was only partially accounted for by leave-one-out sensitivity analyses. All findings were rated as very low certainty according to the GRADE framework. Conclusions: Robotic-assisted splenectomy in pediatric patients has been reported as technically feasible and performed safely in selected cases. However, the small number of studies, their retrospective design, substantial methodological heterogeneity, and the resulting very low certainty of the evidence according to GRADE preclude any firm conclusions about its comparative safety or efficacy versus laparoscopy. Well-designed prospective studies are needed to clarify its clinical benefits. Full article

Background and Clinical Significance: Preoperative planning is crucial for improving surgical safety and outcomes, particularly in minimally invasive surgery, where tactile feedback is absent. Three-dimensional (3D) printing offers patient-specific anatomical models that can enhance surgical planning. Its application in diverticular disease remains underexplored. Case Presentation: We present the case of a 65-year-old male with recurrent diverticulitis involving the sigmoid and descending colon. After conservative management of an acute episode, preoperative imaging revealed extensive diverticulosis. A patient-specific 3D-printed model was created from CT images to plan the surgical approach. The model helped determine the need for a left hemicolectomy rather than a simple sigmoidectomy, anticipated technical challenges such as lowering the left colic flexure and ligating the inferior mesenteric artery, and improved patient counseling. The surgery was performed laparoscopically without complications, and the patient was discharged on postoperative day six. Histology confirmed diverticulosis with perivisceritis and reactive lymphadenitis. Conclusions: This case demonstrates the potential of 3D printing to optimize surgical planning in diverticular disease, enabling tailored resections and improving operative strategy. Broader adoption may be limited by time and cost but offers clear educational and clinical benefits. Full article

Background: Chronic post-surgical pain (CPSP) is a phenomenon that negatively influences patients’ quality of life and well-being. By definition, CPSP is a pain in the surgical area of injury that develops or increases after the operation and persists beyond the healing process. One of the populations that is especially vulnerable to CPSP is patients undergoing bariatric surgery, as obesity, chronic inflammation, pre-existing chronic pain, and severe postoperative pain are its risk factors. Therefore, we conducted a cross-sectional study assessing the prevalence of CPSP in patients undergoing laparoscopic sleeve gastrectomy (LSG). We also aimed to explore the potential influence of the promising opioid-free anesthesia (OFA) technique, assess if the CPSP after LSG had a potential neuropathic component, and additionally, determine whether the bariatric surgery altered chronic pain in this patient population. Methods: The study was registered on 11 November 2024, at ClinicalTrials.gov (NCT06686875). A cross-sectional study using e-survey.io was conducted among the patients who underwent LSG 3 months to 5 years earlier. Clinical data were retrieved from the hospital database. Results: Of the 135 patients who responded to our e-survey, 4.4% (n = 6, 95% CI 0.9–8%) reported CPSP. None of them had a PAIN DETECT score above 19, which would indicate a neuropathic component. Of the 32 patients who had pre-existing chronic pain, 31 reported a reduction in its intensity, and of the 16 patients on chronic opioid treatment, 10 discontinued opioid therapy. In a subgroup analysis, there was no significant difference in the prevalence of CPSP and long-term opioid therapy between the patients who had OFA and standard anesthesia (p > 0.05). Conclusions: The main finding of our study is that a minor, yet significant, portion of patients who underwent LSG develop CPSP, and OFA does not alter the risk. LSG appears to reduce pre-existing chronic pain and opioid use. Full article

Background: Endometrioma recurrence after laparoscopic cystectomy remains a clinical challenge in the long-term management of endometriosis. The Empressin Injection Technique (EIT), which involves the use of a vasopressin analog during surgery, may reduce recurrence by improving the completeness of cyst removal. This study aimed to evaluate the impact of the EIT on recurrence rates compared to standard cystectomy without Empressin. Methods: We conducted a retrospective case–control study of 263 patients who underwent laparoscopic cystectomy for unilateral or bilateral endometriomas between 2014 and 2024 at a tertiary endometriosis referral center. The patients were divided into two groups: EIT (n = 110) and control (n = 153). In the EIT group, 10 mL of diluted Empressin (1 mL in 100 mL NaCl 0.9%) was injected at the cyst capsule–ovarian cortex interface prior to stripping. Demographic and clinical variables were analyzed using descriptive statistics (chi-square test and the Mann–Whitney t-test) and logistic regression to identify factors associated with recurrence between the two groups. Results: No significant differences were found between the groups regarding age, BMI, #ENZIAN O score, or r-ASRM stage. No intraoperative or postoperative complications were reported. Recurrence was significantly lower in the EIT group (5.5%) compared to the control group (19.6%) (p = 0.001; OR 0.2, 95% CI: 0.08–0.55). Hormonal therapy was administered postoperatively in 69.1% of EIT patients and 62.5% of controls. Pregnancy rates were comparable between the groups. Repeat surgery for recurrence was required only in the control group (4.2%, p = 0.004). Conclusions: Use of Empressin during laparoscopic cystectomy significantly reduces endometrioma recurrence without adverse effects, particularly when combined with postoperative hormonal therapy. Full article

