JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献_第4页

Modified Open Anterior Preperitoneal Repair. 改良开放式前腹膜前修补术。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-10-01 DOI: 10.4293/JSLS.2023.00044

Rajeev Sinha, Albail S Yadav, Yasharth Sharma, Swarnava Chanda, Om Kumar Sharma, Nalin Srivastava

{"title":"Modified Open Anterior Preperitoneal Repair.","authors":"Rajeev Sinha, Albail S Yadav, Yasharth Sharma, Swarnava Chanda, Om Kumar Sharma, Nalin Srivastava","doi":"10.4293/JSLS.2023.00044","DOIUrl":"10.4293/JSLS.2023.00044","url":null,"abstract":"Background and objectives: Modified anterior preperitoneal (mAPP) repair for inguinal hernia (IH) was compared with Lichtenstein repair (LR) and laparoscopic transabdominal preperitoneal (TAPP) repairs.Methods: IH patients, after exclusions and subsequent matching for age, type, and extent of hernia, were assigned randomly for mAPP, LR or TAPP repair. The same surgical team performed all operations. Data of predefined endpoints for all the three groups were statistically compared.Results: One hundred thirty-five patients underwent mAPP, 91 patients LR, and 181 patients TAPP. The operating time for both unilateral and bilateral hernias in the mAPP group was significantly shorter than in LR and TAPP groups. mAPP patients were discharged in significantly less time than LR patients but later than TAPP patients. Postoperative visual analog scale (VAS) score at 24 hours in the mAPP patients was significantly less than LR but at 48 hours the difference was equivocal. But VAS score after mAPP at 24 and 48 hrs was more than in TAPP patients. However, the pain score across all the three groups was similar at 7 days. There was no surgical site infection (SSI) or mesh infection in any patient. Chronic postoperative inguinal pain was seen less often after mAPP than after LR but was least in TAPP patients. Recurrence across all the three groups was not much different.Conclusion: mAPP appears to be a better choice for open IH repair than LR and matches the advantages of Laparoscopic repairs.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10690483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478035","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}

引用次数: 0

Energy Device Preferences Among Gynecologic Surgeons. 妇科外科医生对能量装置的偏好。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-10-01 DOI: 10.4293/JSLS.2023.00039

Lulu Yu, Adaeze A Emeka, Princess Urbina, Linda C Yang, Susan C Tsai, Angela Chaudhari, Magdy P Milad

{"title":"Energy Device Preferences Among Gynecologic Surgeons.","authors":"Lulu Yu, Adaeze A Emeka, Princess Urbina, Linda C Yang, Susan C Tsai, Angela Chaudhari, Magdy P Milad","doi":"10.4293/JSLS.2023.00039","DOIUrl":"10.4293/JSLS.2023.00039","url":null,"abstract":"Background and objectives: Multiple vessel-sealing devices are available for use during laparoscopy. The objective of this study is to determine what surgeon-level and device characteristics influence the choice of advanced energy device during gynecologic laparoscopy.Methods: This is a national cross-sectional study of gynecologic surgeons conducted via social media, utilizing an online, publicly-available, anonymous survey. Gynecologic surgeons who had completed residency training were approached for participation in the survey. Survey completion was voluntary and involved no further follow-ups. The web-based survey consisted of six questions with the option to answer three additional questions if time permitted. The institutional review board determined that this study qualified for exemption.Results: There were 92 respondents who participated in the survey. Of these, 81 completed the survey and were included in the analysis. Female respondents were younger and more frequently reported a glove size of 6.5 or less. Surgeon-level characteristics, including gender, age, glove size, case volume, region, and practice setting, were not significantly associated with preferred energy devices. Device availability in the operating room was the only characteristic associated with preferred energy devices (P-value = .0076). Other device-level characteristics such as optimal thermal spread, reduced plume, ease of use, device reliability, and teachability had no statistically significant association with preferred energy devices.Conclusion: Multiple advanced energy devices are available for use during gynecologic laparoscopy. These devices have varying energy profiles, thermal spread, and device size. Despite this diversity, only device availability in the operating room influenced the surgeon's preferred device selection.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10690482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478034","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}

引用次数: 0

Uterine Weight and Perioperative Morbidity in Robotic-Assisted versus Conventional Laparoscopic Hysterectomy. 机器人辅助与传统腹腔镜子宫切除术的子宫重量和围手术期发病率。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-10-01 DOI: 10.4293/JSLS.2023.00042

