Search Results (69)

Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, with over 20 million cases annually. The evolution of hernia surgery has transitioned from tension-based techniques to tension-free approaches, significantly reducing recurrence rates. This review explores the history, advancements, and current trends in minimally invasive inguinal hernia repair, focusing on laparoscopic techniques such as transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted repair. The importance of prosthetic meshes is emphasized, detailing their mechanical properties, pore size, weight classifications, and biocompatibility. Additionally, various mesh fixation methods—including tacks, sutures, and glues—are analyzed, with a discussion on their impact on postoperative complications such as chronic pain, adhesions, and infection risk. The debate between TAPP and TEP techniques is examined, highlighting the ongoing quest to determine the most effective approach. Emerging advancements, including drug-loaded meshes and dual-layered prosthetics, aim to improve integration and reduce complications. Despite significant progress, no universally superior technique or mesh exists, underscoring the need for individualized surgical approaches. Future research should focus on optimizing materials, refining fixation strategies, and enhancing patient outcomes in minimally invasive hernia repair. Full article

Novel laparoscopic optical forceps (OFs), developed and patented by the University of Bari Aldo Moro (EP4119030, Bari, Italy), were designed to enhance safety and efficiency during laparoscopic ovariectomy in dogs by enabling atraumatic ovarian suspension and surgical maneuvers. This study aimed to describe the design, prototyping, sterilization validation, and preliminary clinical evaluation of this instrument. Prototypes were fabricated using ABS-like Pro resin via LSPc 3D printing. EtOx (ethylene oxide) sterilization proved to be the only effective method ensuring both microbiological safety and material integrity after 25 cycles. A randomized clinical trial involving 36 female dogs compared the OFs with conventional extracorporeal suture (ES) suspension using two-port laparoscopic ovariectomy. Surgical performance was assessed via operative times and complication rates. The OF group demonstrated significantly reduced ovariectomy (7.5 ± 1.6 min vs. 23.7 ± 7.6 min, p < 0.01) and overall surgical (14.2 ± 1.7 min vs. 30.4 ± 7.4 min, p < 0.01) times. No intraoperative complications occurred in the OF group, while the ES group exhibited instances of needle breakage, multiple suture attempts, and increased bleeding. The OFs enabled surgical maneuvers and ovarian suspension without requiring additional incisions or complex techniques, offering ergonomic advantages and compatibility with standard optics. These findings support the OFs as a promising tool to simplify and improve minimally invasive ovariectomy in veterinary surgery. Full article

Objectives: This study aimed to compare the impact of robotic (RO) versus laparoscopic single-site ovarian cystectomy (LO) on ovarian reserve, as measured by changes in anti-Müllerian hormone (AMH) levels. Methods: A total of 43 women undergoing LO and 40 women undergoing RO for mature cystic teratoma were included. The baseline characteristics and surgical outcomes were scrutinized. AMH levels were evaluated preoperatively and at 3 months after surgery. Results: BMI (body mass index) was higher in the LO group (23.1 ± 3.6 cm vs. 21.7 ± 2.1 kg/m², p = 0.03) than in the RO group. Otherwise, there were no statistically significant differences in patient characteristics. The LO group showed a shorter operative time (70.0 ± 24.0 vs. 86.5 ± 26.7 min, p = 0.002) than the RO group., However, multiple linear regression analysis revealed that BMI was independently associated with increased operative time (p = 0.001), while the surgical method was not a significant predictor (p = 0.725). There were no significant differences in the rate of decline in AMH level between the LO and RO groups (13.3 ± 21.2 vs. 4.64 ± 34.1%, p = 0.167). There were intergroup differences in the hemostasis method: in the LO group, bipolar coagulation was performed for 27 (62.8%) patients, and sutures were performed for 16 (37.2%) patients; in the RO group, bipolar coagulation was performed for 5 (12.5%) patients, and sutures were performed for 33 (82.5%) patients, while in the case of 2 (5.0%) patients, hemostasis was not performed (p < 0.001). However, note that in our logistic regression analysis, the hemostasis method was excluded as an independent factor affecting AMH. Conclusions: There appear to be no significant advantages of RO over LO in terms of ovarian reserve preservation. Full article

