Laparoscopic Surgery Research Papers - Academia.edu (original) (raw)

2025, British Journal of Surgery

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...

2025, Videosurgery and Other Miniinvasive Techniques

The place of laparoscopy in the resection of Wilms' tumors has remained debatable, but evidence that neoadjuvant chemotherapy causes tumor shrinkage has made laparoscopic nephrectomy (LN) a feasible option. Laparoscopic nephron-sparing surgery (NSS) is technically very demanding and seems to be feasible and effective only when performed by a very experienced surgeon. Aim: We report 7 cases of laparoscopic nephrectomy and 1 case of laparoscopic heminephrectomy for Wilms' tumor. Material and methods: Forty-two consecutive children with primary renal tumor underwent nephrectomy between 2013 and 2020; 11 had an LN. Among them there were 8 children with Wilms' tumor, with age between 13 months and 7 years. All patients received neoadjuvant chemotherapy according to the current SIOP protocol. The mean tumor volume before and after chemotherapy was 174.4 ml (range: 14.7-501) and 32.8 ml (range: 4.3-68) respectively. Results: Seven laparoscopic nephrectomies and one heminephrectomy were performed. No patient had an intraoperative tumor rupture. All children had an attempt of lymph node sampling (their number per pathology assessment was in the range 0-5). There were no intraoperative events. One complication after heminephrectomy occurred, which was urine leak. Five patients had stage I tumor and 3 had stage II. Seven patients had an intermediate-risk and one had a high-risk tumor. There were no local or distant relapses. All patients remained disease-free at a median follow-up of 71 months (range: 16-94). Conclusions: This report demonstrates the feasibility of LN in children with Wilms' tumors. The patients should be carefully selected and specific training in laparoscopy is necessary, particularly with regard to laparoscopic heminephrectomy.

2025, Videosurgery and Other Miniinvasive Techniques

The aim of the stucdy was to present technical aspects and possible intraoperative complications based on the first single port surgery (SPS) laparoscopic nephrectomy performed in our center. The SPS laparoscopic nephrectomy of the right kidney was performed using a transperitoneal access in a 4-year-old child due to a small nonfunctional kidney complicated by hypertension. The intraoperative course was complicated by rupture of the gall bladder wall after grasper removal without leakage of its contents into the peritoneal cavity. No postoperative complications occurred. The SPS nephrectomy appears to be an advantageous method in children which offers a good cosmetic effect. Other benefits require confirmation in further studies. Fixation of the gall bladder is a very helpful but risky maneuver.

2025, Videosurgery and Other Miniinvasive Techniques

A laparoscopic approach to the adrenal gland was introduced in 1992. Since then many studies on adult populations evaluating the safety and results of laparoscopic surgery have been published. A laparoscopic approach to adrenal surgery in children still remains challenging. During the last 20 years we have observed a tendency to minimize surgical trauma that challenged many surgeons to seek new approaches in laparoscopic surgery. Single incision laparoscopic surgery (SILS), in which all instruments are placed through a single, small incision, might be a step towards less invasive surgical procedures. We present two cases of paediatric patients treated in our department with single incision laparoscopic adrenalectomy (SILA). According to our best knowledge this report includes the first such procedure performed in Poland.

2025, International Health

2025, Value in Health

Objectives: Management of patients presenting with influenza-like-illness (ILI) is a source of cost and clinical concern for hospital systems. Influenza test methods vary in cost, accuracy, and convenience. We compared the clinical and economic impact of different test modalities, such as: rapid antigen followed by provider judgment vs. Roche's point of care polymerase chain reaction (PCR) test. MethOds: A budget impact model was developed to compare rapid antigen testing followed by provider judgment to resolve negative results versus the cobas® Influenza A/B nucleic acid test used on the cobas® Liat® System (cobas® Liat® test) in patients presenting with ILI to a healthcare system. The model is based on 100,000 patients stratified by age and risk status presenting to the hospital or physician office. Based on diagnosis, patients receive an antiviral, antibiotic, or no treatment and are sent home/ discharged, admitted, or placed into observation. Complications or an additional episode of care are also assessed. Patient management and cost for both strategies was then compared. Inputs were derived from published literature, HCUP data analysis, and clinical expert opinion. Results: The cobas® Liat® test brings the high sensitivity of PCR to the point of care, enabling lab quality results at the time of visit. Compared to rapid antigen testing with provider judgment, Roche's cobas® Liat® test increased appropriate therapy selection (50% vs. 25%) while decreasing inappropriate therapy selection (3% vs. 54%). Appropriate therapy defined as antiviral use in influenza positive patients and antibiotic use in influenza negative patients. The cobas® Liat® test reduced resource utilization (admissions, complications, observations) in approximately 1,633 patients and overall cost of patient management was reduced by $3,408,853. cOnclusiOns: Adoption of Roche's cobas® Liat® test may improve appropriate therapy use and reduce resource utilization resulting in overall patient management cost savings. Further validation using real world data is warranted.

