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

{"title":"Comparing Outcomes Between Robotic and Laparoscopic Cholecystectomy for Acute Cholecystitis.","authors":"Zamaan Hooda, Deanna Dong, Ahmad Hlayhel, John Paul Bustamante, John Veltri, Franz Yanagawa, Toghrul Talishinskiy, Zbigniew Moszczynski, Derick Christian, Sydney Abaijan, Benjamin Rebein, Alan Sori, Scott Wessner","doi":"10.4293/JSLS.2025.00026","DOIUrl":"https://doi.org/10.4293/JSLS.2025.00026","url":null,"abstract":"<p><strong>Introduction: </strong>Although laparoscopic cholecystectomy (LC) is considered the gold standard surgical approach for acute cholecystitis, there has been increased interest in robotic-assisted cholecystectomy (RAC) as an alternative treatment method. This study compares length of operative time and perioperative outcomes between these 2 techniques.</p><p><strong>Methods: </strong>We identified patients from a single institution between January 1, 2023 and December 31, 2023, who underwent surgical treatment for acute cholecystitis. Gathered data included demographic, clinicopathologic, and perioperative variables. Patients were stratified by LC or RAC surgical approaches. Pearson χ², Fisher's exact, Mann-Whitney <i>U</i>, and unpaired <i>t</i> tests were utilized to compare collected variables.</p><p><strong>Results: </strong>We identified 259 total patients, with 186 patients in the LC group (71.8%) and 73 in the RAC group (28.2%). Females comprised most both groups (LC, n = 125/186, 67.2%; RAC, n-n = 48/73, 65.8%, <i>P</i> = .884). Median age at surgery for LC patients was 43 years, and 49 for RAC patients (<i>P</i> = .341). As for operative time, the median duration for LC was 108 minutes and 68.2 minutes for RAC (<i>P</i> < .001). Nine LC (4.8%) patients and 1 RAC (1.4%, <i>P</i> = .192) had postoperative complications. Conversion to open or fenestrated cholecystectomy occurred in 8 LC (4.3%) patients and 4 RAC (5.5%, <i>P</i> = .745) patients.</p><p><strong>Conclusions: </strong>This study demonstrated that RAC has a shorter operative duration in comparison to LC. RAC also has a similar rate of complications and conversions as the laparoscopic approach. Our findings show that RAC is a safe and feasible alternative approach for treating acute cholecystitis.</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/PMC12057727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033393","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 Analysis of Laparoscopic and Robotic Cholecystectomy: A Multihospital Retrospective Study.","authors":"Marvin A Rhodes, Javier Otero, Summer N Rochester, Dawn W Blackhurst, Andrew M Schneider","doi":"10.4293/JSLS.2024.00068","DOIUrl":"10.4293/JSLS.2024.00068","url":null,"abstract":"<p><strong>Background and objectives: </strong>Laparoscopic cholecystectomy has remained the gold standard approach for gallbladder surgery for nearly 3 decades. However, adoption of robotics for treatment of gallbladder disease continues to grow. Despite this growth, clinical outcomes regarding laparoscopic versus robotic cholecystectomy remain unclear.</p><p><strong>Methods: </strong>We conducted a multihospital retrospective cohort study of patients who underwent cholecystectomy between August 1, 2021 and November 30, 2023. We compared demographic and clinical characteristics, surgical details, and postoperative outcomes between laparoscopic and robotic groups. The postoperative outcomes analyzed included conversion to open, bile leak, major duct injury, return to the operating room, surgical site infection, blood transfusion, readmission, and death. The overall complication rate included any of these outcomes. Statistical analysis included χ² tests, <i>t</i>-tests, Wilcoxon rank sum tests, and multivariable logistic regression.</p><p><strong>Results: </strong>A total of 4,316 patients were analyzed (3,736 laparoscopic, 580 robotic). In bivariate analyses, robotic surgery was associated with lower rates of conversion to open (<i>P</i> = .019), bleeding requiring transfusion (<i>P</i> = .017), and overall complications (2.9% vs 5.5%), respectively (<i>P</i> = .009). Robotic approach was associated with a 5 minute longer average surgery time (<i>P</i> = .002). Using multivariable logistic regression analysis to account for preoperative differences between the groups, robotic surgery was associated with a 62% decreased risk of any complication (odds ratio [OR] = 0.38, 95% confidence interval [CI] [0.20, 0.74]).