JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献

{"title":"Pelvic Organ Prolapse Mesh Graft Revision Surgery: Rates of Complication by Surgical Approach.","authors":"Mehr Jain, Jocelyn Stairs, Aisling Clancy","doi":"10.4293/JSLS.2025.00019","DOIUrl":"10.4293/JSLS.2025.00019","url":null,"abstract":"<p><strong>Objective: </strong>To determine complication rates after surgery for revision of pelvic organ prolapse mesh grafts, and to compare complication rates by surgical approaches.</p><p><strong>Methods: </strong>A retrospective, population-based cohort study was conducted using the American College of Surgeons National Quality Improvement Program database. Patients undergoing mesh revision by gynecology or urology were classified into vaginal, abdominal, or laparoscopic approaches. Patients having a revision of a midurethral sling were excluded. A multivariable logistic regression analysis was completed. The primary outcome was a composite of surgical complications excluding urinary tract infections. Severe Clavien-Dindo IV complications, rates of readmission, rates of reoperation and urinary tract infections were secondary outcomes.</p><p><strong>Results: </strong>Of 1,849 patients, 1,706 underwent vaginal, 78 underwent abdominal, and 65 underwent laparoscopic approach. The composite complication rate, excluding urinary tract infections, was 12.8% in the vaginal group, 21.8% in the abdominal group and 16.9% in the laparoscopic group (<i>P</i> = .052). Compared to a vaginal approach, the abdominal and laparoscopic groups had higher odds of complications (abdominal: adjusted odds ratio [OR] 2.70, 95% confidence interval [CI] 1.29-5.70; laparoscopic: adjusted OR 1.48, 95% CI 0.60-3.68). The abdominal and laparoscopic groups had higher odds of readmission compared to the vaginal group (abdominal: adjusted OR 2.36, 95% CI 0.81-6.90; laparoscopic: adjusted OR 4.12, 95% CI 1.49-11.40). Clavien-Dindo IV complications were rare and only seen after vaginal approach (0.4%, n = 6).</p><p><strong>Conclusion: </strong>Complications were least common after vaginal mesh graft revision surgery, as compared to an abdominal or laparoscopic approach. Serious complications were rare.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Following Surgery As the Main Intervention for Endometriosis in a Low Socioeconomic Setting.","authors":"Salma Moustafa, Liaisan Uzianbaeva, Swati Kumari, Oksana Pylypiv, Alireza Mehdizadeh, Daniel T Farkas, Pengfei Wang","doi":"10.4293/JSLS.2025.00003","DOIUrl":"10.4293/JSLS.2025.00003","url":null,"abstract":"<p><strong>Background and objective: </strong>To evaluate the perioperative and long-term outcomes of surgical management of patients with endometriosis at a community hospital in a low socioeconomic district.</p><p><strong>Methods: </strong>A total of 39 patients underwent surgical management for endometriosis between October 2022 and November 2024. Thirty-six patients were followed up for 1-24 months.</p><p><strong>Results: </strong>Among the 39 cases, 18 (42.6%) were identified incidentally in operations for other indications, while 21 (53.8%) were clinically diagnosed or confirmed with previous laparoscopy. Twelve (30.8%) cases were classified as stage I-II and 27 (69.2%) as stage III-IV. Surgical approaches included laparoscopy in 23 (59.0%) cases, robotic assistance in 13 (33.3%), and 2 cases were converted from laparoscopy to laparotomy. Advanced techniques utilized included ureterolysis, enterolysis, diaphragm resection, bowel shaving, bowel disc resection, segmental bowel resection, appendectomy, partial bladder cystectomy, and hypogastric nerve sparing. Intraoperative complications included 1 ureteral thermal injury and 1 bladder laceration. Postoperative complications consisted of 1 pyelonephritis and 1 incisional cellulitis. No complications related to urinary or bowel functional disorders occurred postoperatively. Among the 19 patients who regularly used pain medication before surgery, 16 patients discontinued pain medications, while 3 patients reduced their usage after surgery. Eight patients are actively trying to conceive, and 1 patient conceived spontaneously. Sixteen patients are receiving various forms of hormonal suppression.