2025, World Journal of Surgical Oncology

Background Mini-invasive colorectal cancer surgery was adopted widely in recent years. This meta-analysis aimed to compare hand-assisted laparoscopic surgery (HALS) with open right hemicolectomy (OS) for malignant disease. Methods PRISMA guidelines with random effects model were adopted using Review Manager Version 5.3 for pooled estimates. Results Seven studies that involved 506 patients were included. Compared to OS, HALS improved results in terms of blood loss (MD = 53.67, 95% CI 10.67 to 96.67, p = 0.01), time to first flatus (MD = 21.11, 95% CI 14.99 to 27.23, p < 0.00001), postoperative pain score, and overall hospital stay (MD = 3.47, 95% CI 2.12 to 4.82, p < 0.00001). There was no difference as concerns post-operative mortality, morbidity (OR = 1.55, 95% CI 0.89 to 2.7, p = 0.12), wound infection (OR = 1.69, 95% CI 0.60 to 4.76, p = 0.32), operative time (MD = − 16.10, 95% CI [− 36.57 to 4.36], p = 0.12), harvested lymph nodes (MD = 0.59, 95% CI − 0.18 to 1.36, p = 0.1...

2025, Applied ergonomics

While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling...

2025, Journal of Minimally Invasive Gynecology

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2025, Journal of Minimally Invasive Gynecology

Objective: The objective of this video is to demonstrate different clinical presentations of peritoneal defects (peritoneal retraction pockets) and their anatomic relationships with the pelvic innervation, justifying the occurrence of some neurologic symptoms in association with these diseases. Design: Surgical demonstration of complete excision of different types of peritoneal retraction pockets and a comparison with a laparoscopic retroperitoneal cadaveric dissection of the pelvic innervation. Setting: Private hospital in Curitiba, Paran a, Brazil. Interventions: A pelvic peritoneal pocket is a retraction defect in the surface of the peritoneum of variable size and shapes . The origin of defects in the pelvic peritoneum is still unknown . It has been postulated that it is the result of peritoneal irritation or invasion by endometriosis, with resultant scarring and retraction of the peritoneum . It has also been suggested that a retraction pocket may be a cause of endometriosis, where the disease presumably settles in a previously altered peritoneal surface . These defects are shown in many studies to be associated with pelvic pain, dyspareunia, and secondary dysmenorrhea . Some studies have shown that the excision of these peritoneal defect improves pain symptoms and quality of life . It is important to recognize peritoneal pockets as a potential manifestation of endometriosis because in some cases, the only evidence of endometriosis may be the presence of these peritoneal defects . In this video, we demonstrate different types of peritoneal pockets and their close relationship with pelvic anatomic structures. Case 1 is a 29-year-old woman, gravida 0, with severe dysmenorrhea and catamenial bowel symptoms (bowel distension and diarrhea/constipation) that were unresponsive to medical treatment. Imaging studies were reported as normal, and a laparoscopy showed a posterior cul-de-sac peritoneal pocket infiltrating the pararectal fossa, with extension to the lateral border of the rectum. Case 2 is a cadaveric dissection of a posterior cul-de-sac peritoneal pocket infiltrating the pararectal fossa, with extension to the pelvic sidewall. After dissection of the obturator fossa, we can observe that the pocket is close to the sacrospinous ligament, pudendal nerve, and some sacral roots. Case 3 is a 31-year-old woman, gravida 1, para 1, with severe dysmenorrhea that was unresponsive to medical treatment and catamenial bowel symptoms (catamenial bowel distention and diarrhea). Imaging studies were reported as normal and a laparoscopy showed left uterosacral peritoneal pocket infiltrating the pararectal fossa in close proximity to the rectal wall. Case 4 is a cadaveric dissection of the ovarian fossa and the obturator fossa showing the proximity between these structures. Case 5 is a 35-year-old woman, gravida 0, with severe dysmenorrhea that was unresponsive to medical treatment, referring difficulty, and pain when walking only during menstruation. A neurologic physical examination revealed weakness in thigh adduction, and the magnetic resonance imaging showed no signs of endometriosis. During laparoscopy, we found a peritoneal pocket infiltrating the ovarian fossa, with involvement in the area between the umbilical ligament and the uterine artery. This type of pocket can easily reach the obturator nerve. Because the obturator nerve and its branches supply the muscle and skin of the medial thigh , patients may present with thigh adduction weakness or difficulty ambulating .

