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Xie C, Wang H, Guo Z, Wang P, Lin W, Yang W. A Novel Endoscopic Approach to Fibroadipose Vascular Anomaly. J Pediatr Surg 2025; 60:162064. [PMID: 39616969 DOI: 10.1016/j.jpedsurg.2024.162064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 10/21/2024] [Accepted: 11/06/2024] [Indexed: 01/20/2025]
Abstract
BACKGROUND Open surgery is the standard treatment for fibroadipose vascular anomalies (FAVA). This study evaluated an endoscopic approach for FAVA, assessing its safety and feasibility. METHODS Data from October 1, 2019, and May 1, 2024, were analyzed from the Vascular Anomalies Center database at our institution. Patients with FAVA Stage I (pain stage) or II (contracture stage) were included and divided into the endoscopic surgery group (ESG) and open surgery group (OSG). RESULTS In total, 101 patients underwent 110 procedures. In ESG, 42 patients (16 males and 26 females; 31 with Stage I and 11 with Stage II) underwent radical excision (with tendon lengthening in 2 patients). Ten patients underwent an open surgery. In OSG, 63 patients (18 males and 45 females; 30 with Stage I and 33 with Stage II) underwent radical excision (with tendon lengthening in 12 patients). The OSG had significantly shorter operative time than the ESG (p = 0.009). Furthermore, The OSG had longer hospitalization time (p = 0.022) than the ESG. The blood loss in the OSG was greater than that in the ESG, but without statistical difference (p = 0.069). During follow-up, the incidence of wound complications (p = 0.121) and residual symptoms (p = 0.179) were slightly higher in the OSG. CONCLUSIONS Endoscopic surgery is a safe and effective treatment for FAVA, promoting faster habilitation and improved patient satisfaction. This method may also serve as a reference for the excision of other benign muscle and soft tissue masses.
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Affiliation(s)
- Chong Xie
- Department of Pediatric Surgery & Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an 710100, China
| | - Huaijie Wang
- Department of Pediatric Surgery & Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an 710100, China.
| | - Zhengtuan Guo
- Department of Pediatric Surgery & Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an 710100, China
| | - Peihua Wang
- Department of Pediatric Surgery & Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an 710100, China
| | - Weilong Lin
- Department of Pediatric Surgery & Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an 710100, China
| | - Weijia Yang
- Department of Pediatric Surgery & Vascular Anomalies, Xi'an International Medical Center Hospital, Xi'an 710100, China
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Wang Y, Xie Z, Huang H, Liang X. Pioneering healthcare with soft robotic devices: A review. SMART MEDICINE 2024; 3:e20230045. [PMID: 39188514 PMCID: PMC11235691 DOI: 10.1002/smmd.20230045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/25/2024] [Indexed: 08/28/2024]
Abstract
Recent advancements in soft robotics have been emerging as an exciting paradigm in engineering due to their inherent compliance, safe human interaction, and ease of adaptation with wearable electronics. Soft robotic devices have the potential to provide innovative solutions and expand the horizons of possibilities for biomedical applications by bringing robots closer to natural creatures. In this review, we survey several promising soft robot technologies, including flexible fluidic actuators, shape memory alloys, cable-driven mechanisms, magnetically driven mechanisms, and soft sensors. Selected applications of soft robotic devices as medical devices are discussed, such as surgical intervention, soft implants, rehabilitation and assistive devices, soft robotic exosuits, and prosthetics. We focus on how soft robotics can improve the effectiveness, safety and patient experience for each use case, and highlight current research and clinical challenges, such as biocompatibility, long-term stability, and durability. Finally, we discuss potential directions and approaches to address these challenges for soft robotic devices to move toward real clinical translations in the future.