</p><p><strong>Conclusion: </strong>With excellent skills and collaboration, the surgical management of endometriosis resulted in minimal complications and optimal postoperative outcomes, significantly benefiting patients in low socioeconomic areas.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Surgical Robotic Skills Through Performance-Guided Training: A Swimmer's Approach for Defining Key Metrics.","authors":"Jeanne Dahmen, Yike Xu, Jeffrey P Spalazzi, Edward Chekan","doi":"10.4293/JSLS.2024.00066","DOIUrl":"https://doi.org/10.4293/JSLS.2024.00066","url":null,"abstract":"<p><strong>Background: </strong>In swimming, a combination of strength, endurance, and targeted skill training significantly enhances performance, particularly by balancing aerobic and anaerobic conditioning. Similarly, in surgery, improving motor control and stamina during lengthy operations, particularly for precise movements like suturing or tissue manipulation, is essential. This literature review aims to explore the parallels between the training paradigms of elite swimming and robotic-assisted surgical practice, focusing on skill acquisition, training methodologies, and performance-guided feedback systems. The hypothesis suggests a significant link between these training principles, offering opportunities to optimize surgeon training, particularly in robotic-assisted surgery.</p><p><strong>Database: </strong>A systematic review was conducted following PRISMA guidelines. A thorough examination of existing literature in both elite swimming and robotic-assisted surgery training identified key elements of skill development, feedback mechanisms, and structured progression. Sources included peer-reviewed studies on swimming techniques, cognitive training in surgery, and simulation-based training programs that emphasize performance-driven improvements.</p><p><strong>Conclusion: </strong>The review identified significant parallels between swimming and robotic-assisted surgery training, with both fields emphasizing structured, feedback-driven approaches to enhance precision and skill. Techniques such as video analysis in swimming and real-time digital feedback in surgery were found to be effective in improving outcomes. Simulation-based training also plays a crucial role in refining skills and promoting adaptability in both disciplines. Applying elite swimming methodologies, particularly those centered on feedback, precision, and structured progression, could help develop key metrics to enhance surgical training programs, in robotic-assisted surgery. Future research could further optimize surgeon training, potentially leading to improved performance and better patient outcomes in robotic procedures.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture Fixation of Levonorgestrel-Releasing Device Using the Hysteroscopic Surgery System.","authors":"Zhengwei Lai, Jin Dong, Ying Zhang, Jun Wu","doi":"10.4293/JSLS.2024.00076","DOIUrl":"https://doi.org/10.4293/JSLS.2024.00076","url":null,"abstract":"<p><strong>Background: </strong>The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely recognized method for contraception and the management of various gynecological conditions. However, the placement of LNG-IUS can be particularly challenging in patients with large or anatomically irregular uteri. The objective of this study was to evaluate the efficacy and safety of hysteroscopic cold-knife-assisted suture fixation of the LNG-IUS in the uteri of patients diagnosed with adenomyosis.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of patients who underwent LNG-IUS placement with the assistance of cold-knife hysteroscopy. The evaluation criteria included surgical success rates, postoperative complications, and subsequent follow-up of LNG-IUS.</p><p><strong>Results: </strong>Our findings indicated that LNG-IUS placement was successfully achieved with cold-knife hysteroscopy, even in cases characterized by large uterine volume or abnormal uterine morphology. The procedure demonstrated a low incidence of postoperative complications, with no instances of device expulsion or displacement. Additionally, it resulted in a reduction of vaginal bleeding and alleviation of dysmenorrhea.