Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Validation of a Pulsatile Model for Laparoscopic Partial Nephrectomy: NEFPAR Model.","authors":"Jose Antonio Campos Sañudo, Saul Higuera Pardo, Roberto Ballestero Diego","doi":"10.1089/lap.2025.0026","DOIUrl":"https://doi.org/10.1089/lap.2025.0026","url":null,"abstract":"<p><p><b><i>Background:</i></b> Laparoscopic and robotic-assisted partial nephrectomy are the gold standard for treating small renal tumors. To improve training while adhering to animal welfare regulations, the NEFPAR pulsatile model was developed as a nonliving alternative for surgical simulation. This study aimed to validate NEFPAR as a realistic and effective training tool. <b><i>Methods:</i></b> The NEFPAR model was constructed using porcine tissue used in other simulations, a pulsatile pump, and standard laparoscopic instruments. Eleven participants (4 urologists and 7 urology residents) were recruited for validation. They performed simulated laparoscopic partial nephrectomies using the model, and their performance was evaluated through a survey assessing the realism, educational impact, and comparison to other simulation models. Data were analyzed using Fisher's exact test, with significance set at <i>P</i> < .05. <b><i>Results:</i></b> Most participants (72.7%) rated the NEFPAR model as realistic for key procedural steps, such as tumor resection and renal hilum dissection. The bleeding component was deemed essential for learning by 100% of participants. The NEFPAR model was superior to nonpulsatile animal models in replicating surgical bleeding and was comparable to cadaveric models in external appearance and tissue texture. However, cadaveric models were rated higher for replicating all procedural steps. No significant differences in responses were found between urologists and residents. <b><i>Conclusions:</i></b> The NEFPAR model effectively simulates key aspects of laparoscopic partial nephrectomy and offers an ethical, cost-effective alternative for surgical training. It was well-received for its educational value, especially for simulating surgical bleeding. Further refinements could enhance tissue consistency and tumor positioning, but the model has strong potential to be integrated into urology training programs to improve surgical skills and reduce reliance on animal models.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short Versus Long Myotomy Length in Peroral Endoscopic Myotomy for Achalasia: Comparable Efficacy with Potential Reduction in Incidence of Reflux-A Meta-Analysis of 10 Comparative Studies.","authors":"Abdul-Rahaman Fadi Diab, Joseph Adam Sujka, Chandan Mitra, Alan Hamza, Yasotha Diana Ananthan, Salvatore Docimo, Christopher Garnet DuCoin","doi":"10.1089/lap.2024.0397","DOIUrl":"https://doi.org/10.1089/lap.2024.0397","url":null,"abstract":"<p><p><b><i>Background:</i></b> Shortening the myotomy length during peroral endoscopic myotomy (POEM) for achalasia has been hypothesized to reduce gastroesophageal reflux disease (GERD) incidence while maintaining procedural efficacy. This meta-analysis compares the outcomes of short POEM (S-POEM) and long POEM (L-POEM). <b><i>Methods:</i></b> A systematic review adhering to PRISMA guidelines identified studies directly comparing S-POEM and L-POEM. Study quality was assessed using the Risk of Bias in Non-randomized Studies of Interventions and Revised Cochrane Risk of Bias for Randomized Trials tools. A pairwise meta-analysis was conducted using the random-effects model. <b><i>Results:</i></b> In perioperative outcomes, S-POEM significantly reduced operative time and required fewer clips compared with L-POEM, with no significant differences in adverse events or length of stay. Regarding GERD-related outcomes, S-POEM demonstrated a statistically significant reduction in abnormal esophageal acid exposure on 24-hour pH-impedance testing, with a number needed to treat of 10. While the reduction in symptomatic GERD did not reach statistical significance (<i>P</i> = .06), the <i>P</i> value was very close to the threshold for significance (.05), and all seven included studies reported decreased symptomatic GERD with S-POEM. This is therefore considered a noteworthy finding. The rates of esophagitis and lower esophageal sphincter pressure did not differ significantly between the groups. Efficacy-related outcomes, including clinical success, Eckardt score, and barium height at 5 minutes, were comparable between S-POEM and L-POEM. However, integrated relaxation pressure was significantly higher in the S-POEM group. <b><i>Conclusions:</i></b> This study suggests that shortening the myotomy length may reduce GERD incidence following POEM without compromising its efficacy in achalasia treatment. In addition, a shorter myotomy length decreases operative time, potentially reducing time-related costs and improving workflow.