Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Prolonged Umbilical Port Insertion Time Increases the Incidence of Umbilical Surgical Site Infection in Laparoscopic Percutaneous Extraperitoneal Closure for Inguinal Hernia in Children.","authors":"Shohei Yoshimura, Kengo Hattori, Emi Tsuji, Jiro Tsugawa, Eiji Nishijima","doi":"10.1089/lap.2024.0172","DOIUrl":"https://doi.org/10.1089/lap.2024.0172","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Umbilical surgical site infection (U-SSI) is the most common complication of laparoscopic percutaneous extraperitoneal closure (LPEC) for the treatment of inguinal hernia in children. Prolonged operative time is known to increase the risk of SSI in general pediatric surgery; however, the association between prolonged operative time and post-LPEC U-SSI is unclear. The present study aimed to elucidate the association between umbilical port insertion time and the incidence of U-SSI. <b><i>Materials and Methods:</i></b> The present study included all patients <16 years of age who underwent LPEC for the treatment of inguinal hernia between June 2018 and May 2023 at our institution. Those who underwent umbilical hernia repair or other procedures were excluded. We retrospectively collected and analyzed the following: patient demographics; operative data; and U-SSI data. The cutoff value for the umbilical port insertion time was determined using receiver operating characteristic analysis, and the incidence of U-SSI was compared based on the cutoff value, determined to be 8 minutes. <b><i>Results:</i></b> A total of 232 patients (133 boys; mean age, 4.6 ± 3.3 years) were eligible for the present study, 7 (3.0%) of which developed superficial incisional post-LPEC U-SSI within a median of 7.5 [4-19] days. The incidence of U-SSI was 20.0% in the long (≥8 minutes) versus 2.3% in the short (<8 minutes) umbilical port insertion time group (<i>P</i> = .03). <b><i>Conclusion:</i></b> Prolonged umbilical port insertion time (≥8 minutes) increases the incidence of post-LPEC U-SSI during the treatment of inguinal hernia in children.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479470","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":"Robotic-Assisted Versus Laparoscopic Approach for Treatment of Acute Cholecystitis in Children.","authors":"Wendy Jo Svetanoff, Karen Diefenbach, Jennifer H Aldrink, Marc P Michalsky","doi":"10.1089/lap.2023.0524","DOIUrl":"https://doi.org/10.1089/lap.2023.0524","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Laparoscopic cholecystectomy (Lap-C) is the standard of care for patients requiring cholecystectomy in the acute setting. Although robotic-assisted cholecystectomy (RA-C) performance has increased, utilization in the acute setting has not been widely reported. We describe the feasibility of RA-C for pediatric patients undergoing acute inpatient cholecystectomy. <b><i>Methods:</i></b> A single institutional retrospective review of patients receiving RA-C while admitted for acute cholecystitis and/or choledocholithiasis (June 2017-June 2022) was compared with a matched cohort who underwent traditional multiport Lap-C (June 2021-June 2022). Demographic, perioperative, and postoperative data were analyzed. <b><i>Results:</i></b> Fifty patients were included: 25 each in the RA-C and Lap-C groups. Fifty-four percent were female; 66% were non-Hispanic white. Median age (15.7 years [interquartile range, IQR 14.7, 17.3] versus 15.3 years [IQR 14.5, 16.9], <i>P</i> = .91) and preoperative weight (92.6 kg [IQR 60, 105.9] versus 72.3 kg [IQR 61.6, 85.6], <i>P</i> = .15) were similar between the RA-C and Lap-C groups, respectively. No differences were observed in median operating time (89 minutes [IQR 76, 103] versus 88 minutes [IQR 77, 137], <i>P</i> = .70), postoperative length of stay (22.5 hours [21.4, 24.9] versus 20.6 hours [18.0, 25.1], <i>P</i> = .06), or 30-day complications (12% versus 16%, <i>P</i> = .69). Although opioid utilization (.23 milliequivalents/kilogram [MME/kg] [IQR .03, .30] versus .03 MME/kg [0, .09], <i>P</i> = .02) was higher in the RA-C cohort overall, no differences were detected during an analysis of the most recent 2 years (<i>P</i> = .96). <b><i>Conclusion:</i></b> RA-C in the acute setting can be performed safely in the pediatric population with comparable