{"title":"Propensity score matching for comparative studies: a tutorial with R and Rex.","authors":"Bora Lee, Nam-Eun Kim, Sungho Won, Jungsoo Gim","doi":"10.7602/jmis.2024.27.2.55","DOIUrl":"10.7602/jmis.2024.27.2.55","url":null,"abstract":"<p><p>Recently, there has been considerable progress in developing new technologies and equipment for the medical field, including minimally invasive surgeries. Evaluating the effectiveness of these treatments requires study designs like randomized controlled trials. However, due to the nature of certain treatments, randomization is not always feasible, leading to the use of observational studies. The effect size estimated from observational studies is subject to selection bias caused by confounders. One method to reduce this bias is propensity scoring. This study aimed to introduce a propensity score matching process between two groups using a practical example with R. Additionally, Rex, an Excel add-in graphical user interface statistical program, is provided for researchers unfamiliar with R programming. Further techniques, such as matching with three or more groups, propensity score weighting and stratification, and imputation of missing values, are summarized to offer approaches for more complex studies not covered in this tutorial.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"27 2","pages":"55-71"},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11187614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The method of using robotic Harmonic ACE curved shears for parenchymal transection in robotic hepatectomy.","authors":"Eun Jeong Jang, Sung Hwa Kang, Kwan Woo Kim","doi":"10.7602/jmis.2024.27.2.114","DOIUrl":"10.7602/jmis.2024.27.2.114","url":null,"abstract":"<p><p>Robotic liver surgery is emerging as a minimally invasive surgery to overcome the disadvantages of laparoscopy. The two biggest barriers to the uptake of robotic hepatectomy are the high cost and instrument limitations. Transection of the liver parenchyma is the main issue in robotic hepatectomy. Nonetheless, with adequate experience and the aid of reliable and enhanced three-dimensional visualization, many robotic surgeons have successfully used robotic Harmonic ACE curved shears (Intuitive Surgical Inc.) for parenchymal transection of the liver. Herein, we share a method of using robotic Harmonic ACE curved shears for parenchymal transection using a video clip.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"27 2","pages":"114-117"},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11187608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kwang Hyun Kim, Eui Hyuk Chong, Incheon Kang, Sung Hwan Lee, Seok Jeong Yang
{"title":"Various retraction techniques for laparoscopic pancreaticoduodenectomy.","authors":"Kwang Hyun Kim, Eui Hyuk Chong, Incheon Kang, Sung Hwan Lee, Seok Jeong Yang","doi":"10.7602/jmis.2024.27.2.118","DOIUrl":"10.7602/jmis.2024.27.2.118","url":null,"abstract":"<p><p>The laparoscopic pancreaticoduodenectomy (LPD), introduced by Gagner and Pomp in 1994, is typically done in high-volume centers due to its technical demands. Our methods aim to provide effective traction, enabling efficient surgery despite limited staffing. A retrospective analysis of 29 patients undergoing LPD by a single surgeon between September 2021 and December 2022 showed promising outcomes: median intraoperative bleeding of 425 mL, operation time of 505 minutes, and postoperative hospital stay of 10 days. With only one case requiring open conversion, our external retraction techniques demonstrate efficacy in overcoming challenges associated with manpower constraints, highlighting potential utility for surgeons in similar settings. We share LPD external retraction techniques and outcomes.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"27 2","pages":"118-124"},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11187611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jenny H Chang, Rasha T Kakati, Chase Wehrle, Robert Naples, Daniel Joyce, Toms Augustin, Robert Simon, R Matthew Walsh, Fadi S Dahdaleh, Philip Spanheimer, Isabella Salti, Alessandro Parente, Samer A Naffouje
{"title":"Incidence of clinically relevant postoperative pancreatic fistula in patients undergoing open and minimally invasive pancreatoduodenectomy: a population-based study.","authors":"Jenny H Chang, Rasha T Kakati, Chase Wehrle, Robert Naples, Daniel Joyce, Toms Augustin, Robert Simon, R Matthew Walsh, Fadi S Dahdaleh, Philip Spanheimer, Isabella Salti, Alessandro Parente, Samer A Naffouje","doi":"10.7602/jmis.2024.27.2.95","DOIUrl":"10.7602/jmis.2024.27.2.95","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative pancreatic fistula (POPF) remains a devastating complication of pancreatoduodenectomy (PD). Minimally invasive PD (MIPD), including laparoscopic (LPD) and robotic (RPD) approaches, have comparable POPF rates to open PD (OPD). However, we hypothesize that the likelihood of having a more severe POPF, as defined as clinically relevant POPF (CR-POPF), would be higher in an MIPD relative to OPD.