Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Robotic Inguinal Hernia Repair for the New Robotic Surgeon-Safety and Early Outcomes in a Large Academic Medical Center.","authors":"Daniel Tagerman, Michelle Nessen, Diego L Lima, Ryan Chin, Nawaf Hindosh, Zachary Solomon, Xavier Pereira, Prashanth Sreeramoju, Flavio Malcher","doi":"10.1089/lap.2025.0051","DOIUrl":"https://doi.org/10.1089/lap.2025.0051","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> This work evaluated outcomes of robotic inguinal hernia repair (RIHR) in a single-institution study comparing surgeons with varying robotic experience. <b><i>Methods:</i></b> A retrospective study of all patients with RIHR performed between July 2016 and September 2021 at a single institution was performed. Baseline characteristics and outcomes between surgeons with >5 years of robotic experience (ERS) were compared with those with <5 years (NRS). <b><i>Results:</i></b> A total of 297 cases of RIHR were performed. Mean age was 58.3 years (standard deviation [SD] 15.3) with a strong male predominance (88.2%). Forty-four patients (14.8%) had a previous repair, 87 (29.3%) underwent bilateral repair, and mean body mass index was 27.7 (SD 4.8). Sixty cases were performed by one ERS surgeon, and the remaining 237 cases were performed by eight NRS. ERS had more recurrent hernias (38.3% versus 8.9%, <i>P</i> < .001), previous abdominal surgery (48% versus 25%, <i>P</i> < .001), and more often had bilateral inguinal hernias (42% versus 26%, <i>P</i> = .018). Incarcerated hernias were more commonly repaired by ERS compared with NRS (35% versus 8.9%, <i>P</i> < .001). Mean operative time was higher for ERS (132.8 minutes versus 106.2, <i>P</i> < .001). ERS was associated with more intraoperative complications (10% versus 0%, <i>P</i> < .001) as well as 30-day complications (6.7% versus 1.7%, <i>P</i> = .033); however, these were of minimal clinical significance. While ERS had a higher rate of radiographical recurrence (6.7% versus 3.0%, <i>P</i> < .001) after 30 days, there was no difference in clinical concern for recurrence. <b><i>Conclusions:</i></b> While ERS may approach more complex situations, RIHR is a safe approach for both novice and experienced robotic surgeons.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144240","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":"Comparative Outcomes of Laparoscopic, Retroperitoneoscopic, and One-Trocar-Assisted-Pyeloplasty in Pediatric Ureteropelvic Junction Obstruction: A Scoping Review of Literature.","authors":"Fabiola Cassaro, Pietro Impellizzeri, Angela Simona Montalto, Santi D'Antoni, Vincenzo Bagnara, Carmelo Romeo, Salvatore Arena","doi":"10.1089/lap.2025.0007","DOIUrl":"https://doi.org/10.1089/lap.2025.0007","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Ureteropelvic junction obstruction (UPJO) is a common condition in pediatric urology, with various surgical techniques employed for treatment, including laparoscopic pyeloplasty (LP), retroperitoneoscopic pyeloplasty (RP), and One-Trocar-Assisted-Pyeloplasty (OTAP). This review compares intraoperative and postoperative complications, recurrence rates, and outcomes among these methods. <b><i>Materials and Methods:</i></b> A scoping review of the literature from 2000 to 2024 was conducted, analyzing studies on LP, RP, and OTAP in pediatric UPJO patients. We included studies in English and excluded those involving other surgical techniques and mixed adult-pediatric cases. Data extracted from eligible studies included the number of cases, patient age, operative time, complications, recurrence rates, and conversion to open surgery. <b><i>Results:</i></b> A review of 81 studies involving 3549 pediatric patients compared three surgical techniques: LP (2719 patients), RP (399 patients), and OTAP (476 patients). OTAP had the highest rates of minor intraoperative complications (8%) and conversions to open surgery (7.6%). LP and RP showed lower intraoperative complication rates (1.8% and 4.3%) and conversion rates (0.81% and 4.24%). Postoperative complications and recurrence rates were similar across all techniques, with OTAP having the fewest minor postoperative complications (0.8%) and the shortest surgical times (111.5 minutes). <b><i>Conclusions:</i></b> LP, RP, and OTAP are all effective treatments for pediatric UPJO, with comparable success rates and low recurrence rates. OTAP offers fewer minor postoperative complications in confront of LP and faster surgical times but has a higher conversion rate. LP and RP are more suitable for older patients, whereas OTAP seems to be more appropriate for younger patients.