Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Does the 5-Item Modified Frailty Index Predict Adverse Outcomes after Retrograde Intrarenal Surgery? A Case-Control Study by the RIRSearch Group.","authors":"Cem Başataç, Muhammed Fatih Şimşekoğlu, Kerem Teke, Mustafa Bilal Tuna, Önder Çınar, Hacı Murat Akgül, Oktay Özman, Hakan Çakır, Duygu Sıddıkoğlu, Cenk Murat Yazıcı, Eyüp Burak Sancak, Bülent Önal, Haluk Akpınar","doi":"10.1089/lap.2024.0353","DOIUrl":"10.1089/lap.2024.0353","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> We aim to assess whether severely frail patients have an increased risk of complications and worse surgical outcomes after retrograde intrarenal surgery. <b><i>Methods:</i></b> The data of 340 consecutive patients undergoing retrograde intrarenal surgery to treat upper tract urinary stones were analyzed retrospectively. The 5-item modified frailty index (mFI-5) was used to assess the frailty status. Using a cutoff value of score 2 in the mFI-5 score, patients were divided into two groups: patients with an mFI-5 score <2 were assigned to a non-frail (Group 1) group, and patients with an mFI-5 score ≥2 were assigned to a frail (Group 2) group. The patients' demographics, stone characteristics, operative outcomes, and complication rates were compared between the groups. The primary objective was to examine whether the surgical outcomes were much better in non-frail patients. <b><i>Results:</i></b> After matching confounding factors, Group 1 comprised 255 patients, and Group 2 comprised 85 patients. The baseline characteristics were similar between the groups. There were no statistically significant differences in terms of the median operation time and length of hospital stay among groups. There were no significant differences between groups for intraoperative complication rates (7.6% and 9.4%, respectively; <i>P</i> = .47) and postoperative complication rates (13.8% and 11.8%, respectively; <i>P</i> = .71), and stone-free rates (70.9% versus 72.9%, respectively; <i>P</i> = .73). <b><i>Conclusions:</i></b> Retrograde intrarenal surgery is an efficient and feasible treatment option for upper urinary tract stones in severely frail patients.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"271-276"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417037","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":"Early Laparoscopic Cholecystectomy Versus Percutaneous Cholecystostomy Followed by Delayed Laparoscopic Cholecystectomy in Patients with Grade II Acute Cholecystitis According to Tokyo Guidelines TG18.","authors":"Mostafa R Elkeleny, Hany M K El-Haddad, Mohamed M Kandel, Mostafa I Seif El-Deen","doi":"10.1089/lap.2024.0332","DOIUrl":"10.1089/lap.2024.0332","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> In the past, most patients with acute cholecystitis (AC) were treated conservatively. However, strong evidence from various studies has shown that laparoscopic cholecystectomy (LC) is safe and should be the primary treatment for AC. However, this may not be the case for all AC grades. This study aimed to compare two recommended approaches for grade II AC as outlined in the Tokyo guidelines TG18, focusing on early operative outcomes. <b><i>Methods:</i></b> We conducted a retrospective review of medical records for all patients diagnosed with grade II AC. The study compared patients who underwent early LC (group A, <i>n</i> = 130) with those who initially received percutaneous cholecystostomy (PC) followed by LC (group B, <i>n</i> = 90). <b><i>Results:</i></b> Both groups had similar Tokyo classification parameters. However, there were significant differences in baseline data, operative challenges, and postoperative complications. Cholecystostomy-related complications were observed in seven patients. The conversion rate for was 25% for group A and 5% for group B. The incidence of intraoperative biliary injury was 10% for group A and 2.2% for group B. In group A, 92% of patients with biliary injury and 80% of those who required conversion to open surgery had evidence of localized inflammation around the gallbladder. <b><i>Conclusion:</i></b> For selected patients with grade II AC and higher risks, PC placement can be beneficial in preventing life-threatening consequences. The study suggests a 2-month interval between PC and subsequent LC. Overall, performing LC after PC was found to be easier than early LC. Local inflammatory changes, including empyema, were associated with higher complication rates in the early LC group.