2025, Journal of Minimally Invasive Gynecology

service. However, urinary catheters are a potential source of patient dissatisfaction. Methods We conducted a prospective cohort QA study of 111 patients undergoing major surgery on a gynecologic oncology service between 2016-2018. In the first cohort, the urinary catheters were removed at 6 AM on postoperative (POD) day # 1. In the second cohort, the catheters were removed 4 hours after surgery. In both cohorts, a satisfaction survey was collected in the afternoon on POD # 1. The primary outcome was patient satisfaction with several secondary clinical outcomes. Results Thirty-three patients (29.7%) were excluded due to postoperative concerns, including hemodynamic instability and necessity for prolonged urinary catheterization. The majority of patients described their hospital experience as good or excellent (Cohort 1: 30/32, 93.8% vs. Cohort 2: 28/30, 93.3%). Overall, only a single patient (in Cohort 1) experienced acute urinary retention requiring urinary catheter replacement. There were no significant differences in the duration of hospital stay, frequency of urinary tract infections, and hospital readmissions. In Cohort 1, 97.7% of patients ambulated by noon on POD # 1, while 91.2% of patients in Cohort 2 ambulated by 6 AM. Conclusions Patient satisfaction and clinical outcomes with early postoperative urinary catheter removal following major surgery on a gynecologic oncology service were not inferior to routine removal the following morning. We recommend early removal unless otherwise indicated by postoperative concerns.

2025, Pediatric Cardiology and Cardiac Surgery

Malignant hyperthermia has been described as a rare genetic hypermetabolic disorder of skeletal muscle that is triggered by exposure to certain inhalation anesthetics and depolarizing muscle relaxants. e incidence of malignant hyperthermia has declined with improvements in anesthesia in recent years, but it is still a lethal complication of cardiac surgery. We experienced a case of postoperative fulminant malignant hyperthermia a er pediatric cardiac surgery. e patient was an 11-month-old boy with a ventricular septal defect (VSD) and Down syndrome. He previously had undergone pulmonary artery banding and ligation of the persistent ductus arteriosus on day 21 a er birth due to respiratory distress. In the present treatment, he underwent closure of VSD and de-banding. e operation was performed uneventfully, but soon a er surgery, his body temperature rose to as high as 40°C. Two days a er surgery, desaturation and cardiac failure occurred with hypermetabolic disorders. We re-opened the sternum, and his condition recovered a er this procedure. We diagnosed this condition as a fulminant type of postoperative malignant hyperthermia. Dantrolene sodium hydrate was infused, and strong cooling via a mat was applied. He recovered with no signi cant neurological damage. We should be aware of this lethal complication a er cardiac surgery. is case reminded us that early diagnosis and quick treatment are most important.