</p><p><strong>Conclusion: </strong>Robotic cholecystectomy demonstrates favorable clinical outcomes compared to laparoscopic cholecystectomy. These findings support the advantages of robotic assistance during cholecystectomy. To our knowledge, this represents one of the largest retrospective studies showing a clinical benefit from the robotic approach.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780344","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 Caudate Lobectomy: Feasibility and Techniques with Da Vinci Xi and SP Systems.","authors":"Eun Jeong Jang, Kwan Woo Kim","doi":"10.4293/JSLS.2024.00057","DOIUrl":"10.4293/JSLS.2024.00057","url":null,"abstract":"<p><strong>Background and objectives: </strong>Minimally invasive hepatectomies, including laparoscopy and robotics, offer potential advantages over traditional open surgery, such as reduced postoperative pain, lower complication rates, and improved oncological outcomes. However, resections involving the caudate lobe remain technically demanding owing to its complex anatomy and proximity to major vasculature. This study aimed to evaluate the feasibility and safety of robotic caudate lobectomy in a small-volume center using both multiport and single-port systems.</p><p><strong>Methods: </strong>From January 2023 to May 2024, 3 patients underwent robotic caudate lobectomy at Dong-A University Hospital. Two procedures utilized the Da Vinci Xi multiport system, whereas 1 employed the Da Vinci SP single-port system. The surgical techniques and outcomes were analyzed in detail.</p><p><strong>Results: </strong>The first patient, with a 6.8-cm hemangioma, underwent Spiegel lobectomy with the Xi system in 157 minutes and was discharged on day 3 without complications. The second patient, with a 2.5-cm hepatocellular carcinoma, underwent complete caudate lobectomy using the Xi system and was discharged on day 5. The last patient, with a 3-cm cystic lesion, underwent Spiegel lobectomy with the SP system and was discharged on day 6.</p><p><strong>Conclusion: </strong>Our findings indicate that robotic caudate lobectomy is feasible and safe even in small-volume centers. Advanced robotic systems enable minimally invasive approaches to challenging liver resections, potentially achieving outcomes comparable with those in larger institutions. Further studies with larger patient cohorts are required to validate these findings.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803729","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":"Laparoscopic Appendectomy versus Open Surgery.","authors":"Aziz Bulut, Mehmet Ucar","doi":"10.4293/JSLS.2024.00077","DOIUrl":"10.4293/JSLS.2024.00077","url":null,"abstract":"<p><strong>Background and objectives: </strong>Acute appendicitis is an inflammation of the appendix caused by various factors and is the most common cause of acute abdominal pain presenting to the emergency department. Open appendectomy was first described by McBurney in 1894 using an incision method, and in 1983, Semm performed the first laparoscopic appendectomy. The aim of this study is to share the outcomes of patients who underwent open and laparoscopic appendectomy in our center.</p><p><strong>Methods: </strong>Data from patients who underwent appendectomy between 2014 and 2023 at our center were retrospectively obtained from patient records and the Hospital Information Management System (HIMS). Sociodemographic characteristics, operation durations, hospital stay, complication rates, and pathology results of the patients were evaluated.</p><p><strong>Results: </strong>A total of 627 patients were operated on for acute appendicitis between 2014 and 2023, of which 298 (47.5%) underwent laparoscopic appendectomy and 329 (52.5%) underwent open appendectomy. No statistically significant differences were found between the groups in terms of age, sex, American Society of Anesthesiologists (ASA) score, operation duration, and final pathological results. However, hospital stay was significantly longer in the open appendectomy group (<i>P</i> = .001). Additionally, the complication rate was higher in the open appendectomy group, with a statistically significant difference (<i>P</i> = .046).</p><p><strong>Conclusion: </strong>Laparoscopic appendectomy is supported in the literature by lower complication rates, shorter hospital stays, and shorter operation times. Although laparoscopic appendectomy is as safe as open appendectomy, it is thought to provide the surgeon with an advantage in assessing other potential acute intra-abdominal pathologies. Therefore, we recommend laparoscopic surgery for patients with a preoperative diagnosis of appendicitis.