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Affiliation(s)
- Yuzhe Wang
- Singapore Institute of Manufacturing TechnologyAgency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Zhen Xie
- Advanced Remanufacturing and Technology CentreAgency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Huishi Huang
- Advanced Remanufacturing and Technology CentreAgency for Science, Technology and Research (A*STAR)SingaporeSingapore
- Department of Mechanical EngineeringNational University of SingaporeSingaporeSingapore
| | - Xinquan Liang
- Singapore Institute of Manufacturing TechnologyAgency for Science, Technology and Research (A*STAR)SingaporeSingapore
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Wu S, Yang C, He L, Hu Z, Yao J. Meta-synthesis of qualitative studies on patient perceptions and requirements during the perioperative period of robotic surgery. J Robot Surg 2024; 18:44. [PMID: 38240864 DOI: 10.1007/s11701-023-01791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/02/2023] [Indexed: 01/23/2024]
Abstract
This research undertakes a comprehensive evaluation and amalgamation of patient experiences and requirements during the perioperative period of robot-assisted surgery (RS), with the goal of enriching clinical practice with patient-centered insights. A meta-synthesis was performed and reported according to the preferred reporting Items for systematic reviews and meta-analyses and the enhancing transparency in reporting the synthesis of qualitative research statement. A rigorous literature search was conducted across multiple Chinese and English databases, namely PubMed, CINAHL (EBSCO), Embase, Web of Science, Scopus, China Biomedical Literature Database (CBLD), China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Information. This study incorporated ten qualitative studies, the outcomes were classified into three overarching themes: personalized patient requirements related to RS; the psychological and physiological experiences of patients; and the divergent perceptions of male and female patients regarding RS. Greater emphasis needs to be placed on patient comprehension of RS, augmenting focus on patient psychological experiences, recognizing unique patient needs at various stages of RS, and providing patients with specialized knowledge and technical support.
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Affiliation(s)
- Shuang Wu
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China
| | - Chunzhi Yang
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China
| | - Liu He
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China
| | - Zhixuan Hu
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China
| | - Jie Yao
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China.
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Judge C, Bandle J, Wang A, Gadbois K, Simsiman A, Wood R, Wisbach G. Laparoscopic-Assisted Transvaginal Cholecystectomy - the US Military Experience With Long-Term Follow Up. JSLS 2024; 28:e2023.00059. [PMID: 38562949 PMCID: PMC10984372 DOI: 10.4293/jsls.2023.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Objectives We present our initial clinical experience applying Natural Orifice Transluminal Endoscopic Surgical (NOTES) technique to perform cholecystectomy in ten patients at a military institution. Methods A posterior colpotomy was created to accommodate a single site working port used to facilitate dissection and gallbladder mobilization under direct visualization via an infraumbilical port. The specimen was retrieved through the vagina and the colpotomy was closed with absorbable suture under direct visualization. Long-term follow up was performed over the phone to assess quality of life with 2 widely used health-related quality of life (HRQoL) surveys including RAND-36 Health Item Survey (Version 1.0),1 and the Female Sexual Function Index (FSFI).2. Results Ten women underwent a laparoscopic-assisted transvaginal cholecystectomy (TVC) with 7 available for long-term follow-up. The average age was 28.9 years (20-37) and the indications for surgery included symptomatic cholelithiasis (9) and biliary dyskinesia (1). The mean operative time was 129 mins (95-180), and median blood loss was 34 ml (5-400). There were no conversions and the average length of stay was 9.98 hours (2.4-28.8). Pain (analogue scale 1-10) on postoperative day three was minimal (mean 2.3) and was limited to the infraumbilical incision. On average patients returned to work by postoperative day six and resumed normal daily activities at seven days. Immediate postoperative complications included one incident of postoperative urinary retention requiring bladder catheterization. One intra-operative cholangiogram was successfully performed due to elevated preoperative liver enzymes without significant findings. Long-term complications included one asymptomatic incisional hernia repair at the infraumbilical port site. The RAND-36 survey demonstrated an average physical and mental health summary score of 82.2 and 63.7 with an average general health score of 63.6. The average FSFI total score was 21.8. Conclusion TVC is safe and effective. Implementation may improve operational readiness by returning service members to normal activities more expeditiously than conventional laparoscopy.