</p><p><strong>Conclusion: </strong>Hysteroscopic cold-knife-assisted suture fixation of LNG-IUS offers an effective solution for patients with a history of device expulsion, significantly reducing the expulsion rate and demonstrating high safety and efficacy.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Outcomes of Laparoscopic Radical Hysterectomy and Nerve-Sparing Technique in Cervical Cancer Patients.","authors":"Shailesh Puntambekar, Maitreyee Parulekar, Sneha Venkateswaran, Saranya Naidu, Madhavi Patil, Kshitij Manerikar, Suyog Bharambe, Mihir Chitale, Mangesh Panse, Ravindra Sathe, Seema Puntambekar","doi":"10.4293/JSLS.2024.00073","DOIUrl":"10.4293/JSLS.2024.00073","url":null,"abstract":"<p><strong>Objective: </strong>Aim was to analyze and compare the oncological outcomes, genitourinary quality of life (QOL), disease-free survival (DFS), and overall survival (OS) of patients treated by laparoscopic radical hysterectomy (LRH) and laparoscopic nerve-sparing radical hysterectomy (LNSRH) for early cervical cancer.</p><p><strong>Design: </strong>Retrospective study in patients of carcinoma cervix FIGO (2009) grade 1A to 2A1 from January 1, 2016 until the publication of Laparoscopic Approach to Cervical Cancer (LACC) trial in 2018, after which only 1A and 1B1 were included up to December 31, 2020.</p><p><strong>Setting: </strong>Total of 285 patients operated over 5 years at the center were placed in 2 groups, LRH and LNSRH, based on surgical approach.</p><p><strong>Measurements: </strong>Tumor characteristics, clinical profile, tumor clearance, histopathology, adjuvant treatment, period of follow-up and recurrence were compared. The QOL was analyzed in terms of bladder and sexual function.</p><p><strong>Results: </strong>LNSRH group had significantly faster recovery of bladder (lesser number of days required for PVR <50 mL, quicker catheter removal time, less requirement of self-catheterization, less incidence of urinary retention and incontinence) and sexual function as compared to LRH group. There was no significant difference in radicality of the procedure. None of them had vault recurrences. DFS at 5 years for LRH and LNSRH was 95.3% and 94.1%, respectively. OS at 2 years for LRH and LNSRH was 95.9% and 96.3%, respectively, whereas the OS at 5 years was 95.3% and 94.1%, respectively.</p><p><strong>Conclusion: </strong>LNSRH group had significantly better genitourinary QOL as compared to the LRH group without compromising on oncological clearance. The survival is comparable to the results of open surgery in LACC trial.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Management of Diverticular Colovaginal and Colovesical Fistulas.","authors":"Amanda D Rebic, Dante L S Souza, Angela N Fellner, Hamza Guend","doi":"10.4293/JSLS.2025.00009","DOIUrl":"https://doi.org/10.4293/JSLS.2025.00009","url":null,"abstract":"<p><strong>Background and objectives: </strong>Colovesical and colovaginal fistulas are a complication of diverticular disease that often requires surgical intervention. Minimally invasive surgery is associated with improved postoperative outcomes, but reported laparoscopic rates of conversion to open for these patients have been relatively high. There are limited studies evaluating robotic-assisted management of these fistulas. This study aims to report our single-center experience of robotic management of such fistulas, with the primary outcome being the conversion rate to open.</p><p><strong>Methods: </strong>All elective robotic sigmoid resections for diverticular colovaginal and colovesical fistulas performed from January 2018 to August 2023 were included. Patient demographic variables and 30-day postoperative outcomes were retrospectively collected.</p><p><strong>Results: </strong>Thirty-five patients were included, 21 with colovesical and 14 with colovaginal fistulas. Overall, the conversion to open rate was 8.6% (3 out of 35). All patients converted to open were patients with colovesical fistulas. Operating time (median of 354 vs 347 minutes, <i>P</i> = .583) and estimated blood loss (median of 100 vs 100 mL, <i>P</i> = .538) were similar for colovesical and colovaginal fistulas, respectively. Two patients required ostomy creation, both in the colovaginal group. Three patients in the colovesical group developed an ileus compared to one in the colovaginal group. There were 2 urinary tract infections (UTIs), both in the colovesical group. Thirty-day readmission (2 vs 1, <i>P</i> = .652) and length of stay (median 2 vs 2 days, <i>P</i> = .855) were similar for colovesical and colovaginal fistulas, respectively.