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803723","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":"A Management Algorithm for High-Grade Acute Cholecystitis in High-Risk Patients.","authors":"Timothy J Morley, Jeremy Fridling, Jennifer M Brewer, Ronald Gross, Stephanie Montgomery, Corrine Miller, Sarah Posillico, Elan Jeremitsky, Vijay Jayaraman, Kurt E Roberts, Thomas Russell Hill, Manuel Moutinho, Andrew R Doben, Chasen J Greig","doi":"10.4293/JSLS.2024.00060","DOIUrl":"10.4293/JSLS.2024.00060","url":null,"abstract":"<p><strong>Background: </strong>Acute cholecystitis (AC) is among the most frequently encountered surgical problems. Current management typically includes laparoscopic cholecystectomy (LC). Suboptimal outcomes of LC can include bile duct injury, open conversion (OC), and/or subtotal cholecystectomy (SC). Percutaneous cholecystostomy tube (PCT) drainage with interval cholecystectomy has emerged as an alternative in high-risk patients but outcomes vary widely. We describe an evidence-based algorithm for managing AC in high-risk patients via PCT followed by minimally invasive cholecystectomy (MIS-C). We hypothesized that our algorithm would prove safe, effective, and decrease OC and SC rates.</p><p><strong>Methods: </strong>Retrospective chart review of patients undergoing PCT and MIS-C according to our algorithm from January 2020 to June 2023. The primary outcome was OC or SC. Secondary outcomes included bile leak, bile duct injury, and perioperative complications. Demographic, clinical, and operative data were collected. Statistical analysis was performed using Minitab Software.</p><p><strong>Results: </strong>Twenty-nine patients met criteria and were treated according to our algorithm during the study period. One patient (3.4%) required conversion to SC. Other complications included 3 postoperative bile leaks (10.4%). There were no bile duct injuries and no deaths. None were lost to follow up. When stratified by LC or robotic-assisted cholecystectomy (RC), complications occurred more frequently in the LC group, including the lone conversion to SC.</p><p><strong>Conclusion: </strong>Our management protocol of high-grade AC in high-risk patients appears safe, feasible, and may reduce adverse events. Additionally, our data suggest a potential benefit of RC in this setting which may be an underutilized tool in acute care surgery. Prospective data are needed to validate and further refine this algorithm.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11935645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719967","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":"Evaluating Surgical Outcomes in Acute Cholecystectomies.","authors":"Illés Tóth, Ria Benkő, Mária Matuz, Dániel Váczi, László Andrási, László Libor, János Tajti, György Lázár, Szabolcs Ábrahám","doi":"10.4293/JSLS.2024.00061","DOIUrl":"10.4293/JSLS.2024.00061","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study aimed to identify the predictors of surgical outcomes in acute cholecystitis (AC).</p><p><strong>Methods: </strong>Patients undergoing cholecystectomy for AC between January 1, 2007 and December 31, 2019 at a single center were retrospectively reviewed. Conversion rate (CR), laparoscopic success rate (LSR), mortality, and bile duct injury (BDI) were evaluated in light of sex, age, ultrasound morphological diagnoses, severity of cholecystitis, performance status, time frame, and introduction of percutaneous transhepatic gallbladder drainage (PTGBD).</p><p><strong>Results: </strong>A total of 465 patients underwent early cholecystectomy. CR and LSR were 16.89% and 78.28%, respectively; the mortality rate was 1.62%. Increased severity of cholecystitis (grade I vs II vs III) was associated with increased mortality (1.17 vs 2.27 vs 8.33%, <i>P</i> = .183) and CR (7.09 vs 32.93 vs 28.57%, <i>P</i> < .001) and decreased LSR (91.11 vs 61.11 vs 38.46%, <i>P</i> < .001). Surgery within 72 hours had lower mortality (1.41 vs 2.6%, <i>P</i> = .613) with significantly lower CR (14.45 vs 25.71%, <i>P</i> = .008) and higher LSR (81.69 vs 67.53%, <i>P</i> = .008) compared to surgery after 72 hours. Mortality (0 vs 0.92 vs 6.19%, <i>P</i> = .001) and CR (4.2 vs 16.27 vs 39.53%, <i>P</i> < .001) increased with an increase in Charlson comorbidity index (CCI), while LSR decreased (95.8 vs 79.91 vs 50.49%, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>CCI and the severity of cholecystitis had the strongest influence on CR and LSR. Cholecystectomies performed within 72 hours were associated with reduced CR and increased LSR. PTGBD is a viable treatment option in elderly high-risk patients.