Background/Objectives: For surgical candidates with metastatic renal cell carcinoma with a tumor thrombus (mRCC-TT), surgery is cytoreductive nephrectomy with tumor thrombectomy (CN-TT). This is carried out through an open (OCN-TT), laparoscopic (LCN-TT), or robotic (RCN-TT) approach. The purpose of this study was to compare survival outcomes to CN-TT by operative approach. Methods: This was a retrospective analysis of all patients with a diagnosis of mRCC-TT, who underwent CN-TT from a multi-institutional database from 1999–2024. Metastatic locations were qualified as either lung, bone, brain, liver, retroperitoneum, adrenal, paraaortic nodes, or other nodes. Progression was defined as radiographic evidence of recurrence or metastasis not seen on imaging prior to CN-TT. Progression locations were all metastatic locales previously noted plus the nephrectomy bed. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) were calculated. Comparisons were performed between OCN-TT, LCN-TT, and RCN-TT. Results: A total of 131 patients were included in the analysis (97 OCN-TT, 25 LCN-TT, and 9 RCN-TT). The TT level was not different (p-value > 0.05) by approach (p-value > 0.05). Preoperative tumor size, final pathologic tumor subtype, and postoperative tumor size were equivalent between the three surgical approaches (p-value > 0.05). Rates of progression were equivalent as were all locations of disease progression in the study (p-value > 0.05). Median OS was 1.6 years in OCN-TT, 1.5 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.42). Median CSS was 2.1 years in OCN-TT, 3 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.86). PFS was 0.8 years in OCN-TT, 1.2 years in LCN-TT, and 1.2 years in RNC-TT (p-value = 0.76). Conclusions: The operative approach does not affect survival outcomes for CN-TT. Surgeon comfort and patient preference should weigh heavily in operative decision making. Full article

Obesity and bariatric surgery are both associated with disrupted iron homeostasis. These alterations may be mediated by newly identified iron metabolism regulators. The aim of this study was to conduct a short-term, detailed analysis of hepcidin, soluble hemojuvelin, ferroportin, and erythroferrone—as well as whole-body composition—before and five months after sleeve gastrectomy. This approach may help elucidate the potential impact of bariatric surgery on iron metabolism and the timing of these changes. The study included 40 obese patients aged 26–64 eligible for laparoscopic sleeve gastrectomy. Iron parameters were assessed with immunoenzymatic methods. We found significantly increased iron levels (79 µg/dL vs. 95 µg/dL, p = 0.0016) as well as reduced hepcidin concentrations five months after bariatric surgery (54.46 ng/mL vs. 33.88 ng/mL, p = 0.0177). The change in the reduction in mean body fat (delta MBF) and body fat percentage (delta BPF) was positively associated with delta hepcidin levels with correlation coefficients of R = 0.36 (p = 0.0228) for MBF and R = 0.42 (p = 0.0070) for BPF. Moreover, significant correlations were observed between the reduction in body fat and soluble hemojuvelin (R = 0.31 p = 0.0489 for MBF) (R = 0.45 p = 0.0032 for PBF). No patient showed laboratory signs of iron deficiency. Decreased serum hepcidin levels observed five months after sleeve gastrectomy are associated with improved iron status, as indicated by increased serum iron and red blood cell indices. Positive correlations between body fat reduction and both hepcidin and soluble hemojuvelin levels suggest that the resolution of adipose tissue-related inflammation may contribute to improved iron bioavailability. Full article

Background: Neuraxial anesthesia, delivered as a combined spinal–epidural without intubation or neuromuscular blockade, is a promising alternative for patients undergoing minimally invasive colorectal surgery. Evidence is limited to case series, with no cohort studies available. Methods: This is a retrospective analysis of consecutive patients undergoing minimally invasive colorectal surgery for both benign and malignant disease at a single institution, between October 2022 and October 2024. Patients were divided by the type of anesthesia. Propensity score matching was performed to reduce confounding bias. Outcomes assessed included anesthesiologic preparation time, duration of surgery, intraoperative features, intensive care unit admission, length of hospital stay, and 90-day postoperative complications, including anastomotic leak and readmission rates. Results: Thirty-two patients (40.5%) received neuraxial anesthesia and forty-seven (59.5%) received general anesthesia. No conversions from neuraxial to general anesthesia occurred. After matching, anesthesia preparation time was longer in the neuraxial group (42.5 vs. 30 min, p = 0.011), while operative time was significantly shorter (181 vs. 231 min, p = 0.002). Length of stay, postoperative complications, including leak, and readmission rates were comparable between groups. Conclusions: Neuraxial anesthesia may be a valid alternative to general anesthesia for minimally invasive colorectal surgery. In this single-center experience, it required longer anesthetic preparation but was associated with shorter operative times, without affecting surgical outcomes or increasing complication rates. These results support further investigation into its application in colorectal procedures. Full article