Courtney K Pfeuti, Lianteng Zhi, Matthew K Hoffman

{"title":"Uterine Weight and Perioperative Morbidity in Robotic-Assisted versus Conventional Laparoscopic Hysterectomy.","authors":"Courtney K Pfeuti, Lianteng Zhi, Matthew K Hoffman","doi":"10.4293/JSLS.2023.00042","DOIUrl":"10.4293/JSLS.2023.00042","url":null,"abstract":"Background and objectives: Minimally invasive approaches to benign hysterectomy are the current standard of care when feasible. Use of robotic-assisted laparoscopic hysterectomy (RA-LH) has been increasing; however, direct comparative data that accounts for uterine weight in conventional laparoscopic hysterectomy (CLH) and RA-LH is limited. We sought to examine the impact of uterine weight on immediate perioperative morbidity in CLH versus RA-LH. The primary outcome was a composite of complications including visceral injuries, conversions to abdominal procedures, and transfusions.Methods: A retrospective cohort study of patients who underwent a minimally invasive laparoscopic hysterectomy (CLH and RA-LH) in a single hospital system between January 1, 2014 and December 31, 2017 as identified by Current Procedural Terminology codes. The primary exposure was CLH or RA-LH. Uterine weight was categorized into four groups: <150 g, 150 to < 250 g, 250 to < 450 g, and ≥ 450 g.Results: A total of 1506 patients were included; 539 underwent CLH and 967 underwent RA-LH. Median uterine weight was higher in patients who underwent CLH (161.0 g) compared to RA-LH (147.0 g), P = .001. The odds of the composite of complications in CLH was 4.43 (2.84 - 6.92) higher than the odds of the composite in RA-LH. When stratified by the uterine weight, the odds of complications was significantly higher in CLH in the following categories: <150 g, 250 to < 450 g, and ≥ 450 g (OR: 4.41, 3.28, and 7.81, respectively).Conclusion: Surgical morbidity was lower in RA-LH across the spectrum of uterine weights compared to CLH. Patients may particularly benefit from RA-LH at higher uterine weights.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10690484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478036","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}

引用次数: 0

Development of Medical Shark Skin Forceps: Improved Grasping Power and Easy Manipulation. 医用鲨鱼皮钳的研制：握力提高，操作简便。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-10-01 DOI: 10.4293/JSLS.2023.00037

Yuma Takamura, Tetsuro Tominaga, Rui Zhu, Ikuo Yamamoto, Keitaro Matsumoto, Takeshi Nagayasu

{"title":"Development of Medical Shark Skin Forceps: Improved Grasping Power and Easy Manipulation.","authors":"Yuma Takamura, Tetsuro Tominaga, Rui Zhu, Ikuo Yamamoto, Keitaro Matsumoto, Takeshi Nagayasu","doi":"10.4293/JSLS.2023.00037","DOIUrl":"10.4293/JSLS.2023.00037","url":null,"abstract":"Background and objectives: Important safety requirements for forceps used in surgical procedures are the ability to stably grasp fine tissue and to cause minimal tissue damage. Shark skin has the structural feature of circumpolar scales, which increase the frictional force of the scales by roughening their surface. We have developed and patented medical forceps with a shark skin pattern placed on the tip surfaces. The aim of this study was to examine the safety and efficacy of the shark skin forceps compared with existing forceps, both fundamentally and clinically.Methods: To evaluate gripping power and usability, we compared bead transfer times for each forceps type. Grasping force and frictional force were measured quantitatively and compared among the types. To evaluate safety, we performed pathological examination of lung and urethral tissue after grasping, in an animal experiment. Subjective assessment of user experience was then performed using a questionnaire.Results: In the dry lab assessment, transfer time was fastest using the shark skin forceps (34 s vs 61 s and 62 s, p < 0.05). Frictional force values were highest for the shark skin forceps (p < 0.05). In the animal experiment, there was no difference in pathological tissue damage to lung or ureter tissues among the forceps types after grasping. The questionnaire responses indicated advantages of the shark skin forceps in terms of ease of grasping membranes and lower degree of grasp failure.Conclusion: Forceps with shark skin on the tips showed greater stability of tissue grasping and equivalent safety compared with existing forceps.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71483070","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}

引用次数: 0

Spinal Anesthesia Prior to Laparoscopic Hysterectomy Resulted in Decreased Postoperative Pain and Opioid Use. 腹腔镜子宫切除术前的脊髓麻醉可减少术后疼痛和阿片类药物的用量。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-10-01 DOI: 10.4293/JSLS.2023.00050

