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

{"title":"Impact of Body Mass Index on Operative Time in Women Undergoing Benign Hysterectomy.","authors":"A Caroline Cochrane, Evan Olson, Tim Craven, Erica F Robinson, Janelle K Moulder","doi":"10.4293/JSLS.2024.00024","DOIUrl":"10.4293/JSLS.2024.00024","url":null,"abstract":"<p><strong>Background: </strong>Optimization of surgical scheduling represents an opportunity to improve resource utilization and increase patient access. Increasing body mass index (BMI) has been associated with increased operating time and may provide an opportunity to more accurately predict operating time.</p><p><strong>Objective: </strong>To investigate the relationship between BMI and operative time for benign hysterectomy and develop a predictive model for hysterectomy operating time based on patient BMI.</p><p><strong>Methods: </strong>A secondary analysis of women undergoing benign laparoscopic, abdominal, or vaginal hysterectomy between 2014 and 2019 was performed using the American College of Surgeons National Surgical Quality Improvement Program database, N<i> </i>=<i> </i>117,691. Our primary outcome was log₁₀ transformation of operative time. Multivariable linear regression was used to analyze the relationship between operative time and BMI. A model to predict operating time was created using variables that could be reliably obtained preoperatively.</p><p><strong>Results: </strong>From our cohort, 22% of benign hysterectomies were performed abdominally, 16% were vaginal, and 62% were laparoscopic, and mean operative times were 144, 133, and 158 minutes, respectively. For every 10-unit increase in BMI, estimated mean operation time (OT) increased by 12.8%, 8.1%, and 6.5% for abdominal, vaginal, and laparoscopic hysterectomy, respectively. Neither an expanded nor a concise model was able to account for the variability in log₁₀(OT).</p><p><strong>Conclusion: </strong>Increasing BMI differentially impacts the operative time in abdominal greater than laparoscopic and vaginal hysterectomy. However, operative time for hysterectomy is highly variable, and its estimation is difficult to reliably predict using common preoperative variables.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971515","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":"Novel Concept of Electrocoagulation and Tumor Cell Implantation: Creation of Minimally Invasive Orthotopic Murine Model of Pancreatic Cancer.","authors":"Binit Katuwal, Maryam Aleissa, Neha Varshney, Michael J Jacobs, Vijay Mittal, Jasneet Bhullar","doi":"10.4293/JSLS.2024.00048","DOIUrl":"10.4293/JSLS.2024.00048","url":null,"abstract":"<p><strong>Background: </strong>Orthotopic murine models of pancreatic cancer represent an important tool for evaluating treatment strategies. Several genetically modified mouse tumors and xenograft models have been reported. Genetic models have unpredictable growth and variable waiting period, while orthotopic models are operative ones, difficult to create and result in irregular metastasis. There is a constant endeavor to create an orthotopic model which replicates the human disease process.</p><p><strong>Study design: </strong>Orthotopic human pancreatic tumors were induced in 20 SCID mice using a novel technique. Low dose electrocoagulation of pancreas under laparoscopic guidance (using Coloview-mouse colonoscope) with thin electrode, followed by injection of 0.1 cc BxPC3 pancreatic cancer cells was done (n = 12, study group). Control mice underwent electrocoagulation alone (n = 4, group 1) and tumor cell injection alone (n = 4, group 2). Mice were evaluated for tumor growth and metastasis by necropsy (4 and 8 weeks for experimental group; 8 weeks for control group).</p><p><strong>Results: </strong>Tumors were detected in 11/12 mice in experimental group, 1/4 in control group 2, and none in control group 1. Over time there was an increase in tumor growth, tumor volume, lymphovascular invasion of pancreas, with metastasis to lymph nodes and surrounding organs.</p><p><strong>Conclusion: </strong>We report a novel concept of tumor cell implantation at site of electrocoagulation of pancreas. Combined with the minimally invasive technique, yields a replicative orthotopic murine model of pancreatic cancer. Our model is minimally invasive, easy to create, and overcomes the limitations of the existing models while questions the possibility free floating tumor cell implantation at resection site.