Background/Objectives: Barbed sutures have been recognised to offer numerous advantages compared to traditional sutures in minimally invasive procedures including holding tension. However, they are also associated with increased reports of small bowel obstructions (SBOs) in laparoscopic procedures. We are the first to conduct a review on the incidence of SBOs secondary to the use of barbed sutures in robotic surgery. Our aim is to raise awareness about this rare complication and promote early recognition and timely intervention, leading to a reduction in the incidence of severe complications and thereby improving patient outcomes. Methods: A systematic review of the literature was performed by searching the Ovoid Medline, PubMed and Cochrane Databases. After applying our exclusion criteria of articles unavailable in English, seven articles remained. We examined the literature and calculated the median and mean ranges for surgical procedures, time to presentation, symptoms of presentation, type of complications involving the bowel, the type of barbed suture and the additional length of hospital stay. Results: Our systematic review revealed eight cases of bowel obstruction secondary to the use of a barbed suture during robotic surgery. Robotic sacrocolpopexy had the highest complication rate: the median time to presentation was 14 days with vomiting being the most common presenting symptom. Most cases were resolved with a diagnostic laparoscopy and truncation of the barbed suture, and length of re-admission was a median of 4 days. Discussion: The introduction of new devices always carries advantages as well as unfortunate complications. Minimisation of complications through learnt surgical techniques including shortening thread tails and prompt recognition of the complication on re-presentation are key to optimising future patient care. Conclusions: Further prospective trials in this field will be useful to assess the appropriate use of the barbed suture as well as research dedicated to exploring alternate adhesive sutures. Full article

Background and Objectives: Total laparoscopic hysterectomy (TLH) is a commonly performed gynecological procedure. Vaginal cuff closure significantly impacts operative time and outcomes. This study evaluates the newly developed Anchorflow Suture (AFS) technique compared to conventional continuous suturing in terms of efficiency and safety. Materials and Methods: A multicenter retrospective cohort study was conducted at two tertiary referral hospitals involving 208 women who underwent TLH for benign indications. Women were divided into two groups based on vaginal cuff closure technique: AFS and continuous suturing. Demographic characteristics, surgical parameters, and postoperative outcomes were analyzed using appropriate statistical tests, with a significance level of p < 0.05. Results: No significant differences were found between groups in age, BMI (body mass index), gravida, parity, or menopausal status. Vaginal cuff closure time was significantly shorter with AFS (10.26 ± 2.3 min) compared to continuous suturing (13.36 ± 2.8 min, p < 0.001). Operative time was shorter in the AFS group, though not statistically significant (p = 0.15). Both techniques demonstrated similar safety profiles, with no cases of vaginal cuff dehiscence and comparable rates of granulation tissue formation, bleeding, and urinary incontinence. The AFS group showed a slightly lower incidence of postoperative bleeding (five cases vs. three cases). Conclusions: The AFS technique significantly reduces vaginal cuff closure time and demonstrates a comparable safety profile to continuous suturing. This method enhances surgical efficiency without increasing complications. Further prospective studies are needed to evaluate its long-term effects on pelvic floor integrity, sexual function, and surgeon proficiency. Full article