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811126","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":"Umbilical Morcellation and Postoperative Pain in Patients Undergoing Benign Hysterectomy.","authors":"Colette Gnade, Kelly Kasper","doi":"10.4293/JSLS.2024.00052","DOIUrl":"10.4293/JSLS.2024.00052","url":null,"abstract":"<p><strong>Background: </strong>Morcellation has allowed patients with enlarged uteri to obtain a minimally invasive hysterectomy with improved outcomes; however, there is little information regarding postoperative pain. Our study aims to compare pain scores and opioid requirements in patients undergoing umbilical morcellation during benign minimally invasive hysterectomy versus those who do not require morcellation.</p><p><strong>Methods: </strong>A retrospective cohort study was performed at a tertiary care center including patients who underwent total laparoscopic or supracervical hysterectomy by one high volume surgeon from 2019 to 2022. Baseline characteristics, postoperative pain scores, and morphine milligram equivalents in the acute and late setting were recorded. Two-sample <i>t</i> test for continuous variables and χ² or Fisher's exact test for categorical variables were used to compare differences. A multiple regression model evaluated the effect of groups with the adjustment of confounders.</p><p><strong>Results: </strong>A total of 232 patients underwent hysterectomy in which 57 underwent umbilical manual morcellation and 175 did not. There was no difference in postoperative complications, readmissions, or blood products required (<i>P</i> > 0.05). Individuals that underwent umbilical morcellation had longer operative times (226.6 vs 120.1 minutes, <i>P</i> < 0.01), more blood loss (311.1 vs 82.0 mL, <i>P</i> < 0.01), longer length of stay (0.60 vs 0.44 days, <i>P</i> < 0.01), increased uterine weight (1,293.2 vs 151.6 g, <i>P</i> < 0.01), and fibroid pathology (93.0% vs 46.3%, <i>P</i> < 0.01). There were no differences in postoperative pain scores, immediate and later opioid use between groups on multivariate analysis.</p><p><strong>Conclusions: </strong>Patients who undergo umbilical morcellation, typically for large fibroid uteri, have similar postoperative pain scores, opioid use, and postoperative complications to those who undergo hysterectomy for other indications.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780359","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 Common Bile Duct Exploration for Choledocholithiasis.","authors":"Chi Zhang, Dillon C Cheung, Eleanor Johnson, McKinna Tillotson, Hasan Al Harakeh, Nicholas Nolan, Zhi V Fong, Megan Nelson, Irving Jorge","doi":"10.4293/JSLS.2024.00075","DOIUrl":"10.4293/JSLS.2024.00075","url":null,"abstract":"<p><strong>Background and objectives: </strong>Robotic surgery has facilitated minimally invasive surgery with its enhanced visualization and improved dexterity compared to open and laparoscopic approaches. However, widespread adoption remains limited by steep learning curves. We describe procedural steps, technical considerations, and early clinical outcomes with a 1-stage robotic-assisted cholecystectomy with common bile duct exploration.</p><p><strong>Methods: </strong>A single-institution case series of 21 patients undergoing robotic-assisted cholecystectomy with common bile duct exploration from October 2022 to August 2024 was retrospectively reviewed.</p><p><strong>Results: </strong>Nine patients were female (43%), and the median age was 70 (interquartile range [IQR] 64-76). No patient required conversion to laparotomy or laparoscopy. Two patients (10%) required postoperative endoscopic retrograde cholangiopancreatography for duct clearance. The median total operative time was 215 minutes (IQR 180-290). The median fluoroscopy time was 1.5 minutes (IQR 1.2-2.1). We review the bed orientation, overall room set up, and robot arms rearrangements that were required to accommodate the C-arm for intraoperative fluoroscopy.</p><p><strong>Conclusion: </strong>Robotic-assisted cholecystectomy with common bile duct exploration is possible but requires dedicated equipment and staff arrangements. Engagement of hospital staff including surgeons, anesthesiologists, radiology technicians, operating room nurses, and surgical technologists are paramount for success.