procedural times as well as perioperative and 30-day outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479473","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":"Predictors of Persistent Prostate-Specific Antigen Persistence after Radical Prostatectomy.","authors":"Chenhao Guo, Kangwei Zuo, Qi Zhao, Yongjuan Zhang, Nan Jiang, Suoshi Jing, Qiaokai Yang, Xiumei Li, Panfeng Shang, Weiping Li","doi":"10.1089/lap.2024.0275","DOIUrl":"https://doi.org/10.1089/lap.2024.0275","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To investigate the predictors of persistent prostate-specific antigen (PSA) after radical prostatectomy (RP). <b><i>Methods:</i></b> From January 2019 to December 2022, 212 patients with prostate cancer who underwent RP were retrospectively analyzed. According to the PSA value at 4-8 weeks postoperatively, the patients were divided into the PSA <0.1 ng/mL group (<i>n</i> = 142) and PSA ≥0.1 ng/mL group (<i>n</i> = 70). Logistic regression was used to analyze the independent risk factors of persistent PSA, and the logistic regression equation was established to predict the probability of persistent PSA. <b><i>Results:</i></b> Total PSA (tPSA) levels at diagnosis >49.73 ng/mL, free PSA (fPSA) levels at diagnosis >2.07 ng/mL, or clinical T stage >T3a were independent risk factors for PSA persistence after RP. <b><i>Conclusion:</i></b> Patients with tPSA at diagnosis >49.73 ng/mL, fPSA at diagnosis >2.07 ng/mL, and T3b prostate cancer showed strong associations with persistent PSA.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479469","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":"Less Is (<i>Sometimes</i>) More: Laparoscopic Peritoneal Lavage and Drainage for Diverticulitis.","authors":"Gustavo R Rodriguez, R Natalie Reed, Fred Brody, James E Duncan","doi":"10.1089/lap.2024.0328","DOIUrl":"https://doi.org/10.1089/lap.2024.0328","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Laparoscopic lavage and drainage (LLD) emerged as an alternative to Hartmann's procedure (HP) for patients with diverticulitis and uncontained perforation. Although initially popular as a less invasive approach, its use in modern practice is in question. This summary will review the available literature to show techniques, outcomes, and indications. <b><i>Methods:</i></b> The literature was reviewed for relevant case studies, randomized trials, prospective series, retrospective analyses, and meta-analyses to define peritoneal lavage and determine the clinical outcomes of peritoneal lavage. <b><i>Results:</i></b> LLD can be considered on an individual basis for Hinchey III diverticulitis (purulent peritonitis), but there are several contraindications. The extent of adhesionolysis (limited versus extensive) as well as the management of sites of perforation found during surgery are debated. Most surgeons continue lavage with warm saline until water runs clear and place drains in the operation. Three randomized controlled trials (RCTs), the LADIES, SCANDIV, and DILALA trials compared LLD with either resection and anastomosis or Hartmann's procedure. One other RCT (the LapLAND trial) is still with results pending. The LADIES trial studied LLD versus primary anastomosis and resection in Hinchey III diverticulitis and was terminated early secondary to higher 30-day morbidity in the LLD arm; however, 3-year data showed no significant difference in morbidity and mortality. The SCANDIV trial compared LLD with resection in acute diverticulitis (Hinchey I-III) and saw no difference in 90-day morbidity or mortality; however, it noted higher rates of reoperation in the LLD group. The DILALA trial compared Hinchey III diverticulitis patients undergoing LLD with open HP and found that the LLD group had a lower rate of reoperation at 2 years, but no difference in rates of readmission or mortality. <b><i>Conclusions:</i></b> Debate still remains over the technique of LLD and specific indications, as well as outcomes compared with resection and primary anastomosis or HP.