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural Orifice Extraction Techniques (Natural Orifice Specimen Extraction and Natural Orifice Transluminal Endoscopic Surgery) for Left-Sided Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Bernardo Fontel Pompeu, Luiza Soares Guerra, Lucas Soares de Souza Pinto Guedes, Julia Hoici Brunini, Lucas Monteiro Delgado, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga","doi":"10.1089/lap.2025.0003","DOIUrl":"https://doi.org/10.1089/lap.2025.0003","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Minimally invasive surgery is the standard approach for colorectal cancers and requires an abdominal incision for specimen removal. Natural orifice specimen extraction (NOSE) may improve outcomes, reducing trauma, and speeding postoperative recovery. This study compares both techniques regarding postoperative complications, operative outcomes, and recurrence. <b><i>Methods:</i></b> We searched PubMed, Scopus, and Cochrane Central Register of Clinical Trials for studies published up to November 2024. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model, and heterogeneity was assessed with <i>I</i>² statistics. Statistical analyses were conducted using R Software version 4.4.1 (R Foundation for Statistical Computing). <b><i>Results:</i></b> Four randomized controlled trials involving 439 patients with colorectal cancer were included, with 212 (48.2%) undergoing NOSE and 227 (51.7%) undergoing conventional laparoscopic specimen extraction. NOSE significantly reduced postoperative pain (visual analog scale score: mean difference [MD] -1.8; 95% confidence interval [CI] -2.5 to -1.1; <i>P</i> = .01), time to pass flatus (MD -0.8; 95% CI -1.1 to -0.6; <i>P</i> < .01), and surgical site infection rates (OR 0.15; 95% CI 0.03-0.69; <i>P</i> = .015) but was associated with a longer operative time (MD 11.1 minutes; 95% CI 1.5-20.6; <i>P</i> = .02). No significant differences were observed between the groups in bowel leaks, lymph nodes harvested, intraoperative blood loss, hospital stay duration, or local recurrence rates. <b><i>Conclusion:</i></b> NOSE was associated with reduced postoperative pain, faster time to pass flatus, and lower infection rates but required longer operative time than conventional laparoscopic specimen extraction. Other outcomes, including complications, operative characteristics, and recurrence, showed no significant differences between the techniques.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience With an Innovative Surgical Treatment Option for Gastroesophageal Reflux Disease: Results of 28 Patients in a Retrospective Analysis.","authors":"Moustafa Elshafei","doi":"10.1089/lap.2024.0390","DOIUrl":"https://doi.org/10.1089/lap.2024.0390","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Standard-of-care gastroesophageal reflux disease (GERD) procedures are associated with adverse events (AEs) (i.e., dysphagia, gas-bloating). RefluxStop has been developed to circumvent these outcomes. This study presents the results of 28 patients managed with RefluxStop in Germany. <b><i>Methods:</i></b> Between July 2021 and November 2023, 28 patients with GERD underwent RefluxStop surgery, a novel laparoscopic antireflux procedure. Retrospective chart analysis with patient-informed consent was conducted to determine clinical outcomes, such as GERD Health-Related Quality of Life (GERD-HRQL) score, proton pump inhibitors (PPI) use, symptomatology, patient satisfaction, and perioperative AEs. <b><i>Results:</i></b> Baseline characteristics (<i>n</i> = 28): age 47 ± 13.1 years; 67.9% female; body mass index (BMI) 27.3 ± 4.1 kg/m²; 93% PPI use for 5.6 ± 2.7 years; and hiatal hernia in 100% of cases of mean (standard deviation [SD]) size 3.4 (0.8) cm, whereof 35.7% were large hiatal hernia (4-6 cm). At a mean (SD) follow-up of 14.1 (4.7) months, patients experienced 88.6% improvement in median (IQR) total GERD-HRQL score from a baseline of 35 (7.7) to 4 (4.2) at follow-up (<i>P</i> < .05). Preoperative dysphagia (35.7%) resolved completely in all patients (<i>P</i> < .001). The mean (SD) GERD-HRQL heartburn subdomain decreased by 90.6% from a baseline of 18.1 (6.1) to 1.7 (1.2) at follow-up and all patients (100%) had scores <5. Similarly, the mean (SD) regurgitation subdomain decreased from a baseline of 13.2 (4.7) to 2 (1.6) at follow-up and all patients (100%) had scores <5. Patient satisfaction was achieved in 96.4% of patients with no PPI use required in 93% of patients (<i>P</i> < .001); only one patient required PPIs for persistent GERD symptoms. No cases of reoperation or esophageal dilatation were performed. Minor intraoperative AEs occurred in seven patients (i.e., neck emphysema). <b><i>Conclusion:</i></b> RefluxStop provides excellent safety and effectiveness outcomes for GERD treatment. Dysphagia completely resolved (0%) with 88.6% improvement in median GERD-HRQL score and satisfaction achieved in 96.4% of patients. These promising results reproduced the outcomes noted in the RefluxStop CE trial in real-world settings.