Management of complex and recurrent ureteral stricture disease remains one of the more challenging aspects of reconstructive urology. While standard techniques such as ureteroureterostomy, psoas hitch, Boari flap, and ileal ureter creation serve as the foundation of ureteral reconstruction, each technique has limitations, particularly when faced with recurrence, long strictures, and previously irradiated fields. Two alternative techniques—buccal mucosal graft (BMG) ureteroplasty and appendiceal onlay/interposition—have been previously described and are now being utilized more frequently in recent years. Furthermore, the advancement of robotic-assisted laparoscopic surgery has allowed for even more reconstructive capabilities. BMG ureteroplasty and appendiceal onlay/interposition can serve as valuable augmentations to the aforementioned surgical techniques. BMG has now long been established in urethral reconstruction and serves as a viable graft option for longer segment ureteral strictures, given its panvascular lamina propria and epithelium well-suited to a wet environment. Similarly, the appendix has other uses in urologic surgery, including the Mitrofanoff channel in pediatric surgery, and is chiefly used in right-sided ureteral stricture repair. Both of these techniques allow the surgeons to take on more complex ureteral stricture cases and avoid the morbidity of bowel harvest. In this perspective, we argue for a broader recognition and adoption of BMG and appendiceal onlay/interposition in ureteral reconstructive surgery. In this article, we highlight the rationale for use, technical considerations, outcomes, and clinical evidence suggesting their advantages over traditional approaches. By incorporating these techniques into practice, urologists can expand their ability to manage more complex ureteral stricture cases with improved outcomes. Full article

Background/Objectives: Hysterectomy is the most common gynecologic surgical procedure. While extensive research has been conducted on the advantages of laparoscopy, the gynecology literature lacks sufficient studies on scar-related outcomes, patient satisfaction, and cosmetic outcomes. In this regard, this study aimed to compare cosmetic outcomes and patient satisfaction between laparotomy and laparoscopic hysterectomy cases performed at our tertiary university hospital center. Methods: Patients who underwent hysterectomy for benign gynecologic reasons were included in the study. The study group consisted of patients who had surgery via the laparoscopic technique, while the control group comprised patients who had laparotomy through a transverse abdominal incision (Pfannenstiel). Postoperative scar areas, scar thickness, color, height, and pain scores were evaluated after the 12th postoperative month. A digital caliper was used to calculate the scar area. Scar satisfaction and general body perceptions were assessed using questionnaires. Results: The mean scar area was significantly lower in the study group (p = 0.003). The physician’s scar assessments revealed no significant differences between the Manchester Scar Scale, POSAS Observer Scale, Vancouver Scar Scale, and SCAR Scale. The mean POSAS Patient Scale score, which assesses patients’ opinions of postoperative scars, was significantly lower in the study group than in the control group. In contrast, the Body Image Questionnaire score was higher (p < 0.01). There were no significant differences between the groups in mean Rosenberg Self-Esteem Scale and Body-Cathexis Scale scores. Conclusions: The patients in the study group were more satisfied with their scars but less satisfied with their body image. Contrary to general expectations, the patients were found to be less satisfied with the visible scar outcomes on the abdominal wall resulting from multi-port surgical procedures. Studies are needed to inform patients about scars before operations, select ports for use during operations, and evaluate the effect of the port-site surgical repair technique on cosmetic outcomes. Full article

Background: Acute cholecystitis (AC) is characterized by gallbladder inflammation and is commonly accompanied by disordered gallbladder motility. Although laparoscopic cholecystectomy is the standard treatment, it carries procedure-related risks. Low-intensity pulsed ultrasound (LIPUS), a safe and noninvasive modality widely applied for muscle repair, may offer therapeutic benefits for AC-associated motility dysfunction. Methods: In vivo, LIPUS (0.5 W/cm²) was applied for 15 min daily to acute cholecystitis guinea pigs over three consecutive days, starting 24 h after reversing common bile duct ligation (CBDL) surgery. In vitro, LIPUS (0.5 W/cm²) was delivered for 5 min to isolated gallbladder muscle strips and for 30 s to isolated interstitial cells of Cajal (ICCs). Gallbladder function and histology were assessed in vitro and in vivo using immunofluorescence, Western blotting, calcium imaging, muscle strip contractility testing, and related molecular methods. Results: LIPUS increased intracellular Ca²⁺ by activating the Ano1 channel in ICCs, thereby enhancing gallbladder smooth muscle contractility. At 72 h, the LIPUS 72 h (+) group showed a 71.3% increase in gallbladder muscle tone (p = 0.0001) and a 40.7% reduction in inflammation scores (p = 0.0001) compared with the LIPUS 72 h (−) group. Conclusions: LIPUS alleviates gallbladder contractile dysfunction in acute cholecystitis by acting on ICCs through mechanisms involving the promotion of ICC recovery and a reduction in inflammation. Full article