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479468","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":"Diastasis Recti with Concomitant Ventral Hernia Repair: An Initial Experience in the United Arab Emirates Population.","authors":"Alfredo D Guerron, Gabriela Restrepo-Rodas, Juan S Barajas-Gamboa, Jose Luis Guzman Fuentes, Juan Pablo Pantoja, Carlos Abril, Suleiman Al-Baqain, Miguel Bravo, Mario Cherubino, John Rodriguez","doi":"10.1089/lap.2024.0216","DOIUrl":"10.1089/lap.2024.0216","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Diastasis recti (DR) is characterized by an abnormal separation between the rectus abdominis muscles. Traditional repair includes only plication; however, complications may arise in the presence of concurrent ventral hernias (VH). This study aims to evaluate the safety and feasibility of diastasis repair in a United Arab Emirates (UAE) population. <b><i>Methods and Procedures:</i></b> This retrospective cohort study was conducted with IRB approval. All patients who underwent a DR repair (DRR) with concomitant ventral hernia repair between October 2022 and February 2024 were included. <b><i>Results:</i></b> A total of 20 patients were included in the study. The cohort was 80% female, with a mean overall age of 44.05 years. The mean body mass index was 27.4 kg/m². All patients (100%) presented with DR associated with an abdominal wall defect; 17 patients (85%) with umbilical hernia, 2 patients (10%) with umbilical and incisional hernia, and 1 patient (5%) with umbilical with epigastric hernia. A total of 12 (60%) patients underwent laparoscopic DRR concomitant with VH repair, 5 (25%) patients underwent open DRR with VH repair and abdominoplasty, and 1 patient (5%) underwent DRR with VH repair and liposuction. All cases were successful without complications or conversions. Complications within 30 days included only seromas in 6 patients (30%), one requiring drainage. <b><i>Conclusion:</i></b> Our initial experience suggests that DR repair with concomitant VH repair and/or abdominoplasty is feasible and safe in the UAE population. Our experience demonstrated surgical outcomes compared to other regions in the world.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037615","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":"Treating Benign Ovarian Lesions in the Pediatric Population: A Single Institution's Retrospective Investigation of Laparoscopy Versus Open Repair.","authors":"Nicole Chicoine, Niloufar Hafezi, Victoria Sanchez, Victoria Elliott, Brian Gray","doi":"10.1089/lap.2023.0364","DOIUrl":"10.1089/lap.2023.0364","url":null,"abstract":"<p><p><b><i>Background:</i></b> Benign ovarian lesions in the pediatric population have variable risk of recurrence or development of metachronous lesions, leading to variations in operative approach. Our study compares outcomes with differing surgical approaches to better elucidate risk of recurrent or metachronous lesions, time to development of these lesions, and hospital length of stay to determine if one operative approach has superior outcomes. <b><i>Methods:</i></b> We retrospectively examined data from Indiana University Health facilities from 2002 to 2020. Patients ≤18 years old who underwent surgical management of a benign ovarian lesion were included. Patients were categorized as undergoing oophorectomy versus ovarian sparing surgery (OSS), with open and laparoscopic approaches. Significance was defined as <i>P</i> < .05. <b><i>Results:</i></b> We identified 127 patients who underwent an open (<i>n</i> = 65) versus laparoscopic (<i>n</i> = 55) surgical approach. Patients undergoing open surgery had a greater mean size of lesion (<i>P</i> = .05) and longer length of stay (<i>P</i> < .01). Complication rates (<i>P</i> = .1), rates of developing a metachronous or recurrent lesion postoperatively (<i>P</i> = .47), and time to formation of additional lesions were similar between groups (<i>P</i> = .25). The incidence of identifying an additional lesion after surgery was 14.2% (<i>n</i> = 18) in the mean time of 29.5 ± 31.6 months [SEM 7.5]. Risk of developing a metachronous lesion was similar regardless of the operative approach. Surgery for recurrent ovarian lesions was rare and occurred in only 1 case. <b><i>Conclusions:</i></b> Laparoscopic surgery was performed for smaller lesions and was associated with a shorter length of hospital stay. Laparoscopic and OSS was found to have no increased risk of developing metachronous lesions nor increased reoperative risk compared with traditional open and oophorectomy techniques.