</p><p><strong>Conclusion: </strong>Diverticular fistulas can be managed successfully with a robotic approach and appropriate surgeon experience, having minimal morbidity or complications.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Ultrasound-Guided Quadratus Lumborum Block Improve Pain after Hysterectomy.","authors":"Amro Elfeky, Nimra Dad, Adi Borovich, Allix Hillebrand, Shantel Jiggetts, Michael Silver, David Herzog, Lily Shamsnia, Scott Chudnoff, Lindsey Michel, Pedram Bral, Justin To","doi":"10.4293/JSLS.2025.00002","DOIUrl":"10.4293/JSLS.2025.00002","url":null,"abstract":"<p><strong>Objective: </strong>Determine whether the quadratus lumborum block (QLB) is an effective adjunct to control postoperative pain during the first 24 hours after minimally invasive hysterectomy.</p><p><strong>Methods: </strong>Prospective cohort observational study of patients who underwent laparoscopic or robotic hysterectomy. Patients either received a QLB or did not. Initial postoperative pain scores were recorded in the postanesthesia recovery area using a numeric rating scale. Patients were then called to collect 24-hour scores and analgesic medication usage. The primary outcome was the 3-hour pain score. Secondary analysis evaluated use of analgesic medication.</p><p><strong>Results: </strong>Fifty patients were enrolled in the study: 25 patients in the no-QLB cohort and 25 patients in the QLB group. The median postoperative pain scores (out of 10) were 4, 2, and 6 at 1, 3, and 24 hours in the no-QLB group. Scores were 5 (<i>P</i> = .541), 3 (<i>P</i> = .418), and 6 (<i>P</i> = .358), respectively, in the QLB group. A total of 11 of 25 patients at 1 hour, 8 of 25 patients at 3 hours, and 21 of 25 patients at 24 hours used analgesia postoperatively in the no-QLB group, compared to 11 of 25 patients at 1 hour (<i>P</i> = 1.0), 18 of 25 patients at 3 hours (<i>P</i> = .005), and 23 of 25 patients at 24 hours (<i>P</i> = .384) in the QLB group. Opioid, acetaminophen, and ibuprofen usage was not significantly different between groups.</p><p><strong>Conclusion: </strong>There was no significant pain difference between the no-QLB and QLB groups. Patients who received a QLB were more likely to receive pain medication 3 hours after surgery. Thus, the use of a QLB does not appear to be a suitable adjunct for postoperative pain.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Employment in America: Private Practices Dominate Despite Increased Hospital Employment.","authors":"Jesse L Popover, Trevor Jones, Chris Kalathia, Alexandra Mackey, Nathalie King, Emily Sardzinski, Zachary Oulton, Adnan Imam, Majd Al-Masri, Paul G Toomey","doi":"10.4293/JSLS.2025.00012","DOIUrl":"10.4293/JSLS.2025.00012","url":null,"abstract":"<p><strong>Objective: </strong>A common perception is that physician-owned practices are in decline in the United States. However, there has been a lack of recent academic research to comprehensively characterize these trends. Our aim is to assess the current trends in physician employment over the last 2 decades to assess the interplay between private practices and hospital employment.</p><p><strong>Methods and procedures: </strong>We analyzed data from the United States Census Bureau's Statistics of U.S. Businesses (SUSB) and the Bureau of Labor Statistics' Occupational Employment and Wage Statistics (OEWS). Industry classifications were defined under the North American Industry Classification System.</p><p><strong>Results: </strong>In 2022, the United States had 760,000 physicians, a 22% increase over the past decade. Hospital employment rose by 33%, while private medical practices grew by 17%. Currently, 55% of physicians work in private practices, down 3% from a decade ago, and 27% are hospital employed, up from 25% from a decade ago. Government employment decreased from 14% in 2013 to 12%. University employment remained stable (3%). There were 213,000 private medical practices in 2020, with 73% being small practices. There has been an increase in large practices(≥50 employees), while small practices (<50 employees) decreased by 16% over 2 decades.