Kaitlin A Warta, Xiaoyin Lu, Tam D Nguyen, Robert M Shakar, Todd M Beste

{"title":"Spinal Anesthesia Prior to Laparoscopic Hysterectomy Resulted in Decreased Postoperative Pain and Opioid Use.","authors":"Kaitlin A Warta, Xiaoyin Lu, Tam D Nguyen, Robert M Shakar, Todd M Beste","doi":"10.4293/JSLS.2023.00050","DOIUrl":"10.4293/JSLS.2023.00050","url":null,"abstract":"Study objective: To determine if a pre-operative morphine/bupivacaine spinal injection prior to laparoscopic hysterectomy reduced postoperative pain and resulted in less opioid consumption during the hospital stay.Methods: A retrospective cohort study (Canadian Task Force Classification II-2) was conducted at a single institution regional referral center (community hospital) in North Carolina. Three hundred nineteen patients met criteria for inclusion: 192 received spinal anesthesia and 127 did not. Baseline demographics were similar between the two groups. Median pain scores were significantly lower in the treatment than the control group on day of surgery (DOS) (2 vs. 6; P < 0.001) and postoperative day 1 (POD1) (2 vs. 4; P < 0.001).Results: Primary outcomes were pain scores on DOS and POD1 and inpatient opioid use. Pain scores were obtained using the 0 to 10 Numerical Rating Scale. Opioids were converted to oral morphine milliequivalents (OME). Median opioid use was also significantly lower in the treatment than the control group on DOS (0 vs. 15.00 OME; P < 0.001) and POD1 (0 vs. 7.5 OME; P < 0.001). Median length of stay between the groups was not significantly different.Conclusion: Pre-operative morphine spinal injection for laparoscopic hysterectomy led to significantly lower pain scores and inpatient opioid consumption. Pre-operative spinal anesthesia for benign laparoscopic hysterectomy appears helpful for enhancing the postoperative experience.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10789438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472469","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}

引用次数: 0

Propensity Score Matched Comparison of Robotic Single-Site and Laparoscopic Cholecystectomy. 机器人单部位胆囊切除术与腹腔镜胆囊切除术倾向评分匹配比较。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-10-01 DOI: 10.4293/JSLS.2023.00043

Eun Jeong Jang, Sung Hwa Kang, Kwan Woo Kim

{"title":"Propensity Score Matched Comparison of Robotic Single-Site and Laparoscopic Cholecystectomy.","authors":"Eun Jeong Jang, Sung Hwa Kang, Kwan Woo Kim","doi":"10.4293/JSLS.2023.00043","DOIUrl":"10.4293/JSLS.2023.00043","url":null,"abstract":"Background and objectives: To demonstrate the feasibility and potential of robotic single-site cholecystectomy, the study aimed to compare it with conventional laparoscopic cholecystectomy.Methods: In total, 791 consecutive patients underwent conventional laparoscopic cholecystectomy or robotic single-site cholecystectomy at our center between 2019 and 2022. After 1:1 propensity score matching, 117 patients for each group were selected.Results: After propensity score matching, the only statistically significant difference between conventional laparoscopic cholecystectomy and robotic single-site cholecystectomy was operative time, which was 29.15 ±11.45 min in the conventional laparoscopic cholecystectomy group versus 38.57 ± 12.59 min in the robotic single-site cholecystectomy group (P < 0.001). Because the difference in surgical time between the two groups was minimal, it has little clinical relevance. Using cumulative sum analysis, the maturation phase of the total operation and docking times occurred after the 53rd case. To reduce bias, a comparison of results with conventional laparoscopic cholecystectomy and cases of robotic single-site cholecystectomy was performed in the maturation phase, which revealed only total operative time as statistically significant (P < 0.001).Conclusion: Robotic single-site cholecystectomy is a technically feasible and safe method for treating benign gallbladder diseases, with a relatively short learning curve and reasonable operative time.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10690481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138480003","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}

引用次数: 0

Bariatric Surgery in the Elderly Population: A Multi-surgeon, Single-institution Retrospective Review. 老年人群的减肥手术：一项多外科医生、单一机构的回顾性综述。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-07-01 DOI: 10.4293/JSLS.2023.00028

Michael Kachmar, Isaac Soliman, Nicholas Mason, Christopher Sandifer, Charalampos Papachritou, Adam Goldstein, Adeshola Fakulujo, Louis Balsama, Marc Neff