2025, Biomedical Journal of Scientific and Technical Research

The SARS-CoV-2 pandemic of 2019 represents the third significant infection from a corona virus during the last two decades; this time producing a pandemic with more than a million deaths due to the immune InflammoThrombotic Response (ITR) to the virus. This investigation studied 10 different treatments and 52 treatment combinations to determine if there is an effective treatment regimen for SARS-CoV-2. Methods: 1800 people testing positive for SARS-CoV-2 from 23 sites in 7 countries were studied including outpatient and inpatient care and treatment. Outpatients were either treated with an aminoquinoline or followed without specific treatment. Hospitalized patients were divided into two Phases of the study comparing 10 treatments and 52 treatment combinations using quantitative nuclear imaging (FMTVDM), Ferritin and IL-6 to measure the severity of the infection and resulting ITR in addition to measured treatment response. Phase I looked at treatment outcomes as drug treatments were added sequentially. Phase II looked at combination treatments focusing on treating the immune ITR to SARS-CoV-2. ANOVA was used to determine the effect of each Treatment and Treatment combinations on Treatment outcomes including intubation, extubation, deaths and time to discharge. Results: Of the 1800 patients seeking medical care, 847 received no outpatient treatment with 59.5 % recovering and 40.5 % requiring hospitalization. Of the 953 treated with an aminoquinoline in the outpatient setting, 16.6 % required further treatment and hospitalization. Five hundred and one people required admission representing a 27.8 % failure to respond to outpatient management. Three hundred and forty patients entered Phase I and received sequentially added medical Treatment(s) until the patient demonstrated treatment success or expired. Of the 340 in Phase I who failed outpatient aminoquinoline treatment, 89.7 % responded to initiation of treatment with Tocilizumab, Interferon a-2b, or Methylprednisolone. Combining patients who received outpatient aminoquinoline treatment with those who received no outpatient treatment, 74.5 % of the patients admitted to Phase I responded to Interferon a-2b. This number increased to 90 % among patients who received outpatient aminoquinoline treatment. During Phase II of the study patients receiving combination treatments consisting of one of three regimens focusing on treating the immune ITR to SARS-CoV-2 responded 99.83 % of the time. These three ITR regimens consisted of 1. Tocilizumab & Interferon a-2b 2. Primaquine, Clindamycin, Tocilizumab & Interferon a-2b, and 3. Methylprednisolone. These three ITR treatments regimens demonstrated a statistically significant (p < 0.0001) treatment effect and were associated with a significant reduction in intubation with earlier hospital discharge (p < 0.0001). The answer to the question is, Yes. The treatment of SARS-CoV-2, like HIV, requires a multi-drug treatment regimen focusing on the immune ITR to SARS-CoV-2. The three successful treatment regimens include 1. Tocilizumab & Interferon a-2b 2. Primaquine, Clindamycin, Tocilizumab & Interferon a-2b, and 3. Methylprednisolone. These three regimens were effective 99.83 % of the time and shortened hospital stays from 40 ± 3 days to 1-2 weeks.

2025, British Journal of Surgery

2025, Revista do Colegio Brasileiro de Cirurgioes

The coronavirus infection, also known as SARS-COV2, has proven to be potentially fatal, representing a major global health problem. Its spread after its origin in the city of Wuhan, China has resulted in a pandemic with the collapse of the health system in several countries, some with enormous social impact and expressive number of deaths as seen in Italy and Spain. Extreme intra and extra-hospital measures have been implemented to decrease the transmission and dissemination of the COVID-19. Regarding the surgical practice, a huge number of procedures considered non-essential or elective were cancelled and postponed until the pandemic is resolved. However, urgent and oncological procedures have been carried out. In this publication, we highlight and teach adaptations to be made with commonly used materials in laparoscopy to help prevent the spread and contamination of the healthcare team assisting surgical patients.

2025, Fertility and Sterility

. The use of Tranilast, an anti-allergic drug, was approved in 1982 in Japan and South Korea for treatment of bronchial asthma. It is a relatively safe drug that is well tolerated by most patients at doses of up to 600 mg/day. It reduces collagen synthesis in fibroblasts, inhibits growth of neurofibroma cells, and produces interleukin-6 in endothelial cells that processes EMT in vitro. In this preliminary clinical trial, we evaluated the efficiency of Tranilast that was given to 8 patients of endometriosis with pelvic pain. DESIGN: Clinical trial. MATERIALS AND METHODS: This study was carried out with the approval from IRB of Kumamoto University. Tranilast was administered to patients with adenomyosis or endometriosis complaining of pelvic pain at a dose of 300mg/day for six months. The patients continued to record the degree of pain every day in the Numerical Rating Scale (NRS), which is based on a scale from 0 to 10; 0 represents no pain and 10 represents the worst possible pain. RESULTS: The average NRS score of low back pain or lower abdominal pain during menstruation period decreased from 6.25 to 3.63 at the end of the administration. One of eight patients showed a decrease in score of 70% or more (markedly improved). Four patients showed a 69-50% score reduction rate. In addition, three patients who were suffering with severe pain no longer required bed rest. CONCLUSION: Tranilast is considered a useful drug to relieve the symptoms of pelvic pain of endometriosis by mechanisms different from the drug to control the ovarian endocrinological function.