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152752","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":"Simple Versus Radical Cholecystectomy for Pathological Stage T1B Gallbladder Cancer: A Systematic Review and Meta-Analysis.","authors":"Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Gabriel Henrique Acedo Martins, Caio Mendonça Magalhães, Sérgio Mazzola Poli de Figueiredo","doi":"10.1089/lap.2025.0049","DOIUrl":"https://doi.org/10.1089/lap.2025.0049","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Gallbladder cancer (GBC) is the sixth most common gastrointestinal malignancy and the most prevalent cancer of the biliary tract. Although recent studies suggest that extended resection may be the optimal approach for managing T1b GBC, there is no clear consensus on whether simple cholecystectomy (SC) or radical cholecystectomy (RC) offers better outcomes. Therefore, we conducted this systematic review and meta-analysis to compare these two surgical techniques in the treatment of T1b GBC. <b><i>Methods:</i></b> We systematically searched PubMed, Embase, and the Cochrane Library through June 20, 2024. We pooled odds ratios (ORs) with 95% confidence intervals (CIs) for binary outcomes and assessed heterogeneity using the <i>I</i>² statistic. <b><i>Results:</i></b> We included 10 studies comprising 2,964 patients, of whom 51.5% underwent SC and 48.5% underwent RC. RC was associated with significantly higher 2 year (OR: 0.46; 95% CI: 0.28-0.77; <i>P</i> < .01; <i>I</i>² = 51%) and five-year overall survival rates (OR: 0.79; 95% CI: 0.64-0.98; <i>P</i> = .03; <i>I</i>² = 0%), and higher 5-year disease-specific survival (OR: 0.59; 95% CI: 0.35-0.99; <i>P</i> = .04; <i>I</i>² = 0%) compared with SC. However, we found no significant differences in 10-year overall survival (OR: 0.71; 95% CI: 0.45-1.13; <i>P</i> = .15; <i>I</i>² = 43%) or recurrence rates (OR 1.44; 95% CI: 0.72-2.88; <i>P</i> = .30; <i>I</i>² = 0%). <b><i>Conclusion:</i></b> RC provides a short- to medium-term survival advantage over SC in patients with T1b gallbladder cancer, but this benefit appears to diminish over time.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144246","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":"The Hidden Challenge: Hepatic Artery Variations and Their Impact on Laparoscopic Gastric Cancer Surgery Outcomes.","authors":"Selim Tamam, Mehmet Şah Benk, Serdar Çulcu, İsmail Can Tercan, Fırat Tekeş, Gökhan Gökten, Ezgi Altınsoy, Cengiz Ceylan, Ali Ekrem Ünal, Salim Demirci","doi":"10.1089/lap.2025.0061","DOIUrl":"https://doi.org/10.1089/lap.2025.0061","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Few studies have evaluated the relationship between vascular anatomical variations and laparoscopic gastrectomy outcomes in patients with gastric cancer. In this study, we aimed to evaluate the effects of preoperatively detected hepatic artery variations on surgical outcomes in patients with gastric cancer undergoing laparoscopic radical gastrectomy. <b><i>Materials and Methods:</i></b> A retrospective analysis was conducted on the radiological, intraoperative, postoperative, and clinical data of 186 patients who underwent laparoscopic gastrectomy for gastric cancer. Patients were divided into two groups: those with variations and those without. The distinction between the two groups was determined by preoperative radiological imaging. The impact of these variations on perioperative and postoperative complications, as well as surgical outcomes, was subsequently evaluated. <b><i>Results:</i></b> Arterial variations were identified in 69 patients (37.1%). The most prevalent arterial variation was the aberrant left hepatic artery, observed in 25 patients (13.4%). In the cohort exhibiting arterial variations, operation time (<i>P</i> < .001; 203 minutes [195-220] versus 191 minutes [180-202]), intraoperative blood loss (<i>P</i> < .001; 100 mL [70-150] versus 50 mL [40-80]), and the total number of dissected lymph nodes (<i>P</i> = .006; 24 [20-34] versus 21 [17-29]) were found to be significantly higher, with statistically significant differences observed between the groups. <b><i>Conclusions:</i></b> A comprehensive evaluation of radiological imaging in patients prior to laparoscopic gastric cancer surgery, employing a multidisciplinary approach and preoperative identification of potential variations, has the potential to prevent