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Affiliation(s)
- Carolyn Judge
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Jesse Bandle
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Andrew Wang
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Kyle Gadbois
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Amanda Simsiman
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Robin Wood
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
| | - Gordon Wisbach
- Department of General Surgery, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Judge, Bandle, Gadbois, and Wisbach)
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Command, San Diego, California, USA. (Drs Wang, Simsiman, and Wood)
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Moparthi KP, Javed H, Kumari M, Pavani P, Paladini A, Saleem A, Ram R, Varrassi G. Acute Care Surgery: Navigating Recent Developments, Protocols, and Challenges in the Comprehensive Management of Surgical Emergencies. Cureus 2024; 16:e52269. [PMID: 38352101 PMCID: PMC10864012 DOI: 10.7759/cureus.52269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Acute care surgery (ACS) is a crucial medical field that specifically deals with the rapid treatment of surgical emergencies. This investigation encompasses the most recent progress, procedures, and obstacles in ACS, utilizing various sources such as scholarly articles, clinical trials, and expert statements. The development of ACS as a specialized field is a significant area of concentration, particularly emphasizing its contribution to improving patient care. An examination is conducted on the efficacy of contemporary triage systems and prompt response mechanisms, specifically in diminishing the incidence of illness and death rates associated with illnesses such as trauma, acute appendicitis, and obstructed viscera. The emphasis is placed on the surgical protocols and principles that form the basis of ACS. Examining regional and international approaches provides insight into the distinctions and commonalities in surgical techniques. An assessment is conducted to determine the effects of the transition to minimally invasive procedures on patient outcomes, recuperation periods, and healthcare expenses. The assessment also examines the logistical obstacles that ACS encounters, such as resource allocation and managing diverse teams. The examination focuses on the delicate equilibrium between prompt decision-making and care grounded in evidence. It also evaluates the possible contribution of technical breakthroughs such as telemedicine and AI to improving patient care and overcoming current obstacles. The topic of training and education for surgeons in ACS is of utmost importance and requires careful consideration. The evaluation evaluates the sufficiency of existing educational frameworks and the necessity of specific training to equip surgeons for the requirements of ACS. This analysis explores the current discourse surrounding the standardization of ACS training, considering its potential ramifications for the future of surgical procedures. Exploring ethical and legal problems in ACS also includes situations when prompt decision-making may clash with patient autonomy and informed consent. The significance of proficient communication with patients and their families during emergency surgical scenarios is underscored, emphasizing the necessity for ethical awareness and interpersonal aptitude. The investigation of ACS demonstrates its dynamic character, signifying notable advancements while recognizing enduring obstacles. Continual research, interdisciplinary collaboration, and policy adjustments are necessary to improve ACS procedures. This thorough investigation offers valuable insights for professionals and researchers, facilitating future progress in managing surgical crises.
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Affiliation(s)
- Kiran Prasad Moparthi
- General Practice, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Herra Javed
- Graduate, Shifa College of Medicine, Islamabad, PAK
| | - Monika Kumari
- Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Peddi Pavani
- General Surgery, Kurnool Medical College, Andhra Pradesh, IND
| | | | - Ayesha Saleem
- General Surgery, Hayatabad Medical Complex (HMC), Peshawar , PAK
| | - Raja Ram
- Medicine, MedStar Washington Hospital Center, Washington, USA
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Basunbul LI, Alhazmi LSS, Almughamisi SA, Aljuaid NM, Rizk H, Moshref R. Recent Technical Developments in the Field of Laparoscopic Surgery: A Literature Review. Cureus 2022; 14:e22246. [PMID: 35340455 PMCID: PMC8929761 DOI: 10.7759/cureus.22246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/06/2022] Open
Abstract
The benefits of laparoscopic surgery (LS) include a speedy recovery, shorter duration of hospital stay, minimal postoperative pain, discomfort and disabilities, and better cosmetic outcomes (less scarring) that help an individual to resume normal daily activities and return to work. A comprehensive literature search on laparoscopic surgeries was conducted using different Internet-based search engines and databases from August 2021 to October 2021. The search was limited to articles published in the English language and those published between years 2005 and 2021. A total of 126 articles were initially identified. Two independent reviewers thoroughly examined the quality and content of the articles. Articles with duplicate data were excluded, and the remaining articles were screened and assessed by the titles and abstracts. After a vigorous assessment, we included data from 49 articles for this review process. Bibliographic management was done using the software “EndNote” (Thomson Reuters, New York, NY, USA). It was concluded that LS has become the technique of choice for virtually every kind of abdominal surgery, evident by numerous scholarly publications in this field. Level I evidence demonstrating the advantage of LS over open surgery has been reported for numerous operations, including fundoplication for gastroesophageal regurgitation disease, bariatric surgery for weight loss, and cancer resection. Advanced LS has subsequently been expanded to include hepatectomy, pancreatectomy, urology, and gynecology. Patients who are at risk of having elevated abdominal pressure during LS, however, should proceed with care. Recent advances in natural orifice transluminal endoscopic surgery, single-incision laparoscopic surgery, and robot-assisted laparoscopic surgery are promising.