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854405","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 Postoperative Outcomes and Long-Term Survival Rates between Patients Who Underwent Robotic and Laparoscopic Complete Mesocolic Excision for Right-Sided Colon Cancer.","authors":"Afag Aghayeva, Mustafa Ege Seker, Serra Bayrakceken, Ebru Kirbiyik, Aysegul Bagda, Cigdem Benlice, Tayfun Karahasanoglu, Bilgi Baca","doi":"10.1089/lap.2024.0144","DOIUrl":"10.1089/lap.2024.0144","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Right colon cancer often requires surgical intervention, and complete mesocolic excision (CME) has emerged as a standard procedure. The study aims to evaluate and compare the safety and efficacy of robotic and laparoscopic CME for patients with right colon cancer and 5-year survival rates examined to determine the outcomes. <b><i>Materials and Methods:</i></b> Patients who underwent CME for right-sided colon cancer between 2014 and 2021 were included in this study. Group differences of age, body mass index, operation time, bleeding amount, total harvested lymph nodes, and postoperative stay were analyzed by the Mann-Whitney U test. Group differences of sex, American Society of Anesthesiology, and tumor, node, and metastasis stage were analyzed by the Chi-squared test. Disease-free and overall survival were assessed using Kaplan-Meier curves with the log-rank Mantel-Cox test. <b><i>Results:</i></b> From 109 patients, 74 of them were 1:1 propensity score matched and used for analysis. Total harvested lymph node (<i>P</i> ≤ .001) and estimated blood loss (<i>P</i> = .031) were found to be statistically significant between the groups. We found no statistically significant difference between the groups in terms of disease-free and overall survival (<i>P</i> = .27, .86, respectively), and the mortality rate was 9.17%, with no deaths directly attributed to the surgery. <b><i>Conclusions:</i></b> Study shows that minimally invasive surgery is a feasible option for CME in right colon cancers, with acceptable overall survival rates. Although the robotic approach has a higher lymph node yield, there was no significant difference in survival rates. Further randomized trials are needed to determine the clinical significance of both approaches.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428145","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 Inflammatory Response and Long-Term Outcomes Between Open and Laparoscopic Pancreatoduodenectomy:A Propensity-Matched Single-Institution Study.","authors":"Jiaping Wang, Shuang Yu, Shun Liu, Xue Liang, Shupeng Wang, Lin Li","doi":"10.1089/lap.2024.0006","DOIUrl":"10.1089/lap.2024.0006","url":null,"abstract":"<p><p><b><i>Background:</i></b> In recent years, although laparoscopic pancreatoduodenectomy (LPD) has experienced rapid development both domestically and internationally, however, there are still varying opinions toward LPD. <b><i>Methods:</i></b> From January 2020 to July 2022, the data were collected. We compared the inflammatory response at various postoperative time points and evaluated long-term outcomes between the two groups. <b><i>Results:</i></b> In the early stage, the LPD group exhibited lower values of white blood cells, C-reactive protein, neutrophils, and platelets after surgery compared with open pancreatoduodenectomy (OPD) (<i>P</i> all<0.05). However, no statistically significant differences were observed in terms of procalcitonin, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. Before propensity score matching, no statistical significance was observed between two groups, whether in terms of disease-free survival (DFS) (<i>P</i> = .406) or overall survival (OS) (<i>P</i> = .851). However, to further control for confounding factors, propensity score matching was used. The analysis revealed that DFS still showed no significant difference (<i>P</i> = .928), but, in the term of OS, a statistical significance was observed between the two groups. <b><i>Conclusion:</i></b> LPD demonstrates a comparable long-term outcomes to OPD and even slightly superior OS. Moreover, the LPD group exhibits a lower inflammatory response during early postoperative period.