complications and enhance surgical outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129178","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":"Long-Term Outcomes of Sleeve Gastrectomy at a Veterans Affairs Medical Center.","authors":"Fatima Khambaty, R Natalie Reed, James Alex Randall, Lila Brody, Parini Shah, Jennifer C Kerns","doi":"10.1089/lap.2025.0072","DOIUrl":"https://doi.org/10.1089/lap.2025.0072","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure for morbid obesity. However, there is limited data on long-term outcomes in the veteran population. This study attempts to determine long-term weight loss and resolution of comorbidities following an LSG in a veteran population. <b><i>Methods:</i></b> A retrospective review was performed of a prospectively maintained database of LSG patients at a single veterans Affairs Medical Center from 2013 to 2019. Patient preoperative factors, 5-year weight loss, resolution of comorbidities, and morbidities were collected and analyzed using univariate and multivariate analysis. An alpha level of 0.05 was used to determine significance. Statistical analyses were performed by using SAS version 9.4. <b><i>Results:</i></b> A total of 153 patients underwent LSG, with 98.7% completing a 5-year follow-up. At 5 years, rates of diabetes (50.9% versus 37.7%, <i>P</i> < .001), hypertension (59.2% versus 49.7%, <i>P</i> < .001), gastroesophageal reflux disease (51.6% versus 40.9%, <i>P</i> < .001), and sleep apnea (67.3% versus 40.9%, <i>P</i> < .001) were significantly reduced from baseline. Average total weight lost was 13.5% from baseline weight, with no perioperative mortalities. Preoperative body mass index (BMI) was the only factor predictive of postoperative BMI. <b><i>Conclusions:</i></b> LSG remains a safe and effective option for veterans with morbid obesity with concurrent resolution of several comorbidities. As the treatment of obesity continues to evolve, postoperative data remains critical to guide patient care.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129177","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":"Strategies for Resection of Esophageal and Gastroesophageal Junction Submucosal Tumors.","authors":"Mohammad Alomari, Daniel Knewitz, Rocio Castillo Larios, Jamii St Julien, Mathew Thomas, Enrique F Elli, Steven P Bowers","doi":"10.1089/lap.2025.0079","DOIUrl":"https://doi.org/10.1089/lap.2025.0079","url":null,"abstract":"<p><p><b><i>Background:</i></b> Submucosal tumors (SMT) of the esophagus and gastroesophageal junction (GEJ) are rare entities, which often present a significant challenge to surgeons. Prior studies have reported only single-modality approaches. We report our experience with SMTs using multiple surgical techniques with the intent of margin-negative resection and organ preservation. <b><i>Methods:</i></b> Between 2001 and 2022, a total of 55 patients underwent surgical resection for SMT of the esophagus or GEJ at our institution. We reviewed the electronic medical records to obtain demographic information and details of the operation. We also report peri- and early (<30 days) postoperative outcomes. <b><i>Results:</i></b> Median age at operation was 62 years (22-93), and 54.5% were male. Endoscopic ultrasound was used in 45 (81.8%) patients preoperatively to classify tumors as possibly amenable for enucleation versus requiring mucosal resection. Forty-eight (87.3%) patients underwent minimally invasive procedures. Enucleation was performed in 23 (41.8%) patients, whereas 32 (58.2%) required full-thickness resection (wedge: 18; segmental: 11) or tumor resection with mucosectomy. One patient experienced Clavien-Dindo grade III or greater complications. There were no reoperations or postoperative mortality. Pathology revealed gastrointestinal stromal tumor in 25 (45.5%) patients, leiomyoma in 22 (40%), and other histology in 8 (14.5%). Negative surgical margins were achieved in 100% of the cases. Involvement of the cardia was associated with the need for full-thickness or tumor resection with mucosectomy (68.4% versus 31.5%, <i>P</i> = .0214). Surveillance was conducted in 20 (36.4%) patients with a median follow-up of 656 days (210-3091). One patient had progressive multifocal disease, and another went on to develop metastatic disease. <b><i>Conclusion:</i></b> Minimally invasive approaches are appropriate in most esophageal and GEJ SMTs and are associated with low complication rates and disease recurrence. Involvement of the gastric cardia increases the likelihood of requiring full-thickness resection or tumor resection with mucosectomy rather than enucleation.