2025, Nepalese journal of cancer

The study was conducted to compare the analgesic and adverse effect profiles of intravenous infusion of Tramadol and Diclofenac in post-operative pain management. Method: Cancer patients undergoing major surgery were prospectively randomized into two groups of 35 and was entered into single blinded clinical trial. Patients in each arm received either Tramadol (Gr A) or Diclofenac Infusion (Voveran®) (Gr B) for first 48 hours after surgery. Pain intensity was measured based on a 10 point Verbal Rating Scale (VRS). VRS was obtained at 6, 12, 18, 24, 30, 36, 42 and 48 hrs post-operatively. Result: The mean age was 56.3 and 49.5 years in Gr A and B, respectively (p=.056). Mean length of incision was 16.46 cm and 18.23 cm in Gr A and B, respectively (p=.1). On 0 post-operative day, 14 patients in Gr A and 6 patients in Gr B required accessory analgesics (p=.18). On 1st post-operative day, 2 patients in Gr A and 1 patient in Gr B required accessory analgesics (p=.6). One patient on Tramadol group had nausea post-operatively. Average cost was 471.73 and 227.80 Nepali rupees in Gr A and Gr B, respectively (p=.032). Intravenous infusion of Diclofenac should be considered as a safe and cheaper alternative to Tramadol infusion for pain management after major surgical oncological procedures.

2025, Human Reproduction

The purpose of this study was to assess the operating time of the most common gynaecological laparoscopic procedures. We analysed retrospectively 1000 consecutive operative laparoscopies on a procedure-by-procedure basis. Diagnostic laparoscopy and laparoscopic sterilization were specifically excluded from the analysis. The various laparoscopic procedures were grouped and analysed under six major categories. The average operating time for all cases was 76.9 min (range 10-400). In 38 cases (3.8%) the laparoscopic procedure was converted to laparotomy. The average operating time for treating ectopic pregnancy and tubal disease was approximately 60 min (range 13-240). Surgery for endometriosis and ovarian cysts averaged 72 min (range 10-240). Laparoscopic myomectomy and hysterectomy averaged 113 and 131 min respectively (range 25-400). Our results show that while the operating time for most operative laparoscopies is less than 75 min, the range of operating times is great. The relative lack of predictability in procedure times means that the efficient utilization of fixed theatre sessions is difficult.

2025, Human Reproduction

The purpose of this study was to compare the variability of operating times for some of the most common gynaecological procedures performed laparoscopically and by open surgery. The case notes of 60 women randomly selected from a cohort of 600 who had undergone laparoscopic surgery for ectopic pregnancy, ovarian cysts, leiomyoma and hysterectomy were reviewed. These patients were matched with an equal number of women who had been treated by open surgery for similar indications. Additional matching criteria included age (⍨2 years), size of the lesion in cases of ovarian cysts and fibroids (⍨3 cm), the period of amenorrhoea in ectopic pregnancies, and uterine size and pelvic pathology in women undergoing hysterectomy. Comparison of laparoscopy and laparotomy showed that the mean procedure times were similar for the two routes of surgery, with the exception of hysterectomy which took significantly longer if done laparoscopically. The duration of laparoscopic surgery for ectopic pregnancy, ovarian cystectomy and hysterectomy was significantly less predictable than at laparotomy. These data indicate that with the exception of hysterectomy, the average operating time for laparoscopic procedures is comparable to that for laparotomy. In contrast, the variability of duration of laparoscopic surgery tends to be much greater than with laparotomy for all procedures considered.

2025, Revista Médica del Hospital General de México

Background: At present, there is no known risk factor analysis in patients undergoing nephrectomy secondary to lithiasis that favor their entry into the intensive care unit. There is no consensus in methods that report post-surgical complications. As a consequence, the reported incidence of complications in renal surgery ranges from 2% to 54%, regardless of the surgical approach. Methodology: A total of 58 patients with diagnosis of renal exclusion confirmed by renal scintigraphy, and lithiasis, were submitted to simple nephrectomy by a group of expert surgeons. A total of 58 patients were evaluated. Descriptive statistics were measured for the demographic variables. Inferential statistics were evaluated in quantitative variables using the Student's T test, with a p < 0.005. Chi square test was used for the qualitative variables. Results: When the multivariate analysis was carried out between the variables: age, weight, height, diabetes mellitus, systemic hypertension, smoking, abscess and transfusion, it was not possible to identify correlation between these and the development of complications or admission to the intensive care unit. However, when assessing by logistic regression the relationship between transfusing a patient and developing complications, a positive relationship was found with a p = 0.003, and an OR 13.45 CI [2.4---72]. Patients who suffered complications required a Q3 longer stay in the intensive care unit (p = 0.002). Conclusions: It was observed that patients with comorbidities such as hypertension, diabetes mellitus and anemia are more likely to require handling per unit of intensive care, even greater