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"277-285"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061281","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":"Laparoscopy for Gastrointestinal Perforation in Neonates: A New Animal Model for Training.","authors":"Victoria Leones de Matos, Elisa Siano, Esperança Vidal Quipungo, Alice Miranda, Peter Etlinger, Jorge Correia-Pinto","doi":"10.1089/lap.2024.0342","DOIUrl":"10.1089/lap.2024.0342","url":null,"abstract":"<p><p><b><i>Background:</i></b> Gastrointestinal (GI) perforation in the neonatal period can result from different conditions with varying degrees of severity. Optimal timing for surgery is challenging to establish and laparoscopy has been proposed as a diagnostic tool to minimize surgical delays and refine surgical indications. However, no standard animal model is universally accepted for training laparoscopic management of neonatal GI perforations. We aimed to define a small-sized animal model and (1) assess the effectiveness of laparoscopy in identifying GI perforations and (2) evaluate the viability of intracorporeal suturing, in a confined working space. <b><i>Methods:</i></b> In total, 30 Sprague Dawley rats underwent laparoscopy. In Part I, a random GI perforation was performed. In Part II, the perforation was identified and sutured. The surgeon of Part II remained blinded during Part I. The suture line was assessed for leaks and strictures once the rats were euthanized. <b><i>Results:</i></b> In Part I, 29 perforations were created: 22 in the ileum, 3 in the colon, 2 in the jejunum, 1 in the stomach, and 1 in the duodenum. In one rat, the GI tract was left intact. In Part II, all 29 perforations were identified and sutured. The average duration of Part II was 53 ± 16 minutes. During suture evaluation, a leak was observed in two cases, and a stricture in two additional cases. <b><i>Conclusions:</i></b> Laparoscopy was technically feasible and highly sensitive in detecting isolated GI perforation in a rat model. This model holds particular value for training laparoscopic skills in a space-limited setting. Further investigation is needed to see if a learning curve can be achieved.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"351-356"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392344","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-Rahman Fadi Diab, Joseph Adam Sujka, Chandan Mitra, Alan Hamza, Yasotha Diana Ananthan, Salvatore Docimo, Christopher Garnet DuCoin","doi":"10.1089/lap.2024.0397","DOIUrl":"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":"300-312"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","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":"The Effects of Having Surgeon's Hands in Line of Vision During Single-Incision Laparoscopic Surgery: A Feasibility Study.","authors":"Balkis Zaitoun, Abdulrahman Maziek, Emad Eddin Dalla, Muhammad Eyad Ba'Ath","doi":"10.1089/lap.2025.0005","DOIUrl":"10.1089/lap.2025.0005","url":null,"abstract":"<p><p><b><i>Aim:</i></b> Single-incision laparoscopic surgery (SILS) provides improved cosmesis compared with multiport laparoscopy. However, it involves hand-clashing and cross-triangulation, making it challenging even for experienced surgeons to adopt in their practice. This study aims to assess the effect of providing an additional view of the surgeon's hands on task performance in SILS. <b><i>Methods:</i></b> Surgically naive participants were recruited via volunteer sampling and instructed to perform tasks using a laparoscopic trainer set and a singular triport access device. A head-mounted camera was worn by the participant and angulated inferiorly to provide an additional view of the operators' hands. Both views were displayed on a 90″ monitor. Tasks were performed with and without the additional view in an alternating manner. Attempts were recorded and assessed blindly for duration and success. Chi-squared and Mann-Whitney <i>U</i> tests were applied as required. A <i>P</i> value <.05 was considered significant. <b><i>Results:</i></b> A total of 467 attempts were conducted by 30 volunteers. The pass rates were 79.09% and 69.23% for the additional and traditional views, respectively (<i>P</i> = .015). A trend toward shorter durations was seen in attempts using the additional view (<i>P</i> = .128). Males (<i>P</i> = .003) and PC video game players (<i>P</i> = .022) were more likely to pass and mobile video game players were more likely to fail (<i>P</i> = .003). <b><i>Conclusion:</i></b> The use of a head-mounted camera to directly visualize surgeon's hands enhances performance in an <i>ex vivo</i> setting. More research is needed to assess clinical impact.