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postmyotomy Esophageal Diverticulum-A Unique Entity Mimicking Achalasia Recurrence.","authors":"Gad Marom, Ronit Brodie, Ram Elazary, Alon Pikarsky, Avraham I Rivkind, Brigitte Helou, Yuri Fishman, Yoav Mintz","doi":"10.1089/lap.2025.0023","DOIUrl":"https://doi.org/10.1089/lap.2025.0023","url":null,"abstract":"<p><p><b><i>Background:</i></b> Recurrence of dysphagia following myotomy for achalasia poses clinical and diagnostic challenges. Postmyotomy esophageal diverticula is a rare disorder, usually developing due to inadequate myotomy, resulting in dysphagia. We herein present a new entity of esophageal diverticula developing after successful complete myotomy, which causes dysphagia and mimics recurrence of achalasia. <b><i>Methods:</i></b> A review of the prospectively maintained database of all patients with achalasia and diverticula between January 2012 and June 2024 was performed. Demographic, clinical data, diagnosis, treatment, and outcomes were collected and analyzed. <b><i>Results:</i></b> A total of 9 patients underwent esophageal diverticulectomy in our institution. Five patients had achalasia and myotomy either by per-oral endoscopic myotomy, laparoscopic Heller myotomy, or pneumatic dilation. All patients suffered from a recurrence of symptoms, with an open lower esophageal sphincter confirmed by manometry or EndoFLIP™. The time from myotomy to diagnosis was 31-117 months. Four were males and 1 was female between the ages of 33 and 58 years, with an average body mass index of 22.4 kg/m². All patients underwent esophageal diverticulectomy with no additional myotomy. Median preoperative and postoperative Eckardt scores were 5 and 0 respectively, with complete resolution of symptoms. <b><i>Conclusions:</i></b> Epiphrenic diverticula is a rare cause of postmyotomy dysphagia in achalasia patients. Previously, this entity was described in the context of insufficient myotomy; however, we present here a case series of patients with epiphrenic diverticula following adequate myotomy with no distal obstruction. Following diverticulectomy, their dysphagia was resolved. We suggest an algorithm for the diagnosis and treatment of dysphagia following myotomy for achalasia.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nomogram for Predicting Anastomotic Stricture after Laparoscopic Radical Resection of Rectal Cancer.","authors":"Yanhao Sun, Yilong Hu, Yuanfang Sun","doi":"10.1089/lap.2024.0401","DOIUrl":"https://doi.org/10.1089/lap.2024.0401","url":null,"abstract":"<p><p><b><i>Background:</i></b> Anastomotic stricture is a common complication following laparoscopic radical resection of rectal cancer, affecting up to 30% of patients and significantly impacting quality of life. This study aimed to develop a predictive model to identify high-risk patients and characterize stricture subtypes. <b><i>Methods:</i></b> Retrospective analysis of 304 patients undergoing laparoscopic rectal cancer resection (August 2019-April 2024) identified independent risk factors through multivariate logistic regression. A nomogram was developed and validated using receiver operating characteristic curves, calibration plots, and decision curve analysis. Subtype analysis compared Type I (dilatable, <i>n</i> = 51) and Type II (refractory, <i>n</i> = 38) strictures. <b><i>Results:</i></b> The nomogram incorporated five independent predictors: preoperative radiotherapy (odd ratio [OR] = 4.13), diverting stoma creation (OR = 6.98), lack of left colic artery preservation (OR = 3.95), anastomotic leakage (OR = 16.53), and anastomotic distance ≤3 cm (OR = 4.02), achieving an area under the curve (AUC) of .827. Type I strictures were significantly associated with diverting stoma creation (82.4% versus 39.5%, <i>P</i> = .004) and an anastomotic distance >3 cm (70.6% versus 36.8%, <i>P</i> = .001). The refined nomogram for Type II strictures demonstrated superior discrimination (AUC = .883, <i>P</i> < .001). <b><i>Conclusion:</i></b> This dual-phase nomogram effectively predicts overall anastomotic stricture risk and identifies refractory subtypes, enabling personalized postoperative management.