2025, MOJ clinical & medical case reports

The 30-day mortality associated with complicated PUD is estimated at 8.6% for hemorrhage and 23.5% in case of perforation. Occasionally ulcer penetration to adjacent viscera without free perforation occurs, the most frequent being to the pancreas, lesser omentum, biliary tract, and greater omentum. Case presentation: A 72-year-old male with a previous diagnosis of peptic ulcer disease presented in the ER due to hematochezia and lightheadedness. The blood work revealed new onset anemia and elevated inflammatory parameters. Upper gastrointestinal endoscopy and CT scan suggested a peptic ulcer complicated by hepatic cyst penetration and fistula. Proton pump inhibitors and empiric broad-spectrum antibiotic were initiated. On the 10th day post-presentation, the patient underwent a subtotal gastrectomy with Billroth II reconstruction and hepatic cyst fenestration and drainage. Discussion/Conclusion: Nowadays, ulcer penetration is a rare complication of peptic ulcer disease. Therapeutic options include conservative management with PPI, antibiotics, and percutaneous/endoscopic drainage or surgical therapy, depending on the extension/location of the ulcer and abscess and the patient's characteristics.

2025, Surgical Endoscopy

Background: Laparoscopic surgery is thought to be associated with a reduced metabolic response compared to open surgery. Oxygen consumption ( _ VO 2 ) and energy metabolism during laparoscopic surgery have not been characterized in children. Methods: We measured respiratory gas exchange intraoperatively in children undergoing 19 open and 20 laparoscopic procedures. Premature infants and patients with metabolic, renal, and cardiac abnormalities were excluded. Anesthesia was standardized. Unheated carbon dioxide was used for insufflation. _ VO 2 was measured by indirect calorimetry. Core temperature was measured using an esophageal temperature probe. Results: We found a steady increase in _ VO 2 during laparoscopy. The increase in _ VO 2 was more marked in younger children and was associated with a significant rise in core temperature. Open surgery was not associated with significant changes in core temperature or _ VO 2 . Conclusions: Laparoscopy in children is associated with an intraoperative hypermetabolic response characterized by increased oxygen consumption and core temperature. These changes are more marked in younger children.

2025, HPB

cysts of the liver and the abdominal cavity, treated also with local cyst excisions. During follow-up, no signs of recurrence have been reported, nine and two years postoperatively, respectively. Conclusion: As hydatid cysts may cause life-threatening complications, the establishment of a right preoperative diagnosis is crucial, and they should be included in the differential diagnosis even in non-endemic areas. The presence of multifocal disease should always be suspected and thoroughly examined, through a detailed medical history and CT examination.

2025

Background Although the incidence of iatrogenic colonoscopic perforation is low, it can result in severe complications and mortality. This study assessed the incidence and surgical management outcomes of iatrogenic colonic perforations. Materials and Methods We reviewed all the medical records of patients with colonic perforations during diagnostic or therapeutic colonoscopies from January 2007 to December 2016 at National Cancer Institute. We collected the patient’s demographic data, colonoscopic reports, and data regarding the location of perforations, their treatment and outcome. Results 16 186 colonoscopies were performed at National Cancer Institute. The overall perforation rate was 0.14% (23 of 16 186). Of the total 23 colon perforations, 20 were managed operatively. The most common location was the sigmoid colon, in 12 cases. The most used surgical technique was simple suture (11 cases) followed by resection with anastomosis (6 cases). Three patients died (one because of mul...

2025, International Journal of Cardiology

2025, Urology

To assess the feasibility of pure natural orifice transluminal endoscopic surgery (NOTES) transvesical venous ligation mimicking bilateral varicocelectomy in an animal model. Transvesical NOTES bilateral venous ligation was performed in 6 female pigs by considering lower epigastric vessels as a model for gonadal vessels. Under flexible cystoscopic guidance, a cystotomy was created on the anterior bladder. The flexible cystoscope was introduced through the over tube, and the lower epigastric vessels were visualized in retroflexion. Thulium laser was used to cut and coagulate the vessels. A bladder catheter was left in place for 4 days in all animals and they were sacrificed 15 days after the procedure. The procedure was successfully carried out in all animals without intraoperative complications. Epigastric vessels were safely cut and coagulated using the thulium laser. Median time for the overall procedure, including establishment of the transvesical port, was 23 minutes (range 20-30). No complications were encountered during the postoperative follow-up period. Postmortem examination revealed complete coagulation and separation of vessels. An animal model mimicking a NOTES transvesical bilateral varicocelectomy procedure is successfully shown in the present study. Despite being encouraging, these novel findings need to be interpreted with caution. Further research is warranted and development of purpose-built instrumentation is awaited to define potential urological applications of transvesical NOTES. UROLOGY 78: 1082-1088, 2011.