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8
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Mirande MH, Durhman MR, Bethel FB, Smith HF, Mirande RA. Pediatric rectal perforation repaired via endoscopic clipping: An alternative technique. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rudiman R. Advances in gastrointestinal surgical endoscopy. Ann Med Surg (Lond) 2021; 72:103041. [PMID: 34888040 PMCID: PMC8636781 DOI: 10.1016/j.amsu.2021.103041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Surgeons have a role in observing, detect abnormalities, disease, and other deficiencies in function which could be treated. Diagnosing and treating back days were challenging for many reasons. However, technology's innovation enhances surgeons' ability to treat their patients. The term endoscopy refers to the Greek prefix endo- ("within") and the verb skopein ("to view or observe"). Endoscopy is practical both in the diagnosis and treatment of various pathologies. Technological advances, especially in endoscopy, gradually progress and discover many possibilities which allow rapid advancement. Endoscopy development aims to assess human orifice that has not been inspected, probed, and examined over the centuries. Endoscopy over these decades is improving, which led to new problem solving using advanced technological approaches. Thus, a surgeon can solve any issues from examination, diagnosis, and treatment using progressive endoscopy evolution. This review delivers a brief history of advances in surgical endoscopy and describes current endoscopy development.
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Affiliation(s)
- Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
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10
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Shanbhag AB, Thota PN, Sanaka MR. Recent advances in third space or intramural endoscopy. World J Gastrointest Endosc 2020; 12:521-531. [PMID: 33362905 PMCID: PMC7739143 DOI: 10.4253/wjge.v12.i12.521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
Third space endoscopy or intramural endoscopy is based on the principle that the deeper layers of the gastrointestinal tract can be accessed by tunneling in the submucosal space and maintaining the integrity of the overlying mucosa. The era of third space endoscopy started with peroral endoscopic myotomy (POEM) for treatment of achalasia and has expanded to treat various other gastrointestinal disorders. The technique is also currently used for treatment of refractory gastroparesis, Zenker’s diverticulum (ZD), resection of subepithelial tumors and early cancers of the gastrointestinal tract and Hirschsprung’s disease (HD). These procedures are rapidly emerging as minimally invasive alternatives to conventional surgery. They are safe and effective with excellent outcomes. This review focuses on the evolution and current applications of third space endoscopy in various gastrointestinal disorders. Key points: (1) Third space or intramural endoscopy initially started with the POEM procedure for treatment of achalasia; (2) Advancements in procedural techniques have expanded its application to treat other gastrointestinal disorders such as refractory gastroparesis, ZD, HD, resection of subepithelial tumors and early gastrointestinal cancers; (3) These procedures are highly effective with excellent outcomes and low complication rates; and (4) Third space endoscopic procedures are rapidly emerging as minimally invasive alternatives to conventional surgery.
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Affiliation(s)
- Akshay B Shanbhag
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Prashanthi N Thota
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
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Sumer F, Bag YM, Aydin MC, Evren B, Aydin ES, Sahin I, Kayaalp C. Mini-laparoscopic adrenalectomy with transgastric specimen extraction. Updates Surg 2020; 73:1487-1491. [PMID: 33119843 DOI: 10.1007/s13304-020-00904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022]
Abstract
We aimed to describe the initial experience of mini-laparoscopic adrenalectomy combined with transgastric specimen extraction and to assess its safety and feasibility. We used only 5-mm trocars, three ports for left adrenalectomy and four for right. Intraoperative gastroscopy was performed for specimen extraction through the mouth via an endoscopic snare. The gastrotomy was closed intracorporeally. Demographic, perioperative and pathological data were analyzed. There were 16 patients (12 females) with the mean age of 46.5 ± 11.3 years and half of them had previous abdominal surgeries. The median operative time was 150 (45-432) min with a median blood loss of 88 (0-350) ml. The median oral intake time was 2 (1-4) days and the median length of hospital stay was 2 (2-5) days. There was no mortality and extraction-related complication. Histopathological median tumor length, width and depth were 3 cm, 2.15 cm, and 1.9 cm, respectively. The median specimen length, width and depth were 6.25 cm, 4 cm, and 2.2 cm, respectively. Mini-laparoscopic adrenalectomy combined with transgastric specimen extraction is a safe and feasible surgical technique. It provides a less invasive surgery and may also have some benefits on wound-related complications and cosmesis.