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007779","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":"Coaching in Surgery: What It is and What It is Not.","authors":"James Butch Rosser, Nigel L Marine, Julie Chu","doi":"10.4293/JSLS.2024.00021","DOIUrl":"10.4293/JSLS.2024.00021","url":null,"abstract":"","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753623","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":"Predicting Robotic Hysterectomy Incision Time: Optimizing Surgical Scheduling with Machine Learning.","authors":"Vaishali Shah, Halley C Yung, Jie Yang, Justin Zaslavsky, Gabriela N Algarroba, Alyssa Pullano, Hannah C Karpel, Nicole Munoz, Yindalon Aphinyanaphongs, Mark Saraceni, Paresh Shah, Simon Jones, Kathy Huang","doi":"10.4293/JSLS.2024.00040","DOIUrl":"10.4293/JSLS.2024.00040","url":null,"abstract":"<p><strong>Background and objectives: </strong>Operating rooms (ORs) are critical for hospital revenue and cost management, with utilization efficiency directly affecting financial outcomes. Traditional surgical scheduling often results in suboptimal OR use. We aim to build a machine learning (ML) model to predict incision times for robotic-assisted hysterectomies, enhancing scheduling accuracy and hospital finances.</p><p><strong>Methods: </strong>A retrospective study was conducted using data from robotic-assisted hysterectomy cases performed between January 2017 and April 2021 across 3 hospitals within a large academic health system. Cases were filtered for surgeries performed by high-volume surgeons and those with an incision time of under 3 hours (n = 2,702). Features influencing incision time were extracted from electronic medical records and used to train 5 ML models (linear ridge regression, random forest, XGBoost, CatBoost, and explainable boosting machine [EBM]). Model performance was evaluated using a dynamic monthly update process and novel metrics such as wait-time blocks and excess-time blocks.</p><p><strong>Results: </strong>The EBM model was selected for its superior performance compared to the other models. The model reduced the number of excess-time blocks from 1,113 to 905 (<i>P</i> < .001, 95% CI [-329 to -89]), translating to approximately 52-hours over the 51-month study period. The model predicted more surgeries within a 15% range of the true incision time compared to traditional methods. Influential features included surgeon experience, number of additional procedures, body mass index (BMI), and uterine size.</p><p><strong>Conclusion: </strong>The ML model enhanced the prediction of incision times for robotic-assisted hysterectomies, providing a potential solution to reduce OR underutilization and increase surgical throughput and hospital revenue.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007780","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":"Describing Sacrocolpopexy in Medical Literature: A Proposed Surgical Classification System.","authors":"Daniel T Nassar, Michael Shu, Molly Dorroh, Dhara Kadakia, Abeer Eddib","doi":"10.4293/JSLS.2024.00023","DOIUrl":"10.4293/JSLS.2024.00023","url":null,"abstract":"<p><strong>Background: </strong>Sacrocolpopexy has become a favored treatment of pelvic organ prolapse due to its durability and efficacy. Sacrocolpopexy has not been standardized and there is no categorization scheme to facilitate communication or research efforts for the procedure. A systematic review was conducted to facilitate construction of a classification system for sacrocolpopexy based on extent of vaginal dissection described in the medical literature.</p><p><strong>Methods: </strong>A systematic review of EMBASE and Medline databases was performed with inclusion criteria of randomized control trials published in the English language. Database entries were reviewed for relevance and, after thorough screening, 52 articles met criteria for analysis.</p><p><strong>Results: </strong>Abdominal, laparoscopic, and robotic approaches were represented in 20, 33, and 20 studies, respectively. In 50% of the reviewed articles (n = 26), extent of anterior dissection was not provided. Dissection to the bladder trigone and bladder neck were found in 37% (n = 19) and the proximal vagina in 13% (n = 7) of studies. In the posterior compartment, 48% (n = 25) did not describe extent of dissection, whereas 15% (n = 8) referenced dissection along the full length of the vagina. Only 2% (n = 1) discussed dissection to the dorsal perineal membrane, 12% described dissection to the perineal body (n = 6), 10% to the distal vagina (n = 5), and 13% (n = 7) to the proximal vagina.</p><p><strong>Conclusion: </strong>Lack of standardization in surgical techniques creates inconsistencies in research on sacrocolpopexy. The systematic review presented informs and demonstrates a framework for classifying sacrocolpopexy based on the extent of dissection in the published literature. This categorization scheme is the first step in standardizing the technique which can aid research efforts and physician communication by unifying language about sacrocolpopexy.