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted pancreatectomy dataset (2014-2020) was reviewed for any POPF after OPD. Propensity score matching (PSM) compared MIPD to OPD, and then RPD to LPD.</p><p><strong>Results: </strong>Among 3,083 patients who developed a POPF, 2,843 (92.2%) underwent OPD and 240 (7.8%) MIPD; of these, 25.0% were LPD (n = 60) and 75.0% RPD (n = 180). Grade B POPF was observed in 45.4% (n = 1,400), and grade C in 6.0% (n = 185). After PSM, MIPD patients had higher rates of CR-POPF (47.3% OPD vs. 54.4% MIPD, <i>p</i> = 0.037), as well as higher reoperation (9.1% vs. 15.3%, <i>p</i> = 0.006), delayed gastric emptying (29.2% vs. 35.8%, <i>p</i> = 0.041), and readmission rates (28.2% vs. 35.1%, <i>p</i> = 0.032). However, CR-POPF rates were comparable between LPD and RPD (56.8% vs. 49.3%, <i>p</i> = 0.408).</p><p><strong>Conclusion: </strong>The impact of POPF is more clinically pronounced after MIPD than OPD with a more complex postoperative course. The difference appears to be attributed to the minimally invasive environment itself as no difference was noted between LPD and RPD. A clear biological explanation of this clinical observation remains missing. Further studies are warranted.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"27 2","pages":"95-108"},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11187613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A retrospective noninferiority study of laparoscopic inguinal hernia repair feasibility for recently graduated surgeons in Thailand.","authors":"Thanat Tantinam, Tawadchai Treeratanawikran, Pattiya Kamoncharoen, Ekawit Srimaneerak, Metpiya Siripoonsap, Thawatchai Phoonkaew","doi":"10.7602/jmis.2024.27.2.85","DOIUrl":"10.7602/jmis.2024.27.2.85","url":null,"abstract":"<p><strong>Purpose: </strong>The feasibility of starting laparoscopic surgery among newly graduated surgeons lacking extensive experience in open approaches remains a topic of interest. We aimed to evaluate the safety and efficacy of laparoscopic inguinal hernia repair (LHR) compared to open inguinal hernia repair (OHR) in this population.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted on inguinal hernia surgeries performed by a single recently graduated surgeon during the learning phase. Patient data were collected from July 2021 to November 2022 with a focus on demographics, intraoperative details, and 1-year postoperative outcomes. Noninferiority testing was employed with a predetermined margin of 15% to compare the complication rates, recurrence rates, and other secondary outcomes between LHR and OHR.</p><p><strong>Results: </strong>The study cohort comprised 66 patients (OHR group, n = 45 and LHR group, n = 21). Patient characteristics were similar between groups. No significant differences were observed in the complication rates (OHR, 26.7% and LHR, 19.0%; <i>p</i> = 0.50) or recurrence rates (OHR, 2.2% and LHR, 4.8%; <i>p</i> = 0.54). The LHR group demonstrated noninferior outcomes compared with the OHR group in terms of complication, recurrence, readmission, and reoperation rates. Except for the operative time, secondary outcomes did not differ significantly between the groups.</p><p><strong>Conclusion: </strong>LHR is a feasible initiation for recently graduated surgeons, demonstrating noninferior outcomes compared with open repair. Therefore, the belief that one must master open surgery before beginning laparoscopy may be untrue.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"27 2","pages":"85-94"},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11187610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charnwit Assawasirisin, Wethit Dumronggittigule, Prawej Mahawithitwong, Chutwichai Tovikkai
{"title":"Robotic subtotal left pancreatectomy with preservation of the bile duct and spleen for multifocal pancreatic metastases: a video vignette of organ-sparing pancreatectomy for tumors that do not require regional lymphadenectomy.","authors":"Charnwit Assawasirisin, Wethit Dumronggittigule, Prawej Mahawithitwong, Chutwichai Tovikkai","doi":"10.7602/jmis.2024.27.2.125","DOIUrl":"10.7602/jmis.2024.27.2.125","url":null,"abstract":"<p><p>Pancreatectomy for pancreatic metastases (PM) yields acceptable survival outcomes in selected renal cell carcinoma (RCC) patients. We describe a technique for robotic subtotal left pancreatectomy with preservation of the common bile duct (CBD) and spleen in a patient with multifocal RCC-PM. The patient, who had RCC and underwent nephrectomy 20 years ago, presented with a pancreatic mass. Computed tomography and endoscopic ultrasonography demonstrated one mass at the head of pancreas (HOP), and other three lesions at neck, body, and tail. HOP lesion located near CBD. Subtotal left pancreatectomy was more preferred option than total pancreatectomy due to better endocrine function. The ultrasound-guided CBD and uncinate-preserving resection started at HOP, and then continued with distal pancreatectomy. The pathology revealed metastatic RCC with a negative margin. The patient experienced only biochemical pancreatic leakage. One month after surgery, the patient only required oral medication for diabetes treatment. In conclusion, the robot-assisted technique is helpful in increasing the success rate of organ-sparing pancreatectomy.