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Affiliation(s)
- Fatih Sumer
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Yusuf Murat Bag
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey.
| | - Mehmet Can Aydin
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Bahri Evren
- Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey
| | - Emine Sener Aydin
- Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
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Chand G, Gupta N, Johri G, Moidu S, Mishra A, Mishra SK. Natural Orifice Endoscopic Thyroidectomy via Transoral Vestibular Approach (TOVA): Single Surgeon Experience from North India. Indian J Otolaryngol Head Neck Surg 2020; 73:160-166. [PMID: 34150590 DOI: 10.1007/s12070-020-01935-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/23/2020] [Indexed: 01/04/2023] Open
Abstract
The transoral vestibular approach (TOVA) is the shortest route for endoscopic thyroidectomy (ET) to approach the thyroid and is a totally scar free procedure, hence it has a clear cosmetic advantage not only over conventional open thyroid surgery but also over other remote access approaches for ET like axilla, breast and chest wall approaches. The aim of this study was to evaluate the feasibility, safety and our initial outcomes of TOVA and highlight the advantages of 3D endoscopic equipment in remote access thyroid surgery. We reviewed our prospectively maintained database who underwent ET. 42 patients who fulfilled the stringent inclusion criteria were offered TOVA. We have used novel Trans-vestibular approach with 3D technology for endoscopic thyroid surgery in all cases. Clinico-demographic profile, investigations, operative details, histopathology and postoperative complications and follow-up data were analyzed by using statistical analysis with SPSS19.00 version. Out of 203 ET operated during study period, 42 (20.69%) patients were operated through TOVA. Hemithyroidectomy were performed in all the patients. There were 3 men and 39 women (M:F = 1:13). Mean tumor size was 3.54 ± 1.17 cm. All patients were euthyroid. All patient had cytological diagnosis of Bethesda category II-IV and all underwent hemithyroidectomy. Mean operation time was 107.71 ± 17.60 min and post-operative length of hospital stay was 2.90 ± 1.28 days. Besides magnification, 3D endoscopy provided excellent depth perception which helped in precise dissection in the restricted space and aided in identification and preservation of the two most vital structures i.e. recurrent laryngeal nerve and parathyroid glands. As most of our patients present with larger goitres, not many patients desirous of ET can be offered TOVA. This novel TOVA has fairly stringent inclusion criteria, however it is the only approach which offers completely scarless endoscopic thyroidectomy and should be offered to eligible patients desirous of ET.
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Affiliation(s)
- Gyan Chand
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Nitish Gupta
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Goonj Johri
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Shalikh Moidu
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Anjali Mishra
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
| | - Saroj K Mishra
- Department of Endocrine Surgery, SGPGIMS, 226014 Lucknow, India
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Arntz GJHM. Transvaginal laparoscopic ovariectomy in 60 dogs: Description of the technique and comparison with 2-portal-access laparoscopic ovariectomy. Vet Surg 2019; 48:726-734. [PMID: 30989692 DOI: 10.1111/vsu.13211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a transvaginal laparoscopic ovariectomy (TLOVE) in dogs and compare duration and perioperative complications between TLOVE and 2-portal-access laparoscopic OVE (LapOVE). STUDY DESIGN Retrospective study. ANIMALS Female client-owned dogs (60 in TLOVE group and 202 in LapOVE group) between 6 and 103 months of age with body weights between 10 and 33 kg. METHODS Ovariectomy was performed either through a transvaginal approach (TLOVE) or 2-portal-access laparoscopy (LapOVE). Dog characteristics (breed, weight, body condition score, age), surgical procedure time, and perioperative complications were compared between groups. RESULTS The time required to complete TLOVE (34.3 ± 9.9 minutes) was longer than that for LapOVE (22.3 ± 3.2 minutes, P < .001). Intraoperative complications were encountered in 3 of 60 dogs undergoing TLOVE and 0 of 202 in the LapOVE group. Postoperative complications were not present in the TLOVE group. Suture dehiscence due to early removal of the Elizabethan collar occurred in 4 dogs after LapOVE. CONCLUSION Transvaginal laparoscopic OVE was completed without postoperative complications in all dogs of this study although TLOVE took about 15 minutes longer to complete than LapOVE. CLINICAL SIGNIFICANCE Transvaginal laparoscopic OVE provides a minimally invasive surgical alternative for OVE in dogs weighing 10-33 kg and aged 6-103 months, eliminating incisions through the abdominal wall, placement of suture material, and application of an Elizabethan collar.