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103017","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":"Study on the Safety and Effectiveness of Using Modified Tubular Stomach for Sideoverlap Anastomosis in Laparoscopic Proximal Gastrectomy.","authors":"Zeshen Wang, Qiancheng Wang, Yuming Ju, Shiyang Jin, Pengcheng Sun, Yuzhe Wei, Guanyu Zhu, Kuan Wang","doi":"10.1089/lap.2024.0395","DOIUrl":"https://doi.org/10.1089/lap.2024.0395","url":null,"abstract":"<p><p><b><i>Background:</i></b> The research on laparoscopic proximal gastrectomy has focused on effective methods of preventing reflux, few studies have focused on controlling the blood supply to the anastomosis site. Therefore, we introduced a modified approach to the vascular arch of the tubular stomach (TS) and conducted a preliminary examination of its safety and feasibility. <b><i>Methods:</i></b> Retrospective analysis of clinical data from 37 patients who underwent laparoscopic proximal gastrectomy at our center from March 2021 to June 2023, and comparison of clinical and pathological data, as well as intraoperative and short-term postoperative outcomes, between the modified TS group (<i>n</i> = 16) and the TS group (<i>n</i> = 21). <b><i>Results:</i></b> Compared with the TS, the modified TS had relatively longer operative times (170.63 ± 29.88 minutes versus 166.14 ± 27.49 minutes, <i>P</i> = .64) and anastomosis times (40.44 ± 6.60 minutes versus 36.14 ± 6.72 minutes, <i>P</i> = .06), and there was no significant difference in bleeding volume between the two groups (94.38 ± 75.19 mL versus 67.62 ± 44.15 mL, <i>P</i> = .14). There were 2 cases of postoperative anastomotic-related complications ((both of which were anastomotic bleeding) in the TS. No anastomotic-related complications were observed in the modified TS. There were a total of 6 cases in the postoperative gastroscopy modified TS, including 5 cases of LA-A and 1 case of LA-B; There are 10 cases of TS, including 7 cases of LA-A and 3 cases of LA-B. <b><i>Conclusions:</i></b> The modified TS during laparoscopic procedures is safe and feasible, decreasing to the maximal degree the potential blood supply disorders and bleeding risks at the anastomosis site while preventing reflux.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081579","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":"The Use of Near-Infrared Spectroscopy for the Measurement of Abdominal Wall Tissue Oxygenation During Pneumoperitoneum in Laparoscopic Cholecystectomy.","authors":"Korgün Ökmen, Şule Balk Uçar, Durdu Kahraman Yildiz, Musa Harun Uçar, Aycan Kurtarangil Doğan","doi":"10.1089/lap.2025.0062","DOIUrl":"https://doi.org/10.1089/lap.2025.0062","url":null,"abstract":"<p><p><b><i>Background:</i></b> Near-infrared spectroscopy (NIRS) has been developed to monitor cerebral oxygenation. Various studies have investigated its utility in measuring somatic tissue oxygenation and in noncardiac surgeries. <b><i>Aims:</i></b> The aim of this study was to determine the effect of pneumoperitoneum on the abdominal wall. <b><i>Study Design:</i></b> A prospective, case-control study. <b><i>Methods:</i></b> This study included 70 patients who had elective laparoscopic cholecystectomy. A regional oximetry sensor was placed on the anterior abdominal wall in all patients. Primary outcome measures included preoperative regional tissue saturation (rSO₂) values. For secondary outcome measures, we recorded visual analogue scale (VAS) scores and tramadol usage at postoperative hours 2, 6, 12, and 24: intraoperative end-tidal CO₂ values; peripheral oxygen saturation (spo2); and abdominal subcutaneous fat tissue thickness. <b><i>Results:</i></b> The initial rSO₂ value (T1: 75.6 ± 6.64) was significantly higher than those measured at the predetermined time intervals during pneumoperitoneum (T4: 73.4 ± 6.3, T5: 68 ± 8.9, T6: 68 ± 8.9, T7: 66.6 ± 9.4, T8: 65.81 ± 10.2, T9: 65.6 ± 8.8) (<i>P</i> < .05). The mean change in rSO₂ between preoperative measurements (T1) and mid-pneumoperitoneum measurements (T8) was -12.9 ± 11%. This change was found to be negatively correlated with postoperative VAS scores and 24-hour tramadol consumption amounts. <b><i>Conclusion:</i></b> The results of the present study show that changes in abdominal wall tissue oxygenation during pneumoperitoneum can be measured with NIRS.