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"329-338"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517090","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":"Choledochal Cyst in Children Under Six Months: Is Da Vinci Robot-Assisted Surgery More Advantageous?","authors":"Sai Chen, Zhigang Gao, Qingjiang Chen","doi":"10.1089/lap.2024.0031","DOIUrl":"10.1089/lap.2024.0031","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Surgery for choledochal cysts (CDC) in children younger than 6 months is relatively rare. We report our experience and compare the results between Da Vinci robot-assisted hepaticojejunostomy (RAHJ) and laparoscopic-assisted hepaticojejunostomy (LAHJ) in children younger than 6 months to treat CDC. <b><i>Methods:</i></b> A retrospective study was conducted on all children under 6 months of age who underwent RAHJ or LAHJ at the Children's Hospital, Zhejiang University School of Medicine, from July 2018 to November 2023. <b><i>Results:</i></b> We reviewed 34 patients who underwent RAHJ surgery and 50 patients who underwent LAHJ surgery (<i>P</i> = .243). RAHJ group of the median operation time was 182 minutes (range 161-221), and LAHJ group was 168 minutes (range 143-191) (<i>P</i> = .02). The RAHJ group had a significantly shorter median postoperative hospital stay of 9 days (range 7-10) than the LAHJ group, 11 days (range 10-14), <i>p</i> < .001. The median hospitalization cost in the RAHJ group was significantly higher than that in the LAHJ group (75,474 CNY versus 28,984 CNY, <i>p</i> < .01). The median follow-up time was 18 months in the RAHJ group and 48 months in the LAHJ group (<i>p</i> < .01). All patients in the RAHJ group recovered well and were discharged. One patient in the LAHJ group developed biliary fistula 21 days after surgery and recovered well after reoperation. <b><i>Conclusions:</i></b> For children under 6 months old, on the basis of no consideration of cost, RAHJ has fast postoperative recovery and fewer postoperative complications, which is more recommended.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"252-256"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933419","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 Impact of Enhanced Recovery After Surgery Compliance in Colorectal Surgery for Cancer.","authors":"Ana Sarah Portilho, Maria Luiza Viana Olivé, Rodrigo Moisés de Almeida Leite, Francisco Tustumi, Victor Edmond Seid, Lucas Soares Gerbasi, Rafael Vaz Pandini, Lucas de Araújo Horcel, Sérgio Eduardo Alonso Araujo","doi":"10.1089/lap.2024.0317","DOIUrl":"10.1089/lap.2024.0317","url":null,"abstract":"<p><p><b><i>Background:</i></b> This study aimed to assess the impact of Enhanced Recovery After Surgery (ERAS) compliance and to identify which components of this protocol are most likely to affect postoperative outcomes in patients undergoing colorectal cancer surgery. <b><i>Methods:</i></b> This is a retrospective cohort evaluating patients who underwent elective colon resection. ERAS compliance was assessed based on adherence to the protocol components. The study examined the following outcomes: postoperative complications, readmission rates, mortality, conversion to open surgery, stoma creation, and length of hospital stay. <b><i>Results:</i></b> Of the 410 patients studied, 59% achieved ≥75% compliance. Comparison between compliance groups (<75% versus ≥75%) showed significant differences in overall complications (<i>P</i> = .002), severe complications (<i>P</i> = .001), and length of hospital stay (<i>P</i> < .001). The area under the receiver operating characteristic curve for predicting the absence of severe complications based on ERAS compliance was 0.677 (95% confidence interval: 0.602-0.752). Logistic regression analyses demonstrated that ERAS compliance was significantly associated with a reduced risk of severe complications (<i>P</i> < .001), as well as that the following items: avoiding prophylactic drains (<i>P</i> < .001), minimal use of postoperative opioids (<i>P</i> = .045), avoidance of postoperative salt and water overload (<i>P</i> < .001), postoperative nutritional support (<i>P</i> = .048), and early mobilization (<i>P</i> = .025). <b><i>Conclusion:</i></b> High ERAS compliance is associated with improved postoperative outcomes in colorectal cancer surgery. Key protocol components for preventing severe complications include avoiding prophylactic drains, minimal postoperative opioid use, avoiding salt and water overload, nutritional support, and early mobilization.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"185-197"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558639","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":"Optimizing Prostate Cancer Surgery for Seniors: Single-Port Robotic-Assisted Platform.","authors":"Hakan Bahadir Haberal, Luca Lambertini, Giulio Avesani, Greta Pettenuzzo, Matteo Pacini, Fabio Maria Valenzi, Muhannad Aljoulani, Ruben Calvo Sauer, Juan Ramon Torres-Anguiano, Simone Crivellaro","doi":"10.1089/lap.2024.0387","DOIUrl":"10.1089/lap.2024.0387","url":null,"abstract":"<p><p><b><i>Background:</i></b> The Da Vinci single-port (SP) platform is being used more frequently in radical prostatectomy (RP). In this study we aimed to compare the complications and oncological outcomes of the Da Vinci SP platform in robotic-assisted radical prostatectomy (SP-RARP) between elderly and young age-groups and to further examine differences between young-old and old-old patients. <b><i>Materials and Methods:</i></b> Data from 193 patients who underwent SP-RARP between December 2018 and June 2024 were analyzed. Patients were categorized into two age-groups: young (18-64 years) and elderly (65+ years). The elderly group was further divided into young-old (65-69 years) and old-old (70+ years) subgroups. The analysis considered variables related to patient characteristics, intraoperative outcomes, complications, and postoperative oncological outcomes. <b><i>Results:</i></b> The median age of the patients at the time of surgery was 64 (9.5) years. The intraoperative complication rate of 1.6%, with no cases requiring conversion to open surgery. The overall incidence of postoperative adverse events was 24.4%, and the 30-day readmission rate was 11.4%. Intraoperative complications and 30-day readmission rates were similar between groups (<i>P</i> = .593 and <i>P</i> = .821, respectively), while the postoperative complication rate was significantly higher in the younger patient group (<i>P</i> = .012). The median length of hospital stay (LOS) was 7 (22) hours and 110 (57%) patients were discharged on the same day (SDD). LOS and SDD rates were similar between groups (<i>P</i> = .389 and <i>P</i> = .529, respectively). The 3-year and 5-year biochemical recurrence (BCR)-free survival rates were 80.5% and 75.1%, respectively. The BCR-free survival rates were similar between both young and elderly patients and between the young-old and old-old groups (<i>P</i> = .751, <i>P</i> = .765, respectively). <b><i>Conclusion:</i></b> SP-RARP is a feasible option for elderly patients, delivering acceptable oncological outcomes with a low incidence of postoperative complications.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"240-246"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061294","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":"Frozen Section Doughnuts Obtained with a 5 mm Stapling Device Improve Outcomes in Laparoscopic Endorectal Pull-Throughs for Hirschsprung's Disease.","authors":"John M Hallett, Clair Evans, Gregor Walker, Tim Bradnock","doi":"10.1089/lap.2023.0511","DOIUrl":"10.1089/lap.2023.0511","url":null,"abstract":"<p><p><b><i>Background:</i></b> A primary pull-through for Hirschsprung's disease (HD) requires confirmation of normal ganglionic bowel by intraoperative biopsies to determine the level of resection. Despite this, aganglionic bowel that is not fully resected (so-called \"transition zone pull-throughs\") is reported in 15%-19% of patients. We