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Chen X, Liu H, Sun D, Zhang J, Fan Q, Shi H, Lang J. Author's Reply. J Minim Invasive Gynecol 2018; 26:182-183. [PMID: 30009992 DOI: 10.1016/j.jmig.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Xin Chen
- From the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Haiyuan Liu
- From the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Dawei Sun
- From the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - JunJi Zhang
- From the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Qingbo Fan
- From the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Honghui Shi
- From the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Jinghe Lang
- From the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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Dorozhkin D, Nemani A, Roberts K, Ahn W, Halic T, Dargar S, Wang J, Cao CGL, Sankaranarayanan G, De S. Face and content validation of a Virtual Translumenal Endoscopic Surgery Trainer (VTEST™). Surg Endosc 2016; 30:5529-5536. [PMID: 27129546 DOI: 10.1007/s00464-016-4917-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 04/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical paradigm, where peritoneal access is achieved through one of the natural orifices of the body. It is being reported as a safe and feasible surgical technique with significantly reduced external scarring. Virtual Translumenal Endoscopic Surgical Trainer (VTEST™) is the first virtual reality simulator for the NOTES. The VTEST™ simulator was developed to train surgeons in the hybrid transvaginal NOTES cholecystectomy procedure. The initial version of the VTEST™ simulator underwent face validation at the 2013 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) summit. Several areas of improvement were identified as a result, and the corresponding modifications were implemented in the simulator. This manuscript outlines the results of the subsequent evaluation study, performed in order to assess the face and content validity of the latest VTEST™ simulator. METHODS Twelve subjects participated in an institutional review board-approved study that took place at the 2014 NOSCAR summit. Six of the 12 subjects, who are experts with NOTES experience, were used for face and content validation. The subjects performed the hybrid transvaginal NOTES cholecystectomy procedure on VTEST™ that included identifying the Calot's triangle, clipping and cutting the cystic duct/artery, and detaching the gallbladder. The subjects then answered five-point Likert scale feedback questionnaires for face and content validity. RESULTS Overall, subjects rated 12/15 questions as 3.0 or greater (60 %), for face validity questions regarding the realism of the anatomical features, interface, and the tasks. Subjects also highly rated the usefulness of the simulator in learning the fundamental NOTES technical skills (3.50 ± 0.84). Content validity results indicate a high level of usefulness of the VTEST™ for training prior to operating room experience (4.17 ± 0.75).
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Affiliation(s)
- Denis Dorozhkin
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Arun Nemani
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Kurt Roberts
- Gastrointestinal Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Woojin Ahn
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Tansel Halic
- Computer Science Department, University of Central Arkansas, Conway, AR, USA
| | - Saurabh Dargar
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Jinling Wang
- Biomedical, Industrial and Human Factors Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Caroline G L Cao
- Biomedical, Industrial and Human Factors Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Ganesh Sankaranarayanan
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA.
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Vahdad MR, Rahmanian E, Moslemi S, Najafi SM, Foroutan HR. Totally Transanal Laparo-Endoscopic Single-Site ProctoColectomy-Ileoanal J-Pouch (TLPC-J): An Experimental Study of a Novel Approach. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:425-9. [PMID: 26379349 PMCID: PMC4567602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 03/26/2014] [Accepted: 04/28/2014] [Indexed: 10/31/2022]
Abstract
BACKGROUND The natural orifice transluminal endoscopic surgery (NOTES) has become a commonly considered novel approach in the surgical field. The NOTES provide possibility of operation through the natural orifice and decreases the intentional puncture of the systemic organ and subsequent complications. Totally transanal laparo-endoscopic single-site proctoColectomy-Ileoanal J-Pouch (TLPC-J) is a novel method in minimally invasive surgery for total colectomy. The main goal of this study is to perform this new method on an animal model, to assess probable complication and to resolve probable issues by using patients that are candidate for total colectomy. METHOD Five dogs were prepared in lithotomy position. The TLPC-I procedure consists of endorectal technique with full thickness rectal dissection starting 1 cm orally from the dentate line above the peritoneal reflection and the proximal bowel was replaced into the abdominal cavity. Afterwards, the TriPort system was inserted in the anal canal and mesentrial resection of the total colon, mobilization of a distal ileal segment and intracorporeal suture of an ileal J-loop was accomplished by this system. An incision in the J-loop was conducted transanally. The J-pouch was created with an Endo-GIA® and sutured to the rectal wall. RESULTS All animals survived and passed stool with clear post operation situation. There was no infection in site of anastomosis. CONCLUSION The TLPC-I provides the possibility of surgery without abdominal wall incision and decreases post operation complication such as pain, abdominal wound infection and wound dehiscence. This technique increases the quality of life and surgeons can discharge the patients early.