{"title":"Bariatric Surgery in the Elderly Population: A Multi-surgeon, Single-institution Retrospective Review.","authors":"Michael Kachmar, Isaac Soliman, Nicholas Mason, Christopher Sandifer, Charalampos Papachritou, Adam Goldstein, Adeshola Fakulujo, Louis Balsama, Marc Neff","doi":"10.4293/JSLS.2023.00028","DOIUrl":"10.4293/JSLS.2023.00028","url":null,"abstract":"Background: As the population continues to age, the number of elderly patients affected by obesity is rising. Metabolic and bariatric surgery (MBS) can benefit elderly patients seeking treatment for obesity and its related diseases. We aimed to quantify percent excess weight loss (%EWL) for elderly patients (≥ 65) undergoing MBS at a single institution and compare our results to %EWL previously reported for general and elderly populations. Additionally, we believe the safety and effectiveness of MBS is repeatable in our community setting.Methods: Laparoscopic sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass performed from November 1, 2011 - April 30, 2017 at a single institution was retrospectively reviewed. Weight loss was measured at 3, 6, and 12 month follow-up. A total of 103 patients met inclusion criteria, mean age was 67.75 years old and mean pre-operative body mass index was 45.95 kg/m2.Results: Mean %EWL was 31.9%, 43.7%, and 53.4% at 3, 6, and 12 months, respectively. %EWL at one year was not statistically different to prior reports of elderly bariatric patients (p = 0.979). While statistically lower when compared to reports in the general population, %EWL in our elderly patients was clinically similar (p < 0.001). No 30-day mortality was observed.Conclusions: Elderly patients undergoing MBS were noted to have %EWL similar to previous reports in elderly and general populations. MBS is efficacious and well tolerated in the elderly population with repeatable results. Continued reporting on the safety and efficacy is important in ensuring wider coverage and availability of these important interventions in elderly populations.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10566579/pdf/e2023.00028.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41204337","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}

引用次数: 2

Assessment of Pre-operative Vaginal Preparation for Laparoscopic Hysterectomy. 腹腔镜子宫切除术前阴道准备的评估。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-07-01 DOI: 10.4293/JSLS.2023.00013

Michelle Marinone, Jonathan Serino, Stephanie Stroever, Nicole Brzozowski, Andrea Kliss, David Doo, Linus Chuang

{"title":"Assessment of Pre-operative Vaginal Preparation for Laparoscopic Hysterectomy.","authors":"Michelle Marinone, Jonathan Serino, Stephanie Stroever, Nicole Brzozowski, Andrea Kliss, David Doo, Linus Chuang","doi":"10.4293/JSLS.2023.00013","DOIUrl":"10.4293/JSLS.2023.00013","url":null,"abstract":"Objective: Determine the difference in microbial growth from the vagina and uterine manipulator among patients undergoing laparoscopic hysterectomy after randomization to one of three vaginal preparation solutions (10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine).Method: This was a prospective randomized controlled trial in an academic community hospital. Patients were ≥ 18 years old and scheduled for laparoscopic hysterectomy for benign and malignant indications.Results: Fifty patients were identified and randomized into each arm. Prior to surgery, the surgical team prepared the vaginal field using 10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine, according to group assignment. Cultures were collected from the vagina after initial preparation, prior to the colpotomy, and on surfaces of the uterine manipulator. Bacterial count from the baseline vaginal fornix/cervical canal cultures did not differ significantly among the three groups. There was a difference in bacterial count among the second cervical canal/vaginal fornix cultures (p < 0.01), with the Povidone-iodine arm demonstrating the highest level of growth of cultures (93.8%), followed by 2% Chlorhexidine (47.4%), and 4% Chlorhexidine (20%). There was no difference in growth on the uterine manipulator handle and no difference in vaginal itching or burning was found across the three arms postoperatively.Conclusion: Bacterial growth prior to colpotomy was the lowest with 4% Chlorhexidine followed by 2% Chlorhexidine, the Povidone-iodine group exhibited the highest bacterial growth. There was no difference in moderate to severe vaginal itching or burning. This showed that 4% Chlorhexidine is superior in reducing bacterial growth when used in laparoscopic hysterectomy.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473181/pdf/e2023.00013.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10151876","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}

引用次数: 0

Iatrogenic Thermal Energy-Induced Distal Ureteric Injury and Its Management by Laparoscopy Ureteroureterostomy. 医源性热能致输尿管远端损伤及其腹腔镜输尿管造口术的治疗。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-07-01 DOI: 10.4293/JSLS.2023.00030