Background: Colorectal surgery remains a cornerstone in the management of colorectal cancer, yet postoperative complications continue to impact surgical outcomes. This study investigates key risk factors influencing morbidity, focusing on patient comorbidities, tumor characteristics, surgical techniques, and anastomotic methods. Methods: A retrospective analysis was conducted on 195 patients who underwent colorectal cancer surgery between January 2021 and December 2024 at the Clinical Hospital of Nephrology “Carol Davila”. Variables analyzed included patient demographics, comorbidities, tumor staging, surgical approach, and postoperative complications. Statistical methods included chi-square tests and multivariate logistic regression (significance threshold: p < 0.05). Results: The overall complication rate was 21%, with anastomotic leakage observed in 8.2% of cases. Significant risk factors for morbidity included cardiovascular disease (p = 0.001), chronic respiratory failure (p = 0.003), and chronic renal failure (p = 0.002). Laparoscopic surgery had a lower complication rate (7.1%) than open surgery (28%) (p = 0.003). Mechanical anastomosis showed lower complication rates than manual suturing (p = 0.009). Left-sided resections were associated with higher morbidity than right-sided procedures (p = 0.013). Conclusions: Optimizing colorectal surgery outcomes requires personalized perioperative strategies. Laparoscopic approaches and mechanical anastomosis significantly reduce complications. Further multicenter studies are needed to confirm these findings and enhance surgical guidelines. Full article

Introduction: Congenital duodenal atresia (DA) (Type I) with a fenestrated web can be characterized by a late presentation with a delayed diagnosis. It is even rarer and usually associated with proximal duodenomegaly. Conventional management involves web resection and duodeno–duodeno anastomosis with or without duodenoplasty. We describe our mininvasive surgical strategy and management, detailing the aspects of laparoscopic techniques. Material and Methods: We retrospectively reviewed the medical records of five patients affected by fenestrated duodenal web (DA) with a delayed onset of symptoms and diagnosis who were managed in our Department over a period of 10 years (2013–2023). We analyzed the age of patients at diagnosis, clinical signs and symptoms, associated congenital anomalies, radiological and intraoperative findings, surgical treatment, and outcomes. Diagnostic examinations included ultrasound (US), Upper-Gastrointestinal Study (UGI), and Esophagogastroduodenoscopy (EGDS). Results: Three boys and two girls, median age of 5.5 months (range 3–11 months), were included in this study. Three underwent previous surgery for long-gap esophageal atresia (EA), two of Type A, and one of Type C, requiring a gastrostomy immediately after birth (delayed esophageal repair for prematurity in Type C) and subsequent delayed primary anastomosis. Major associated anomalies were EA (3), anterior ectopic anus (1), cloaca (1), and Type IV laryngeal web (1). An antenatal diagnostic suspicion of duodenal atresia (obstruction) on ultrasound was described in two patients. UGI suggested a fenestrated duodenal web, visualized at ultrasound in two patients. Duodenal dilation was associated in two cases. The symptoms were feeding difficulties, nonbilious vomiting, upper abdominal distension, and poor growth. All presented with a pre-ampullary obstruction. Endoscopic confirmation was only possible in one patient. The older patient underwent an endoscopic resection of a duodenal web. In the other four, we performed a laparoscopic longitudinal antimesenteric duodenal incision, web resection (excision), and transverse suture (closure was performed) without duodenoplasty. Intraduodenal Indocyanine Green (ICG) visualization (under near-infrared light) was used in the last two cases. No postoperative complications were recorded, with a mean hospital stay of 8 days. A contrast study performed at 4 weeks demonstrated an improved proximal duodenal profile; patients tolerated a full diet and remained symptom-free. Conclusions: According to our experience with minimally invasive techniques, laparoscopy and endoscopy are effective and safe, supporting web resection for the management of a duodenal web without tapering of the proximal duodenum. They require advanced technical skills. Intraduodenal-ICG injection during laparoscopic treatment of Type 1 DA allows localization of the duodenal web, confirmation of bowel patency (bowel canalization) and the tightness of suture. Full article