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of a Novel Handheld Robotic Needle Holder Versus Conventional Instrument in Laparoscopic Ureterolithotomy: A Multicenter, Randomized, Single-Blind, Positive Parallel Controlled, and Noninferiority Clinical Trial.","authors":"Zhiyong Wen, Yonglian Guo, Ziqiang Dong, Kun Yang, Xinghuan Wang","doi":"10.1089/lap.2024.0394","DOIUrl":"https://doi.org/10.1089/lap.2024.0394","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study aimed to validate the efficacy and safety of the HTH-1 handheld robotic needle holder versus conventional instrument in laparoscopic ureterolithotomy. <b><i>Methods:</i></b> This is a noninferiority clinical trial conducted in three hospitals. Patients were enrolled and randomly allocated into the experimental or control group on whom laparoscopic ureterolithotomy was performed with the ureteral incision sutured using the HTH-1 and conventional needle holder, respectively. The average suture time per stitch (STPS) of ureter was calculated as the primary efficacy indicator. Postoperative drainage volumes were recorded, and the instruments' operating performance was subjectively evaluated and compared between groups. Adverse events occurred during the trial and interference of the instruments to the monitor were assessed as the safety indicators. <b><i>Results:</i></b> From April to September 2018, 50 patients were enrolled with 25 ones in each group. For the efficacy indicators, the noninferiority of the STPS was determined when the noninferiority margin was 40 seconds. The postoperative drainage volumes were not significantly different between groups. The instruments' operating performance was rated as smooth in all cases of both groups. For the safety indicators, no adverse events or interference of the instruments to the monitor occurred during surgery in any case. Clavien 1 complications occurred in 7 (4 in the experimental group versus 3 in the control group, <i>P</i> = 1.000) patients after surgery. <b><i>Conclusions:</i></b> The HTH-1 is effective and safe and noninferior to conventional needle holder in laparoscopic ureterolithotomy. Adequate training and skills assessment are needed before application on patients. <b><i>Clinical trial registration:</i></b> The clinical trial registration was completed in Jiangsu Provincial Drug Administration (record number: Suxielinbei 20180018).</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational Quality of YouTube^™ Videos on Laparoscopic Radical Prostatectomy.","authors":"Ender Akdemir, Muhammet Çiçek, Battal Selçuk Çakmak, Mehmet Levent Akbulut, Muhammet Serdar Buğday","doi":"10.1089/lap.2025.0002","DOIUrl":"https://doi.org/10.1089/lap.2025.0002","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Prostate cancer is the most prevalent urogenital cancer among males. Radical prostatectomy remains the gold standard for localized prostate cancer treatment, with minimally invasive procedures (laparoscopic, robot-assisted laparoscopic) increasingly replacing open surgeries. YouTube™, a popular digital platform, hosts a substantial volume of prostate cancer-related videos, presenting a mix of accurate and misleading content. Given these challenges, researchers have proposed evaluation frameworks to assess the quality of YouTube™ videos. This study evaluates the educational adequacy and contextual relevance of laparoscopic radical prostatectomy (LRP) videos on YouTube™ using established video evaluation criteria. <b><i>Methods:</i></b> A search using the keyword \"Laparoscopic Radical Prostatectomy\" yielded 200 YouTube™ videos. After applying inclusion and exclusion criteria, 131 videos were analyzed by three laparoscopic prostatectomy specialists. An evaluation was performed using scoring systems, including LAP-VEGaS, DISCERN, JAMA, GQS, and video power index (VPI). <b><i>Results:</i></b> Of the 131 videos, 88 (67%) were from individual participants (Group 1), and 43 (33%) were from corporate channels (Group 2). Group 2 demonstrated significantly higher JAMA, GQS, and mDISCERN scores (<i>P</i> = .028, .005, and .001, respectively). The LAP-VEGaS score was also higher in Group 2 (7.09 ± 0.43) compared to Group 1 (5.08 ± 0.26; <i>P</i> < .001). VPI values were significantly greater in Group 2 (<i>P</i> = .008). <b><i>Conclusion:</i></b> This study highlights a critical gap in the educational quality of LRP videos on YouTube™. Using comprehensive scoring systems, corporate channels consistently provided higher-quality educational content compared to individual contributors.