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971508","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":"Perioperative and Patient-Reported Clinical Outcomes of Robotic Versus Laparoscopic Cholecystectomy.","authors":"Randeep Wadhawan, Anmol Galhotra, Deepa Kizhakke Veetil, Arun Bhardwaj, Naveen Verma","doi":"10.4293/JSLS.2024.00051","DOIUrl":"10.4293/JSLS.2024.00051","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of clinical evidence from India that compare robotic-assisted cholecystectomy (RAC) with laparoscopic cholecystectomy (LC).</p><p><strong>Methods: </strong>This prospective, single-center study compares the short-term perioperative outcomes of RAC against LC. Consecutive patients who were 18 years or older, provided informed consent, and were found to be eligible for multiport RAC or multiport LC were included in the study.</p><p><strong>Results: </strong>A total of 120 patients were enrolled in this study (n = 80, LC group; n = 40, RAC group). The most common preoperative indication was symptomatic cholelithiasis (80% in the LC group and 52.5% in the RAC group). The mean length of hospital stay was comparable for the RAC and LC groups (1.08 ± 0.26 vs 1.13 ± 0.33 days, <i>P</i> = .406). The mean operative time was also similar between the groups (38.06 ± 9.23 minutes in the LC group vs 40 ± 9.78 minutes in the RAC group, <i>P</i> = .290). Within each group, there were no conversions, intraoperative complications, bile duct injuries, surgical site infections, or mortality at day 30 postsurgery. There was just one postoperative complication in the study population (in the LC group). On postoperative days 4 and 7, the RAC group reported significantly lower pain than the LC group (<i>P</i> = .0000 and <i>P</i> = .0122, respectively). In addition, the RAC group returned to work faster than the LC group (<i>P</i> = .0000).</p><p><strong>Conclusion: </strong>Our findings indicate that RAC and LC have comparable perioperative outcomes. There are advantages to the RAC approach in terms of postoperative pain and resumption of work.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11935298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710280","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":"Hysterectomy for Large Uterus by Minimally Invasive Surgery (MIS).","authors":"Pengfei Wang, Liaisan Uzianbaeva, Noemi Hughes, Alireza Mehdizadeh","doi":"10.4293/JSLS.2024.00017","DOIUrl":"https://doi.org/10.4293/JSLS.2024.00017","url":null,"abstract":"<p><strong>Background and objective: </strong>When the uterus is or more than 18 to 20 weeks in size, laparotomy but not minimally invasive surgery (MIS) is commonly performed for hysterectomy. It is, however, acknowledged that MIS carries numerous benefits to patients compared to laparotomy. The uterine size should therefore not be an excluding factor for MIS. This study aims to demonstrate the feasibility and benefits of MIS for hysterectomy for large uterus and explain specific techniques employed.</p><p><strong>Methods: </strong>Data from 73 laparoscopic and robotic hysterectomy cases were collected. Cases were divided in two groups based on uterine weight (≥500 g vs <500 g). Estimated blood loss (EBL), operative time, length of hospital stays, and perioperative complications were compared between the groups.</p><p><strong>Results: </strong>The average specimen weight in two groups was 244 ± 102.75 g vs 903 ± 438.18 g (<i>P</i> < .01). There was no statistically significant difference in length of hospital stay between the two groups. Only 3 patients were hospitalized for more than one day. There were no instances of conversion to laparotomy, intraoperative or postoperative blood transfusion. There was a statistically significant difference in the EBL (78.19 ± 43.8 ml vs 127.88 ± 69.76 ml, <i>P</i> < .01) and operative time (180.68 ± 48.36 vs 228.85 ± 53.04 minutes, <i>P</i> < .01) between the two groups. There were two cases of bladder laceration in the group with uterine weight exceeding 500 g.</p><p><strong>Conclusion: </strong>With advanced surgical skills and the adoption of specific techniques, hysterectomy for large uterus can be performed safely and efficiently by MIS.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503033","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":"Surgeons' Approach to Intraoperative Complications in Total Extraperitoneal (TEP) Hernia Repair.","authors":"Mehmet Esref Ulutas, Abdullah Hilmi Yılmaz","doi":"10.4293/JSLS.2024.00020","DOIUrl":"https://doi.org/10.4293/JSLS.2024.00020","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study aimed to determine the frequency of laparoscopic inguinal hernia repair (LIHR) and how surgeons managed complications such as intraoperative bleeding, organ damage, and peritoneal injury that may develop during this procedure.</p><p><strong>Methods: </strong>The data for the study were collected through an electronic survey created using Google Forms and sent using WhatsApp in May 2024.