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081590","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":"Learning Curve of Single-Port Robotic-Assisted Extraperitoneal Radical Prostatectomy: A CUSUM-Based Analysis.","authors":"Valerio Santarelli, Fabio Maria Valenzi, Muhannad Aljoulani, Hakan Bahadır Haberal, Luca A Morgantini, Arianna Biasatti, Stefano Salciccia, Giovanni Battista Di Pierro, Giorgio Franco, Riccardo Autorino, Simone Crivellaro","doi":"10.1089/lap.2025.0055","DOIUrl":"https://doi.org/10.1089/lap.2025.0055","url":null,"abstract":"<p><p><b><i>Background:</i></b> Single-port robotic-assisted radical prostatectomy (SP-RARP) has been demonstrated to be a feasible and safe procedure. Nonetheless, the challenges of SP surgery could limit the transferability of skills from multi-port (MP) console. The aim of our study was to assess the learning curve of SP-RARP. <b><i>Methods:</i></b> SP-RARPs performed by a single experienced surgeon were reviewed. The surgical learning curve was assessed using risk-adjusted cumulative summation (CUSUM) methodology in terms of operative time, separately for SP-RARPs with pelvic lymphadenectomy (PLND) and without PLND. <b><i>Results:</i></b> 119 extraperitoneal SP-RARPs were evaluated, 83 with PLND and 36 without PLND. After CUSUM calculation, a cubic polynomial regression was performed to plot the learning curves. The inflection points, representing the number of cases required to achieve proficiency, corresponded to the 42^nd and 20^th procedure, respectively, for SP-RARP with and without PLND. The learning curves were subsequently divided into a learning phase and a proficiency phase to compare perioperative and postoperative outcomes of the two phases. In both groups, cases in the proficiency phase demonstrated significantly lower median operative times (<i>P</i> = .01 and <i>P</i> < .001) and hospital stays (<i>P</i> = .015 and <i>P</i> = .04). In the SP-RARP without the PLND group, patients in the proficiency phase demonstrated significantly lower postoperative pain scores (<i>P</i> = .04). No differences were found in terms of estimated blood loss, complication rates, and positive surgical margin rates (<i>P</i> > .05). <b><i>Conclusion:</i></b> Results from our analysis suggest that the learning curve of extraperitoneal SP-RARP is not longer than that reported for MP-RARP. Moreover, when cautiously approached, the learning process can be undertaken without compromising safety and oncological outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081578","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":"Thoracoscopic Stapling Ligation of H-Type Tracheo-Esophageal Fistula: A Viable and Safe Technique.","authors":"Omar Nasher, Anna Morandi, Steven S Rothenberg","doi":"10.1089/lap.2024.0391","DOIUrl":"https://doi.org/10.1089/lap.2024.0391","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> H-type tracheo-esophageal fistula (TEF) is rare. Different techniques of fistula ligation are practiced around the world. The aim of this study is to report our experience of thoracoscopic stapling ligation and division of the TEF. <b><i>Methods:</i></b> Retrospective review of patients who underwent thoracoscopic ligation of H-type TEF from April 2016 to January 2024. The diagnosis was made with a preoperative esophagram and confirmed with intraoperative rigid bronchoscopy. The procedure was standardized, and, in all cases, a 5 mm laparoscopic stapler was used to ligate and divide the TEF. Demographics, operative details, and complications were collected and analyzed. <b><i>Results:</i></b> A total of 12 patients were included (7 males) during the 8-year study period. The median age at surgery was 2.5 months (IQR: 1-3), and the median gestational age at birth was 38 weeks (IQR: 35-39). The median weight was 4.8 kg (IQR: 3-5). One case was a redo surgery of a failed ligation by another surgeon, and another had two previous endoscopic ablation attempts. The median operative time was 55 minutes (IQR: 45-79), and there were no conversions to thoracotomy. None of the patients experienced recurrence of the TEF, leak, or recurrent laryngeal nerve injury. <b><i>Conclusion:</i></b> The thoracoscopy approach to H-type TEF is feasible and allows a clear visualization of the fistula and the surrounding anatomical structures. The use of a 5 mm laparoscopic stapler represents a superior, reproducible, and safe method of ligating the fistula with no reported complications in this series.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024596","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}