</p><p><strong>Conclusion: </strong>Private practices continue to be the dominant employment for physicians. Hospital employment over the last decade increased to just over one-quarter of employed physicians. Small private practices continue to be the most common type of private practice, despite an increase in larger private practices over the last decade.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Robotic Surgical Assistance: Shorten the Learning Curve for Urologic Oncology Cases.","authors":"Lixian Zhu, Dan Xia, Shuo Wang, Sunyi Ye","doi":"10.4293/JSLS.2025.00001","DOIUrl":"https://doi.org/10.4293/JSLS.2025.00001","url":null,"abstract":"<p><strong>Objective: </strong>While robotic surgery platforms are widely used, there is a dearth of literature on robotic assistants. This study aims to provide a comprehensive understanding of the role and functions of a valuable assistant in robotic surgery.</p><p><strong>Methods: </strong>The first author has garnered over 10 years of experience as an assistant at a high-volume urological center, where more than 10,000 robotic operations have been performed. This paper delves into the specific intricacies of how an assistant collaborates with the chief surgeon.</p><p><strong>Results: </strong>The assistant's primary responsibilities encompass ensuring the precise placement of trocars to facilitate the chief surgeon's manipulation of the robot and assisting in the optimal exposure of the surgical area according to the chief surgeon's requirements.</p><p><strong>Conclusions: </strong>The assistant assumes a pivotal role in robot-assisted surgery, necessitating a profound understanding of the chief surgeon's intentions and the ability to effectively expose the operative field.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Surgical Outcomes in Laparoscopic Sacral Hysteropexy with or without Retroperitoneal Tunneling.","authors":"Pei-Hsuan Lai, Wing Lam Tsui, Dah-Ching Ding","doi":"10.4293/JSLS.2024.00055","DOIUrl":"10.4293/JSLS.2024.00055","url":null,"abstract":"<p><strong>Background and objectives: </strong>To evaluate the effectiveness and impact of the retroperitoneal tunneling technique on the surgical time and outcomes of laparoscopic sacral hysteropexy (SHP) for treating pelvic organ prolapse (POP).</p><p><strong>Materials and methods: </strong>This is a retrospective single-center cohort study in a tertiary referral center. Thirty-two consecutive patients underwent laparoscopic SHP for apical prolapse between 2016 and 2023. Laparoscopic SHP with or without right pelvic side wall retroperitoneal tunneling. The primary outcome was surgical time. Secondary outcomes included blood loss, intra-and postoperative complications, length of hospital stay, postoperative pain scores, and improvement in POP quantification (POP-Q) scores. Statistical analyses were performed using t-tests and multiple regression. Statistical significance was set at <i>P</i> < .05.</p><p><strong>Results: </strong>The tunneling group (n = 14) demonstrated significantly shorter surgical times than the nontunneling (n = 18) group (60.79 ± 22.35 minutes vs 98.06 ± 26.28 minutes, <i>P</i> < .001). There were no significant differences between the groups regarding blood loss, intra-and postoperative complications, length of hospital stay, pain scores, or point-C positions during 3 months and 1 year of follow-up. Multiple regression analysis confirmed a significant reduction in surgical time in the tunneling group after adjusting for confounders (-62.36 minutes [95% confidence interval (CI) = -102.7, -21.99, <i>P</i> = .0038]).</p><p><strong>Conclusion: </strong>The retroperitoneal tunneling technique in laparoscopic SHP significantly reduces the surgical time without increasing the risk of complications. These findings suggest that tunneling is a safe and efficient method that can be routinely adopted for SHP.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}