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11935646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719974","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":"Laparoscopic Versus Robotic Elective Sigmoid Resection for Complicated Diverticulitis.","authors":"Peyton Margaret Weaver Murdock, Alexander Carmelo Venero, Robert Eric Heidel, Blake William Hale, Andrew Joseph Russ","doi":"10.4293/JSLS.2024.00079","DOIUrl":"10.4293/JSLS.2024.00079","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive surgical techniques for colorectal surgery have continued to grow in prevalence with robotic surgery potentially providing advantages in complex pelvic operations. We sought to examine the outcomes of laparoscopic versus robotic elective sigmoid colon resection for complicated diverticulitis.</p><p><strong>Methods: </strong>We performed a retrospective review of patients at an academic tertiary care center from 2018-2023 who underwent elective minimally invasive sigmoid colon resections for complicated diverticulitis. Multiple regression analysis was performed with primary outcomes being reoperation within 30 days and overall complications. Secondary outcomes included conversion to open, estimated blood loss, operative time, days until return of bowel function, and length of stay.</p><p><strong>Results: </strong>In this cohort of 131 patients, 38 underwent laparoscopic colectomy and 93 patients underwent robotic colectomy. There were no significant differences between rate of reoperation (7.7% vs 2.1%, <i>P </i>=<i> </i>.42), complications (5.1% vs 8.4%, <i>P </i>=<i> </i>.52), conversion to open (5.1% vs 2.1%, <i>P </i>=<i> </i>.25), days until return of bowel function (1.87 vs 2.01, <i>P </i>=<i> </i>.41), or length of stay (5.2 vs 5.2, <i>P </i>=<i> </i>.92). There were significant differences in operative time and estimated blood loss. Robotic approach was 128.11 minutes longer (β = 128.11, SE = 12, <i>p </i><<i> </i>.001) and had 33.4 cc less estimated blood loss (β = -33.4, SE = 16.6, <i>P </i>=<i> </i>.046), when adjusting for other confounders.</p><p><strong>Conclusion: </strong>Robotic sigmoid colectomy for complicated diverticulitis had mostly equivalent outcomes at this institution. There was some decrease in estimated blood loss, however, operative time was increased in the robotic group.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780351","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":"Minimally Invasive Surgery Benefits Frail Patients Undergoing Emergency Hernia Repairs.","authors":"Anna Distler, Ruben Salas Parra, Xueqi Huang, Hanaa Ahmed, Rafael Barrera, Vihas Patel, Laura Hansen","doi":"10.4293/JSLS.2024.00049","DOIUrl":"10.4293/JSLS.2024.00049","url":null,"abstract":"<p><strong>Background: </strong>Compared to elective surgery, emergent hernia repairs carry higher morbidity. Additionally, frailty is independently associated with worse postoperative outcomes. This study aimed to assess if the surgical approach, minimally invasive surgery versus open, confers improved outcomes for frail patients who underwent emergent hernia repairs.</p><p><strong>Methods: </strong>The National Surgical Quality Improvement Program database (2018-2020) was queried for patients who underwent emergency hernia repair by Current Procedural Terminology (CPT) codes (49505-49659). A modified frailty index-5 score was calculated; only frail patients with a score of ≥2 were included. The impact of surgical approach on length of stay, discharge destination, and mortality was determined by multivariate analysis.</p><p><strong>Results: </strong>A total of 1,893 patients met the inclusion criteria. Most patients (56.5%) were female, and 61.4% of patients were age ≥65. Most patients (83.62%) underwent open repair. After adjusting for covariates, patients who underwent minimally invasive surgery had a shorter length of stay compared to open surgery (hazard ratio = 1.22; 95% confidence interval [1.06,1.41]; <i>P</i> = .006). Surgical approach was not associated with a difference in 30-day mortality (<i>P</i> =.28) or discharge destination (<i>P</i> = .97).</p><p><strong>Conclusion: </strong>Minimally invasive emergent hernia repairs in frail patients in the National Surgical Quality Improvement Program database cohort are associated with a shorter length of stay compared to open surgery, without increased 30-day mortality or change in discharge destination. Prospective studies are needed to validate best-practices in treating frail surgical patients.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11935647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719971","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}