2025, Journal of Gynecologic Surgery

Background: Endometriosis is a common, benign, estrogen-dependent, chronic gynecologic disorder associated with pelvic pain and infertility. Endometriotic lesions have also been found in several remote sites-including the omentum, gastrointestinal tract, peritoneum, operative scars, lymph nodes, umbilicus, skin, lungs, pleura, urinary bladder, kidneys, and pancreas. Only 19 cases of hepatic endometriosis have been found in Englishlanguage publications. Case: A 38-year-old female, with a 5-year history of pelvic endometriosis, was referred to the Aretaieion Hospital, University of Athens, in Athens, Greece. A detailed history of this patient revealed that her shoulder pain was associated with menstruation. A chest computed tomography scan showed a mass in the liver and, subsequently, liver magnetic resonance imaging was performed. The latter revealed a 4.4 • 3.8 cystic mass in segments 7 and 8 of the liver infiltrating the right diaphragm. At exploratory laparotomy, a tumor at the diaphragmatic portion of the liver infiltrating the diaphragm was found. A wedge excision of the tumor was performed with clear margins en bloc with part of the right diaphragm. A histology report confirmed a mixed cystic and solid mass, with endometrial-type epithelium, positive to estrogen receptors and progesterone receptors, and with cholangian differentiation in some sites. The diaphragm excised was infiltrated by endometrial tissue, while the liver margins were free of pathology. Results: The patient was discharged on the second postoperative day and remains free of symptoms 6 months later, as of this writing. Conclusions: Intrahepatic endometriosis is a rare condition. The diagnosis may only be reached preoperatively by high clinical suspicion of the condition, when symptoms are associated with menstruation. (J GYNECOL SURG 30:383)

2025, Scientific Reports

Intestinal obstruction is considered a frequent surgical pathology related to previous surgical procedures. Many different factors can lead to different outcomes when surgical management is needed. Therefore, we aim to describe the factors related to morbidity and mortality in surgical management of IO in a single-center experience. Retrospective observational study with a prospective database, in which we described patients who underwent surgical management due to intestinal obstruction between 2004 and 2015. Demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. 366 patients were included. Female were 54.6%. Mean age was 61.26. Laparoscopic approach was done in 21.8% and the conversion rate was 17.2%. Intestinal resection was performed in 37.9% of the cases. Postoperative complications were observed in 18.85%. Reintervention and mortality were 9.5% and 4.1% respectively. Laparoscopic approach shows lesser time of intestinal transit (mean 28.6...

2025, Kathmandu University Medical Journal

2025, World Journal of Surgery

Background Privatization is widely perceived as a tool to improve healthcare access; however, its impact on the access of surgical care has not been quantified. We used cholecystectomy as a model to assess the variation in access between coexisting public (PB) and private providers (PVs). Methods We performed cross-sectional analysis of patients who underwent cholecystectomy at two major PB and PV groups serving Riyadh, Saudi Arabia. Representative sample sizes were estimated based on 95 % confidence level and ±5 confidence interval (CI). Exclusion criteria were major comorbidities, emergency cholecystectomies, age C60 and concurrent non-minor procedures. Data collected were patients' demographics, payer status, and durations of symptoms, diagnosis and hospitalization. Results Between 2012 and 2104, samples of 330 and 297 were randomly selected from the total of 2164 and 1315 cases performed at PV and PB, respectively. Seventy-eight PV and 73 PB cases were excluded. The distribution of publically funded/insured/self-paid was (3/179/70 PV) and (209/0/4 PB), respectively. Median durations between symptoms and surgery for PV and PB cases were 90 and 365 days (P \ 0.001), respectively, while the wait times after ultrasound-based diagnosis were 125 and 11 days (P \ 0.001), respectively. Median hospitalization time was significantly shorter in PV compared to PB (1 vs. 2 days, P = 0.001), and same-day admissions were more frequent in PV 94 % than PB 41 % (RR 2.3, CI 1.9-2.7). Conclusions When coexist in a competitive environment, PV offers a remarkably better access to cholecystectomies compared to PB. Facilitating access to PV can be an effective strategy to improve patient's access to surgical care.