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of da Vinci Robot-Assisted and Conventional Laparoscopic Surgery for Hiatal Hernia in Children after Repair for Esophageal Atresia.","authors":"Yujia Zhuang, Xiaoyu Tang, Wenjie Wu, Weihua Pan, Jun Wang","doi":"10.1089/lap.2024.0357","DOIUrl":"https://doi.org/10.1089/lap.2024.0357","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To compare the effectiveness and safety of da Vinci robot-assisted and conventional laparoscopic surgery for hiatal hernia (HH) treatment in children after repair of esophageal atresia (EA). <b><i>Methods:</i></b> A retrospective analysis was conducted of 54 children with EA who underwent either conventional or robot-assisted laparoscopic HH repair between January 2018 and December 2023 in our center. Clinical characteristics and postoperative outcomes were compared to explore the effectiveness and safety of both surgical methods. <b><i>Results:</i></b> Fifty-four patients (conventional surgery, <i>n</i> = 32; robot-assisted surgery, <i>n</i> = 22) met the inclusion criteria. No significant difference was found in gender, age, EA repair method, main symptoms, HH type, and previous HH repair between the two groups. Type A EA accounted for more proportion in conventional surgery group (43.8% versus 13.6%, <i>P</i> < .05). There was a higher use of Nissen fundoplication in robot-assisted surgery group (78.1% versus 100%, <i>P</i> < .05). No significant difference was found in terms of operation length, blood loss, time to start enteral nutrition, conversion to open and total, or postoperative length of stay. The incidence of recurrent symptoms, especially reflux during nighttime, was significantly higher in conventional surgery group (31.3% versus 0%, <i>P</i> < .05). No severe complication or death was reported in either group. <b><i>Conclusions:</i></b> Robot-assisted laparoscopic surgery can be performed safely and effectively for HH repair in EA patients, which made Nissen fundoplication more feasible and showed superior control of reflux symptoms than conventional laparoscopic surgery.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Gastrostomy Tube Placement: Avoid the Incision to Avoid the Complications.","authors":"Audra J Reiter, Faraz Longi, Benjamin L Thomae, Michela M Carter, Courtney J Harris, Caitlin Jacobs, Gwyneth A Sullivan, Timothy B Lautz, Mehul V Raval","doi":"10.1089/lap.2024.0036","DOIUrl":"https://doi.org/10.1089/lap.2024.0036","url":null,"abstract":"<p><p><b><i>Background:</i></b> Tremendous practice variation exists for placing gastrostomy tubes. The objective of this study was to determine if the operative approach is associated with 30-day complication rates. <b><i>Methods:</i></b> This single-center retrospective cohort study identified pediatric patients who underwent gastrostomy tube placement from June 2019 to April 2022. Gastrostomy approaches included laparoscopic, laparoscopic-assisted (incision at gastrostomy site), modified open (incision at gastrostomy site), and percutaneous endoscopic gastrostomy (PEG). Multivariable logistic regression models were performed to evaluate the association of 30-day complications and operative approach after controlling for prematurity and weight. <b><i>Results:</i></b> Among 521 gastrostomy patients, the median age was 10 months (interquartile range: 4-33 months), and 181 (34.9%) had a history of prematurity. Weight categories included 217 (41.6%) underweight, 272 (52.2%) normal weight, and 32 (6.1%) overweight. Patients underwent laparoscopic (<i>n</i> = 386, 74.1%), laparoscopic-assisted (<i>n</i> = 73, 14.0%), modified open (<i>n</i> = 33, 6.3%), and PEG (<i>n</i> = 27, 5.2%). Complications included reoperation (<i>n</i> = 17, 3.3%), readmission (<i>n</i> = 12, 2.3%), wound infection (<i>n</i> = 30, 5.8%), wound breakdown (<i>n</i> = 21, 4.0%), tube dislodgement (<i>n</i> = 23, 4.4%), granulation tissue (<i>n</i> = 107, 20.5%), and leakage (<i>n</i> = 33, 6.3%). Following adjustment, laparoscopic-assisted gastrostomy was associated with higher odds of any complication. Laparoscopic-assisted and modified open were associated with higher odds of wound breakdown. Laparoscopic-assisted and modified open were associated with higher odds of leakage. The operative approach was not associated with reoperation, readmission, wound infection, or tube dislodgement. <b><i>Conclusions:</i></b> Techniques for gastrostomy placement, which include an incision around the tube, were associated with higher rates of complications. To improve complication profiles for patients, surgeons should consider laparoscopic or percutaneous endoscopic gastrostomies.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}