</p><p><strong>Results: </strong>The study included 220 of 250 surgeons (88%) working in 25 healthcare centers located in different regions where the survey was distributed. Fourteen respondents with missing data were excluded from the study. The mean age of the remaining 206 participants was 39.6 (27-69) years. The rate of surgeons using laparoscopic techniques in inguinal hernia surgery was 89.3%. The method most preferred by the surgeons performing LIHR was total extraperitoneal (TEP) repair (60.9%), followed by transabdominal preperitoneal (TAPP) repair (39.1%). The surgeons preferred open procedures in patients with a history of lower abdominal surgery, those with scrotal hernia, and elderly patients. Additionally, in cases of intraoperative complications that developed at different stages of TEP, it was observed that participants mostly convert to the TAPP technique (43.5-46%), and in some cases, almost all participants continued the procedure with the same technique, i.e., TEP repair (94.6%).</p><p><strong>Conclusion: </strong>This study revealed that surgeons preferred open procedures in some specific patient groups, but they mostly preferred LIHR in the remaining cases. Young surgeons, in particular, seem more inclined to employ laparoscopic methods. In cases of intraoperative complications, most surgeons chose to continue with laparoscopic techniques.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503034","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":"Electrosurgical Devices Used During Laparoscopic Hysterectomy.","authors":"Toni S Horton, Paulette E Coombs, Yooree Ha, Zhen Wang, Tara J Brigham, Zenobia E Ofori-Dankwa, Olivia O Cardenas-Trowers","doi":"10.4293/JSLS.2024.00022","DOIUrl":"10.4293/JSLS.2024.00022","url":null,"abstract":"<p><strong>Background: </strong>Hysterectomy is one of the most common surgical procedures performed in the United States and most are now being performed in a minimally invasive approach. Electrosurgery and vessel sealing devices are needed in order to provide hemostasis and vascular coaptation; however, there is no guiding evidence and limited recommendations for the use of the currently available devices for laparoscopic hysterectomy. The purpose of this study is to provide a systematic review of electrosurgical devices used in benign hysterectomy and perform a meta-analysis to find the overall effect of various outcomes.</p><p><strong>Database: </strong>A systematic review was performed by searching the literature using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Review, Science Citation Index Expanded, Emerging Sources Citation Index, Scopus, Epistemonikos, and SciELO databases from each database's inception date until May 2023.</p><p><strong>Conclusion: </strong>Advanced bipolar vessel sealing devices demonstrate reduced blood loss and operative times when compared to conventional electrosurgery, however more high-quality evidence and cost analysis is needed to strengthen the clinical significance of these findings.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921871","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":"Inferior-Medial Approach to Laparoscopic Splenic Vessel-Preserving Distal Pancreatectomy.","authors":"Kee Tae Park, Joo Dong Kim","doi":"10.4293/JSLS.2024.00028","DOIUrl":"https://doi.org/10.4293/JSLS.2024.00028","url":null,"abstract":"<p><strong>Background and objectives: </strong>Complete preservation of the splenic vessels is ideal during laparoscopic spleen-preserving distal pancreatectomy (LSPDP). However, this remains challenging and time-consuming because the vessels are often deeply embedded in the pancreatic parenchyma. Herein, we introduce our inferior-medial approach to laparoscopic splenic vessel-preserving distal pancreatectomy (lap-SVPDP) and evaluate its safety and feasibility.</p><p><strong>Methods: </strong>Forty-three patients underwent LSPDP performed by a single surgeon at our institution: 26 (60.5%) lap-SVPDPs with an inferior-medial approach and 17 with the laparoscopic Warshaw technique (lap-WT). We compared the outcomes of the 2 groups. No patient undergoing lap-SVPDP required conversion to laparotomy or lap-WT.</p><p><strong>Results: </strong>Most preoperative characteristics and postoperative outcomes did not differ between the 2 groups; neither the operation time nor the intraoperative blood loss differed despite the greater technical complexity of lap-SVPDP. The mean tumor size was greater in the lap-WT than the lap-SVPDP group (<i>P </i>=<i> </i>.001). The splenic vein patency rate of the lap-SVPDP group was not inferior to that of the open SVPDP group treated by the same surgeon.</p><p><strong>Conclusion: </strong>Inferior-medial approach lap-SVPDP could be a safe and feasible technique for lap-SVPDP; neither blood loss nor operation time is increased.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142516498","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}