Dipak Limbachiya, Rajnish Tiwari, Rashmi Kumari

{"title":"Iatrogenic Thermal Energy-Induced Distal Ureteric Injury and Its Management by Laparoscopy Ureteroureterostomy.","authors":"Dipak Limbachiya, Rajnish Tiwari, Rashmi Kumari","doi":"10.4293/JSLS.2023.00030","DOIUrl":"10.4293/JSLS.2023.00030","url":null,"abstract":"Background and objectives: Most thermal energy-induced distal ureter injuries are missed intraoperatively as they are caused by delayed ischemia-induced necrosis of the affected part leading to fistula, and a delayed presentation. The injuries of the distal ureter are commonly managed by ureteroneocystostomy, which has long-term complications related to vesico-ureteric reflux (VUR). We present our experience of management of distal ureter injury due to thermal energy by laparoscopy ureteroureterostomy and the role of various methodologies for its diagnosis.Methods: It is a retrospective, single-center study that was conducted from January 1, 2020 - December, 31 2022.Results: A total of 8 cases were enrolled in the study. All cases had an uterovaginal fistula (UVF) post-laparoscopic gynecology surgery. The bilateral ureteric injury was observed in 2 cases. The median post-surgery time to diagnose UVF in the study was 10 days. All cases were managed by laparoscopy ureteroureterostomy (LUUS). Six cases underwent immediate surgery after the diagnosis; whereas 2 cases had initial double-J stent placement as treatment, which subsequently failed following which the LUUS was performed. There were not any immediate or long-term complications such as leakage, stenosis, fistula, or any requirement for revision surgery.Conclusion: The management of thermal energy-induced ureteric injury is exceptional as compared to other types of ureteric injury. Our approach should be toward immediate surgical management rather than a conservative one to avoid long-term complications and sequelae. Iatrogenic lower ureteral injury can be managed successfully by LUUS, maintaining the normal anatomy and physiology of VUR.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10516262/pdf/e2023.00030.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41134248","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}

引用次数: 0

Implementation of a Robotic Gynecologic Surgery Program in a Rural Setting: Impact on Presence of Assistant Surgeon and Route of Hysterectomy. 农村环境下机器人妇科手术项目的实施：对助理外科医生的存在和子宫切除术路线的影响。

IF 1.5 4区医学

JSLS : Journal of the Society of Laparoendoscopic Surgeons Pub Date : 2023-07-01 DOI: 10.4293/JSLS.2023.00035

Natasha R Alligood-Percoco, Angela D Huggler, Alexandra N McQuillen

{"title":"Implementation of a Robotic Gynecologic Surgery Program in a Rural Setting: Impact on Presence of Assistant Surgeon and Route of Hysterectomy.","authors":"Natasha R Alligood-Percoco, Angela D Huggler, Alexandra N McQuillen","doi":"10.4293/JSLS.2023.00035","DOIUrl":"10.4293/JSLS.2023.00035","url":null,"abstract":"Background and objectives: Robotic surgical technology may obviate the need for an assistant surgeon when performing hysterectomy. In rural communities where physician shortages remain a major barrier to healthcare access, reducing the number of surgeons necessary to complete a hysterectomy would be of significant consequence. We sought to investigate the impact of robotic surgery on both the presence of an assistant surgeon and route of hysterectomy following implementation of a robotic surgery program at a single-site community hospital.Methods: Retrospective chart review of hysterectomies performed before and after implementation of a robotic surgical program. Hysterectomies were classified by presence of an assistant surgeon, and by mode of hysterectomy (abdominal, laparoscopic, robotic, and vaginal). We observed the distribution of outcomes between the two study periods and compared them with the χ2 test.Results: Following implementation of a robotic surgical program we observed a statistically significant decrease in the presence of an assistant surgeon at the time of hysterectomy from 86.7% to 29.7%, p ≤ 0.0001. There was also an increase in the percentage of hysterectomies performed by minimally invasive technique from 67.0% to 87.4%, p ≤ 0.0001.Conclusion: Following implementation of a robotic gynecologic surgery program at a single-site rural community hospital, we observed a reduction in the utilization of an assistant surgeon at time of hysterectomy. Additionally, we observed a significant increase in the rate of minimally invasive hysterectomies performed.","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"27 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10516264/pdf/e2023.00035.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41099955","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}

引用次数: 0