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560180","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":"Perioperative, Oncological, and Functional Outcomes after Retroperitoneal Laparoscopic Partial Nephrectomy in Elderly Patients: A Propensity Score Matching Analysis.","authors":"Kaan Karamık, Hakan Anıl, Ali Yıldız, Ahmet Güzel, Serkan Akdemir, Murat Arslan","doi":"10.1089/lap.2024.0234","DOIUrl":"10.1089/lap.2024.0234","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> We aimed to assess the perioperative, oncological, and functional outcomes of patients aged 70 years or older following retroperitoneal laparoscopic partial nephrectomy (LPN) and compare their results with younger patients. <b><i>Materials and Methods:</i></b> A retrospective review of our prospectively maintained database identified 329 patients who underwent retroperitoneal LPN from January 2013 to October 2022. The patients divided into 2 groups defined by age ≥70 or <70 years at the time of surgery. A propensity score matching analysis was conducted to obtain two balanced groups. The groups were compared for safety (perioperative outcomes) and efficacy (oncological and functional outcomes). <b><i>Results:</i></b> After matching, all variables were well balanced with no differences between the two cohorts. No significant differences were found in perioperative outcomes, including operative time, warm ischemia time, blood loss, hospital stay, and complications (<i>P</i> values >.05). Concerning functional outcomes, postoperative glomerular filtration rate and decrease in glomerular filtration rate were significantly better in the younger group compared with the elderly groups (<i>P</i> = .003 and <i>P</i> = .001, respectively). Although margin, ischemia, complications rates were similar between the cohorts (<i>P</i> = .068), Pentafecta rates were lower in the elderly patients (<i>P</i> = .029). In terms of oncological outcomes, recurrence-free survival and cancer-specific survival were comparable between the groups. <b><i>Conclusion:</i></b> Retroperitoneal LPN can be performed safely and with adequate oncological efficacy in elderly patients.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114296","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":"Transanal Minimally Invasive Surgery Versus Endoscopic Submucosal Dissection for Rectal Lesions: A Community Hospital Experience.","authors":"Jau-Jie You, Ming-Yin Shen, William Tzu-Liang Chen, Jiun-Wei Fan, Yen-Chen Shao, Chun-Lung Feng, Chu-Cheng Chang, Yu-Hao Su, Abe Fingerhut","doi":"10.1089/lap.2024.0201","DOIUrl":"10.1089/lap.2024.0201","url":null,"abstract":"<p><p><b><i>Background:</i></b> To compare tumor margins and surgical outcomes between transanal minimally invasive surgery (TAMIS) and endoscopic submucosal dissection (ESD) for large or malignant rectal adenomatous polyps. <b><i>Methods:</i></b> Single institution retrospective analysis of patients who underwent TAMIS or ESD surgery. <b><i>Results:</i></b> In total, 30 consecutive patients with similar demographics who underwent either TAMIS (<i>n</i> = 19) or ESD (<i>n</i> = 11) were included. The median (interquartile range, IQR) tumor distances from the anal verge for TAMIS and ESD were 5 cm (3.5-8) and 3 cm (2-4.25) (<i>P</i> = 0.016). Four in TAMIS and two in ESD occupied more than half of the circumference of the bowel lumen. Five (four <i>in situ</i> and one stage 1) in TAMIS and two (one <i>in situ</i> and one stage 1) in ESD were malignant. The median specimen length, width, and height were 3.2 cm, 2.6 cm, and 1.0 cm and 3.5 cm, 2.0 cm, and 0.3 cm for TAMIS and ESD, respectively. There were no statistically significant differences in tumor circumference, malignant ratios, or specimen sizes. Resection margins were involved in two of the ESD, while none of the TAMIS were involved (<i>P</i> = 0.041). The median (IQR) operative time was 72 (62-89) minutes and 120 (90-180) minutes for TAMIS and ESD (<i>P</i> = 0.005). The median (IQR) follow-up time was 3.3 (0.3-11.7) and 0.9 (0.3-15.4) months for TAMIS and ESD. There were no morbidities, no mortalities, or local recurrences among the two groups. <b><i>Conclusions:</i></b> Both TAMIS and ESD were found to be feasible and safe in community hospital practice. Operative time was shorter, and there were no involved margins in TAMIS (versus ESD).</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861472","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}