The portosystemic shunt is characterized by the presence of an anomalous vessel, whether congenital or acquired, that connects the portal circulation to the systemic circulation. Surgical treatment is indicated in congenital cases and involves the progressive occlusion of the anomalous vessel. The objective of this study is to report the use of an innovative and fully laparoscopic technique for the attenuation of a gastrophrenic shunt. The procedure was performed on a two-year-old female German Spitz dog with a history of frequent vomiting and diarrhea. The diagnosis was established through computed tomography. For the procedure, three portals were placed in the left lateral region, employing an ameroid constrictor. This device featured a specific perforation for the passage of a pre-mounted suture, which was subsequently occluded intracorporeally, facilitating the closure of the ring defect. The absence of flow in the anomalous vessel was confirmed five weeks after the procedure. It is concluded that the reported implantation technique represents a new modality for the treatment of this type of shunt using a minimally invasive approach. Full article

Background and Objectives: Vaginal cuff dehiscence (VCD) represents a rare but relevant complication that occurs following minimally invasive hysterectomy. With the rising frequency of this procedure, it is crucial to continuously evaluate VCD incidence, risk factors, and prevention strategies. This systematic review and meta-analysis aimed to update the evidence on VCD incidence and to assess the role of various surgical techniques and materials adopted for vaginal cuff closure. Materials and Methods: A systematic literature search was conducted in PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library for studies published up to January 2025. Eligible studies reported VCD rates after laparoscopic or robotic hysterectomy for benign conditions and compared different closure techniques. The primary outcome was the incidence of VCD across closure methods, while secondary outcomes included potential risk factors. A random-effects model estimated pooled VCD rates with 95% confidence intervals (CI), and heterogeneity was assessed using I² tests. Results: Twenty-six studies involving 10,039 patients were analyzed. The overall pooled incidence of VCD was 0.7% (95% CI: 0.4–1.1%), with higher estimates in randomized controlled trials (RCTs) (1.4%) compared to non-RCTs (0.5%). Robotic-assisted hysterectomy had a pooled VCD rate of 1.7%, compared to laparoscopic hysterectomy at 0.7%. Although not statistically significant, transvaginal closure showed a higher VCD risk than laparoscopic closure (2.3% vs. 1.16%; OR 0.97, 95% CI, 0.33–2.82; OR 2.53 (95% CI, 1.10–5.82) when considering only RCTs), and barbed sutures showed a lower VCD incidence (0.35%) than conventional sutures (1.52%) (OR 0.37, 95% CI, 0.13–1.02). Smoking was identified as a significant risk factor for VCD, while the impact of early postoperative sexual activity remains inconclusive. Conclusions: Laparoscopic closure rather than transvaginal cuff closure and barbed sutures were neither significantly associated with reducing VCD risk. Emphasizing smoking cessation preoperatively is essential for VCD prevention. Future studies should investigate the effects of postoperative sexual activity and refine surgical techniques to minimize VCD risk and improve outcomes. Full article

Background: Artificial Intelligence (AI)-driven training systems are becoming increasingly important in surgical education, particularly in the context of laparoscopic suturing. This systematic review aims to assess the impact of AI on skill acquisition, long-term retention, and clinical performance, with a specific focus on the types of machine learning (ML) techniques applied to laparoscopic suturing training and their associated advantages and limitations. Methods: A comprehensive search was conducted across multiple databases, including PubMed, IEEE Xplore, Cochrane Library, and ScienceDirect, for studies published between 2005 and 2024. Following the PRISMA guidelines, 1200 articles were initially screened, and 33 studies met the inclusion criteria. This review specifically focuses on ML techniques such as deep learning, motion capture, and video segmentation and their application in laparoscopic suturing training. The quality of the included studies was assessed, considering factors such as sample size, follow-up duration, and potential biases. Results: AI-based training systems have shown notable improvements in the laparoscopic suturing process, offering clear advantages over traditional methods. These systems enhance precision, efficiency, and long-term retention of key suturing skills. The use of personalized feedback and real-time performance tracking allows learners to gain proficiency more rapidly and ensures that skills are retained over time. These technologies are particularly beneficial for novice surgeons and provide valuable support in resource-limited settings, where access to expert instructors and advanced equipment may be scarce. Key machine learning techniques, including deep learning, motion capture, and video segmentation, have significantly improved specific suturing tasks, such as needle manipulation, insertion techniques, knot tying, and grip control, all of which are critical to mastering laparoscopic suturing. Conclusions: AI-driven training tools are reshaping laparoscopic suturing education by improving skill acquisition, providing real-time feedback, and enhancing long-term retention. Deep learning, motion capture, and video segmentation techniques have proven most effective in refining suturing tasks such as needle manipulation and knot tying. While AI offers significant advantages, limitations in accuracy, scalability, and integration remain. Further research, particularly large-scale, high-quality studies, is necessary to refine these tools and ensure their effective implementation in real-world clinical settings. Full article