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"27 2","pages":"125-127"},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11187606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on \"Ramadan fasting following laparoscopic sleeve gastrectomy: a prospective online survey cohort study in Egypt\".","authors":"Su-Mi Kim, Sang Hyun Kim","doi":"10.7602/jmis.2024.27.1.12","DOIUrl":"10.7602/jmis.2024.27.1.12","url":null,"abstract":"","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"27 1","pages":"12-13"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tamer N Abdelbaki, Noureldin Ahmed, Mahmoud Ahmed Alhussini, Moustafa Elshafei
{"title":"Ramadan fasting following laparoscopic sleeve gastrectomy: a prospective online survey cohort study in Egypt.","authors":"Tamer N Abdelbaki, Noureldin Ahmed, Mahmoud Ahmed Alhussini, Moustafa Elshafei","doi":"10.7602/jmis.2024.27.1.33","DOIUrl":"10.7602/jmis.2024.27.1.33","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore the feasibility and implications of Ramadan fasting for patients who have undergone laparoscopic sleeve gastrectomy (LSG), assessing impacts on hydration, nutrient intake, weight management, and gastrointestinal symptoms.</p><p><strong>Methods: </strong>A prospective online survey was conducted among 218 LSG patients and 75 control individuals with obesity who had not undergone surgery. Participants were surveyed before and after Ramadan, providing data on fasting practices, hunger and satiety levels, fluid and nutrient intake, and the occurrence of gastrointestinal symptoms. Statistical analysis was used to compare outcomes between fasting and non-fasting periods and between LSG patients and control participants.</p><p><strong>Results: </strong>A total of 70.2% of LSG patients completed the entire month of Ramadan fasting, with a significant correlation found between the duration post-surgery and the ability to fast. Fasting LSG patients reported decreased hunger, increased satiety, and significant reductions in fluid and nutrient intake during Ramadan. Weight loss was reported in 90.8% of fasting patients, with an average total weight loss of 7.2%. Gastrointestinal symptoms were mild and manageable.</p><p><strong>Conclusion: </strong>The majority of LSG patients can successfully fast during Ramadan with appropriate precautions, including adequate fluid and protein intake. The study highlights the need for patient education and tailored nutritional guidance to ensure safe and effective fasting post-LSG. In order to fast for the entire month, patients may be advised to consider postponing surgery for a few months after Ramadan, avoid overeating during non-fasting hours, and ensure sufficient fluid consumption and protein intake during fasting.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"27 1","pages":"33-39"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valentin Butnari, Ahmer Mansuri, Sultana Momotaz, Dixon Osilli, Richard Boulton, Joseph Huang, Nirooshun Rajendran, Sandeep Kaul
{"title":"Laparoscopic right hemicolectomy with complete mesocolic excision and D3 lymphadenectomy using the open book approach: a video vignette.","authors":"Valentin Butnari, Ahmer Mansuri, Sultana Momotaz, Dixon Osilli, Richard Boulton, Joseph Huang, Nirooshun Rajendran, Sandeep Kaul","doi":"10.7602/jmis.2024.27.1.47","DOIUrl":"10.7602/jmis.2024.27.1.47","url":null,"abstract":"<p><p>According to the concept of total mesorectal excision for rectal cancer, Hohenberger translated this concept to colonic cancer by introducing complete mesocolic excision (CME). The concept of this surgical technique was further elucidated by Benz et al. in the form of an open book approach. This article presents and demonstrates in a video a case of laparoscopic right hemicolectomy with CME and D3 lymphadenectomy using open book approach in the treatment of a T3N1M0 distal ascending colonic adenocarcinoma. The final pathology report confirmed moderately differentiated adenocarcinoma with a maximum tumor size of 55 mm and 0/60 lymph nodes. The mesocolic fascia was intact and R0 was achieved. The final staging was pT3pN0pM0. However, D3 lymphadenectomy is not universally adopted due to concerns of higher morbidity we believe that with adequate training and supervision CME with D3 LDN is feasible and safe to be offered to all right-sided colorectal cancers with curative intent treatment.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"27 1","pages":"47-50"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}