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Affiliation(s)
- Mohammad Reza Vahdad
- Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Ehsan Rahmanian
- Department of General Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sam Moslemi
- Colorectal Research Center, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sultan Mohsen Najafi
- Department of Pediatric Surgery, Namazi Hospital, Shiraz University Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reza Foroutan
- Department of Pediatric Surgery, Namazi Hospital, Shiraz University Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Hamid Reza Foroutan, MD; Department of Pediatric Surgery, Shiraz University Laparoscopy Research Center, Namazi Hospital, P.O. Box 7141995377, Shiraz, Iran Tel: +98 71 36279622 Fax: +98 71 32279721
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Hou BH, Jian ZX, Cui P, Li SJ, Tian RQ, Ou JR. miR-216a may inhibit pancreatic tumor growth by targeting JAK2. FEBS Lett 2015; 589:2224-32. [DOI: 10.1016/j.febslet.2015.06.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 12/13/2022]
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Natural orifice translumenal endoscopic surgery (NOTES): emerging trends and specifications for a virtual simulator. Surg Endosc 2015; 30:190-8. [PMID: 25840893 DOI: 10.1007/s00464-015-4182-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/20/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND STUDY AIM A virtual translumenal endoscopic surgical trainer (VTEST) is being developed to accelerate the development of natural orifice translumenal endoscopic surgery (NOTES) procedures and devices in a safe and risk-free environment. For a rapidly developing field such as NOTES, a needs analysis must be conducted regularly to discover emerging research trends and areas of potential high impact for a virtual simulator. This paper presents a survey-based study which follows a similar study conducted by this group in 2011 (Sankaranarayanan et al. in Surg Endosc 27:1607-1616, 2013). METHODS A 32-point questionnaire was distributed at the 2012 Natural Orifice Surgery Consortium for Assessment and Research annual meeting. These data were subsequently augmented by an identical online survey, targeted at the members of the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons, and analyzed. RESULTS Twenty-eight NOTES experts participated in the 2012 study. Cholecystectomy (CE) procedure remained the most commonly performed NOTES technique, with 18 positive responses (64%). In contrast to 2011, the popularity of the NOTES appendectomy (AE) was significantly lower, with only 2 (7%) instances (CE vs. AE, p < 0.001), while the number of peroral endoscopic myotomy (POEM, PE) cases had increased significantly, with 11 (39%) positive responses, respectively (PE vs. AE, p = 0.013). Strong preference toward hybrid rather than pure NOTES techniques (82 vs. 11%, p < 0.001) was also expressed. Other responses were similar to those in the 2011 study, with the VTEST™ utility in developing and testing new techniques and instruments ranked particularly high. CONCLUSION Based on the results of this study, a decision was made to focus exclusively on the transvaginal hybrid NOTES cholecystectomy procedure, including both rigid and flexible scope techniques. The importance of developing a virtual NOTES simulator was reaffirmed, with POEM identified as a promising candidate for future simulator development.
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Ruffolo C, Fiorot A, Pagura G, Antoniutti M, Massani M, Caratozzolo E, Bonariol L, Calia di Pinto F, Bassi N. Acute appendicitis: What is the gold standard of treatment? World J Gastroenterol 2013; 19:8799-8807. [PMID: 24379603 PMCID: PMC3870531 DOI: 10.3748/wjg.v19.i47.8799] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/10/2013] [Accepted: 10/22/2013] [Indexed: 02/06/2023] Open
Abstract
McBurney’s procedure represented the gold-standard for acute appendicitis until 1981, but nowadays the number of laparoscopic appendectomies has progressively increased since it has been demonstrated to be a safe procedure, with excellent cosmetic results and it also allows a shorter hospitalization, a quicker and less painful postoperative recovery. The aim of this editorial was to perform a review of the literature in order to address controversial issues in the treatment of acute appendicitis.