Renal masses are uncommon during pregnancy; they represent the most frequently encountered urological cancer in pregnant patients and require careful surgical planning. The introduction of robotic surgical systems aims to address these challenges by simplifying intra-corporeal suturing and reducing technical complexity. Robot-assisted laparoscopic renal surgery offers potential benefits over both open surgery and conventional laparoscopy, providing greater precision and reduced invasiveness, particularly in tumor excision and suturing. Although urological tumors during pregnancy are rare, early detection significantly improves outcomes by enabling intervention before the tumor advances and while the uterus remains relatively small. The decision regarding the timing and necessity of surgery in pregnant patients requires a careful assessment of maternal health, fetal development, and the progression of the disease. Risks for adverse pregnancy outcomes should be explained, and the patient’s decision about pregnancy termination should be considered. Radical nephrectomy or nephron-sparing surgery are essential treatments for the management of renal tumors. Effective management demands close collaboration between a multidisciplinary team and the patient to ensure individualized care. The aim of this review was to evaluate the renal tumors during pregnancy in terms of epidemiology, risk factors, diagnosis and the safety of a robot-assisted laparoscopic approach in the management of these tumors. Full article

The clinical outcomes of laparoscopic-assisted ovariohysterectomy for the treatment of hydrometra or pyometra in small-sized dogs have not been reported. This study aimed to retrospectively investigate the clinical outcomes of two-port laparoscopic-assisted ovariohysterectomy in small-sized dogs weighing < 6 kg with mild to moderate hydrometra or pyometra. Laparoscopic ports were placed at the umbilicus on the midline, as well as at the midpoint between the umbilicus and pelvic brim. While the uterine horn was externally retracted, the cervical region was ligated and transected. A total of 77 dogs were included, with a median age of 8.8 years (range: 10 months to 16.1 years) and a median weight of 3 (range: 1.26–6.0) kg. Clinical signs included lethargy, anorexia, polydipsia, and polyuria; 51 dogs (66%) were asymptomatic, with an enlarged uterus incidentally detected during health checkups. Histopathological analysis revealed hydrometra and pyometra in 51 and 26 dogs, respectively. The median operative time was 32 (range: 15–83) minutes, and the median hospital stay was 0 (range: 0–3) days. No intraoperative complications occurred, although 18 dogs experienced anorexia postoperatively, and 3 showed signs of incision site infection. All sutures were removed 7–10 days postoperatively, and all dogs were clinically healthy at the two-week follow-up. The findings indicate that two-port laparoscopic-assisted ovariohysterectomy is a safe and effective treatment option for managing mild to moderate hydrometra and pyometra in small-sized dogs. Full article