hypothesize that this may result from insufficient biopsies sent for intraoperative diagnosis. <b><i>Methods:</i></b> A new biopsy protocol has been developed in our institution for patients undergoing a laparoscopic-assisted endorectal pull-through for HD. Laparoscopic seromuscular biopsies are taken as per standard practice and are reported intraoperatively to identify the most distal site of ganglionic bowel. A 5 mm laparoscopic stapling device is used to divide the bowel at the proposed proximal resection margin and 2 cm distally. If there is any evidence of abnormality in the first doughnut, a second, more proximal doughnut is taken. <b><i>Results:</i></b> Between 2015 and 2020, 21 patients underwent a primary laparoscopic endorectal pull-through for HD using the doughnut biopsy protocol. Sixteen patients were male. The mean patient age at the time of surgery was 3 months (range 1-6 months), and the mean weight at the time of surgery was 6.5 kg (range 4.1-8.54 kg). In all 21 cases, initial laparoscopic biopsies were reported showing normal ganglionic bowel; in two cases (10%), the laparoscopic doughnut influenced the proximal resection margin. In both cases, aganglionic tissue was identified intraoperatively in the doughnuts, and a second, more proximal doughnut was sent. No patients had transition zone resections on final histology (mean clear margin 45.55 mm, range 11-72 mm). <b><i>Conclusions:</i></b> In conclusion, intraoperative frozen sections taken from doughnuts of bowel retrieved using 5 mm laparoscopic stapling devices are safe and have resulted in a 0% rate of transition zone pull-throughs while reducing the potential of spillage of enteric contents. We would recommend this protocol for all patients undergoing primary endorectal pull-throughs.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"247-251"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958187","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":"Abdominoperineal Resection in Prone Versus Supine Position: A Systematic Review and Meta-Analysis.","authors":"Bernardo Fontel Pompeu, Eric Pasqualotto, Beatriz D'Andrea Pigossi, Matheus Reginato Araujo, Lucas Monteiro Delgado, Lucas Soares de Souza Pinto Guedes, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga","doi":"10.1089/lap.2024.0372","DOIUrl":"10.1089/lap.2024.0372","url":null,"abstract":"<p><p><b><i>Background:</i></b> Abdominal perineal resection (APR) remains the gold standard for lower rectal cancer involving the anal sphincter. However, the optimal patient position remains unclear. While lithotomy or Lloyd-Davies are commonly used, APR and extra-levator abdominal perineal excision (ELAPE) in a prone jackknife position have been linked to better oncological outcomes. <b><i>Methods:</i></b> We searched PubMed, Embase, the Central Register of Clinical Trials, and Web of Science for randomized controlled trials (RCTs) and observational studies published up to February 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using <i>I</i>² statistics. Statistical analysis was performed with R Software version 4.4.1. <b><i>Results:</i></b> Two RCTs and 26 observational studies, including 4529 patients, were analyzed. Among them, 2249 (49.7%) underwent APR or ELAPE in the prone position and 2280 (50.3%) in the supine position. The prone position was associated with reduced surgical specimen perforation (5.3% versus 9.4%; OR: 0.44; 95% CI: 0.39-0.78; <i>P</i> < .001), lower positive circumferential resection margins (CRMs) rates (9.8% versus 14.3%; OR: 0.69; 95% CI: 0.53-0.89; <i>P</i> < .001), and decreased intraoperative bleeding (mean difference: -63.7 mL; 95% CI: -104.5, -22.8; <i>P</i> < .01). No significant differences were observed in operative time, urinary retention, urinary injury, wound infections, perineal dehiscence, Clavien-Dindo ≥3, reoperation, local recurrence, distal recurrence, or overall survival. <b><i>Conclusion:</i></b> The prone position during APR is associated with reduced specimen perforation, lower positive CRM rates, and less intraoperative bleeding without significant differences in other clinical outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"224-239"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558634","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}