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Barajas-Gamboa JS, Jacobsen GR. Transvaginal Hybrid NOTES Cholecystectomy: Current Techniques and Advantages. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0029-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Needs analysis for developing a virtual-reality NOTES simulator. Surg Endosc 2012; 27:1607-16. [PMID: 23247736 DOI: 10.1007/s00464-012-2637-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/21/2012] [Indexed: 02/07/2023]
Abstract
UNLABELLED INTRODUCTION AND STUDY AIM: Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical technique that requires a cautious adoption approach to ensure patient safety. High-fidelity virtual-reality-based simulators allow development of new surgical procedures and tools and train medical personnel without risk to human patients. As part of a project funded by the National Institutes of Health, we are developing the virtual transluminal endoscopic surgery trainer (VTEST) for this purpose. The objective of this study is to conduct a structured needs analysis to identify the design parameters for such a virtual-reality-based simulator for NOTES. METHODS A 30-point questionnaire was distributed at the 2011 National Orifice Surgery Consortium for Assessment and Research meeting to obtain responses from experts. Ordinal logistic regression and the Wilcoxon rank-sum test were used for analysis. RESULTS A total of 22 NOTES experts participated in the study. Cholecystectomy (CE, 68 %) followed by appendectomy (AE, 63 %) (CE vs AE, p = 0.0521) was selected as the first choice for simulation. Flexible (FL, 47 %) and hybrid (HY, 47 %) approaches were equally favorable compared with rigid (RI, 6 %) with p < 0.001 for both FL versus RI and HY versus RI. The transvaginal approach was preferred 3 to 1 to the transgastric. Most participants preferred two-channel (2C) scopes (65 %) compared with single (1C) or three (3C) or more channels with p < 0.001 for both 2C versus 1C and 2C versus 3C. The importance of force feedback and the utility of a virtual NOTES simulator in training and testing new tools for NOTES were rated very high by the participants. CONCLUSION Our study reinforces the importance of developing a virtual NOTES simulator and clearly presents expert preferences. The results of this analysis will direct our initial development of the VTEST platform.
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Ahn KH, Song JY, Kim SH, Lee KW, Kim T. Transvaginal single-port natural orifice transluminal endoscopic surgery for benign uterine adnexal pathologies. J Minim Invasive Gynecol 2012; 19:631-5. [PMID: 22763314 DOI: 10.1016/j.jmig.2012.04.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 03/28/2012] [Accepted: 04/05/2012] [Indexed: 01/23/2023]
Abstract
Transvaginal natural orifice transluminal endoscopic surgery (NOTES) with pneumoperitoneum has been used in cholecystectomies, appendectomies, and nephrectomies, but transvaginal NOTES using a single port in gynecologic procedures has not been described despite gynecologist familiarity with the vaginal approach. We performed transvaginal single-port NOTES in 10 women with benign uterine adnexal disease: oophorectomy in 3 patients, salpingostomy and salpingectomy in 2 each, and ovarian cystectomy, paratubal cystectomy, and ovarian wedge resection in 1 each. The patients were discharged at 1 or 2 days postoperatively, and were satisfied, with minimal pain, no abdominal scar, and no complications at 2-month follow-up. We conclude that transvaginal single-port NOTES to treat benign uterine adnexal disease is a feasible and attractive option.
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Affiliation(s)
- Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Kumar V, Dadhwal US. Cholecystectomy: What's new? Med J Armed Forces India 2012; 68:288-92. [PMID: 24532890 DOI: 10.1016/j.mjafi.2012.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Vipon Kumar
- Associate Professor, Department of Surgery, AFMC, Pune 40, India
| | - U S Dadhwal
- Associate Professor, Department of Surgery, AFMC, Pune 40, India
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Abstract
This article reviews the principal aspects related to sedation in endoscopy and to the prevention of adverse events in some of the most frequently performed therapeutic upper gastrointestinal (GI) endoscopic procedures (esophageal dilation and stenting, endoscopic resection of upper GI early neoplasia, hemostasis of upper GI bleeding and percutaneous endoscopic gastrostomy insertion). These procedures have an inherent risk of negative outcomes that cannot be entirely avoided. Endoscopic procedures are best performed by well-trained, competent and thoughtful endoscopists in facilities suited to provide for patient safety. Attention to clinical risk management may effectively reduce the frequency and intensity of adverse events, enhance recognition and early detection, and improve responsiveness.
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Affiliation(s)
- Gianluca Rotondano
- Division of Gastroenterology and Digestive Endoscopy, Hospital Maresca, Torre del Greco, Italy.
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Khanna A. Commentary on "Are natural orifice transluminal endoscopic surgery and single-incision surgery viable techniques for cholecystectomy?". J Laparoendosc Adv Surg Tech A 2012; 22:15-6. [PMID: 22296592 DOI: 10.1089/lap.2012.9999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ajai Khanna
- Division of Transplantation & Hepatobiliary Surgery, University of California, San Diego, San Diego, California, USA.
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