Background/Objectives: The aim of this study is to evaluate the impact of modified Blumgart anastomosis methods during pancreaticojejunostomy (PJ) on the incidence of clinically relevant postoperative pancreatic fistula (POPF) after laparoscopic pancreaticoduodenectomy (LPD). Methods: This is a retrospective cohort study analyzing data of patients who underwent LPD from 2018 to 2022. The primary endpoint was the incidence of grade B and C POPF based on the International Study Group on Pancreatic Fistula criteria and PJ anastomosis time. Incidence of postoperative complications (Clavien–Dindo classification grade ≥ III) was also investigated. Results: A total of 148 patients, 99 patients in a modified Blumgart group and 49 patients in a continuous suture group, were enrolled. There were no statistically significant differences in the general and intraoperative characteristics found between the two groups (p > 0.05). There was no significant difference in pancreas texture (p = 0.397) and diameter of pancreatic duct (p = 0.845). Grade B and C POPF occurred in five patients (5.1%) in the modified Blumgart group and three patients (6.1%) in the continuous suture group with no statistical difference (p = 0.781). A total of eleven patients (11.1%) in the modified Blumgart group and four patients (8.2%) in the continuous suture group had postoperative complication (Clavien–Dindo Classification grade 3 or more). Mortality within 90 days was 2 (2%) and 0 (0%), respectively. The PJ anastomosis times in the modified Blumgart group and continuous suture group were 28.8 ± 5.94 min and 35 ± 7.71 min, respectively (p = 0.003). Conclusions: This study suggests that modified Blumgart PJ showed shorter anastomosis time with comparable outcome to continuous suture methods in LPD. Full article

Recently, laparoscopic nephrectomy has become more popular in veterinary medicine. In the majority of these procedures, vascular sealing devices (VSDs) are used. These allow for the closure of renal vessels with advanced bipolar coagulation. However, until now, closure of the ureter was performed with mechanical clips or suturing. There is a lack of information in the literature about the possibility of VSDs being used for ureter closure. This article presents the possibility of renal vessels and ureter closure in cats and dogs with vascular sealing devices. Laparoscopic nephrectomy in dogs and cats was performed entirely with VSDs. Patients with unilateral hydronephrosis qualified for the procedure. The nephrectomies were completely performed using a laparoscopic approach. Both renal vasculature and ureter were closed with VSDs. Additionally, two resected ureters from operated cats underwent histopathological evaluation. Among the operated animals, there were no postoperative complications or signs in the urinary tract. Histopathological evaluation of two cats’ ureters showed lumen closure on the coagulation places. Vascular sealing devices, during laparoscopic nephrectomy, allow for closure of not only the renal vessels but also ureters. Full article

Background and Objectives: Evisceration and incisional hernia (IH) represent a significant morbidity following open or laparoscopic colorectal surgery where midline laparotomy or extraction incision (EI) are performed. We executed a systematic review to evaluate primary mesh closure of laparotomy or EI in colorectal resections of benign or malignant conditions. Methods: A comprehensive literature search was performed using PubMed, Science Direct, Cochrane, and Google Scholar databases for studies comparing prophylactic mesh to traditional suture techniques in closing laparotomy in open approach or EI when minimally invasive surgery was adopted in colorectal procedures, regardless of the diagnosis. Both IH and evisceration were identified as primary outcomes. Secondary outcomes included surgical site infections (SSI), postoperative seroma, and length of hospital stay (LOS). Results: Six studies were included in our analysis with a total population of 1398 patients, of whom 411 patients had prophylactic mesh augmentation when closing laparotomy or EI, and 987 underwent suture closure. The mesh closure group had a significantly lower risk of developing IH compared to the conventional closure group (OR 0.23, p = 0.00001). This result was significantly consistent in subgroup analysis of open laparotomy or EI of laparoscopic surgery subgroups. There was no statistically notable difference in evisceration incidence (OR 0.51, p = 0.25). Secondary endpoints did not significantly differ between both groups in terms of SSI (OR 1.20, p = 0.54), postoperative seroma (OR 1.80, p = 0.13), and LOS (MD −0.54, p = 0.63). Conclusions: primary mesh reinforcement of laparotomy or EI closure in colorectal resections lessens IH occurrence. No safety concerns were identified; however, further high-quality research may provide more solid conclusions. Full article