2025, Turkish Journal of Thoracic and Cardiovascular Surgery

Bul gu lar: Hastaların tümünde primer tanı özofagus kanseri idi. Çalışmaya dahil edilen hastaların tümüne minimal invaziv Ivor-Lewis özofajektomi yapıldı. Neoadjuvan kemoradyoterapi olguların 97ʼsine (%69.3) uygulandı. Ortalama ameliyat süresi 261. 7±30.6 (dağılım, 195-330) dk. idi. Ortalama ameliyat sırası kan kaybı miktarı 115.1±190.7 (dağılım, 10-800) mL idi. Olguların 60'ında (%42.9) ameliyat sırası veya erken ya da geç ameliyat sonrası dönemlerde komplikasyonlar gelişti. Anastomoz kaçağı oranı %7.1 ve pulmoner komplikasyon oranı %22.1 idi. Ortalama hastanede kalış süresi 10.6±8.4 (dağılım, 5-59) gün ve hastane mortalite oranı %2.1 idi. Medyan takip süresi 37 (dağılım, 2-74) ay ve üç ve beş yıllık genel sağkalım oranları sırasıyla %61.8 ve %54.6 idi. Minimal invaziv Ivor-Lewis özofajektomi düşük mortalite ve uzun süreli sağkalım sonuçlarıyla özofagus kanseri tedavisinde güvenle uygulanabilir. Anah tar söz cük ler: Özofagus kanseri, özofajektomi, Ivor-Lewis özofajektomi, laparoskopik torakoskopik özofajektomi, minimal invaziv özofajektomi, cerrahi teknikler.

2025, Advances in Medicine and Medical Research

Background. To compare early oral feeding (EF) versus late oral feeding (LF) on the return of normal bowel functions in spinally anesthetized women after having lower segment Caesarean section (LSCS). Secondary outcomes such as maternal satisfaction and gastrointestinal complications were also evaluated. Methods. Three-hundred and sixty-two singleton pregnant women undergoing elective LSCS with spinal anesthesia were assigned to receive either EF (n= 183) or LF (n= 179) after surgery. Participants began to take normal diet between immediately and 6 hours, or began sipping water after 12 hours and soft diet after 24 hours then normal diet after 48 hours of surgery. Results. The ages of participants ranged from 19 to 47, with a mean age of 35±12 years. There was no-loss follow up and no significant difference in patient characteristics. Participants given EF were more likely to experience bowel sound the next morning after surgery than patients given LF (EF 93% vs. LF 71%, P<0.05)....

2025, The American Surgeon

or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.

2025, Surgical laparoscopy, endoscopy & percutaneous techniques

Background: To determine the relationship between the resected gastric volume (RGV) and the results of laparoscopic sleeve gastrectomy (LSG). The study included 333 patients with LSG. Patients were divided into 4 groups according to RGV: 600 to 999 cm 3 as Group 1, 1000 to 1499 cm 3 as Group 2, 1500 to 1999 cm 3 as Group 3, and ≥ 2000 cm 3 consists the Group 4. Prospectively collected data at first month, sixth month, and at first year were retrospectively reviewed. The percentage of the reduction in body mass index and the excess weight loss and remission of comorbid diseases were recorded. Results: Preoperative demographic data were similar within groups. No statistically significant difference was observed between the groups in terms of the changes in excess weight loss. The major complication rates were highest in Group 4 and the difference between the groups was statistically significant (P = 0.012). The results of this study showed that different RGV do not affect the results of LSG, furthermore in patients with RGV ≥ 2000 cm 3 , surgeons should be careful for major complications.

2025, Obesity Surgery

Background Bariatric surgery has not been routinely presented as an option for patients over 60 years of age. Part of the reason is the long-standing perception that there is additional risk. Additionally, until its recent ruling, Medicare was inconsistent in its coverage, thus making it difficult for some beneficiaries to gain access to the procedures. The aim of this study was to evaluate the perioperative morbidity in our patients who were 60 years of age or older who underwent a laparoscopic gastric bypass Roux-en-Y (LGBRY). We also report the impact of surgery on five objectively graded comorbidities in the early postoperative period. Methods Our prospectively maintained database was used to identify and report on all patients operated on at our program from January 2002 through January 2007. Results One hundred twenty patients were identified with 100% follow-up through the perioperative phase and 85% follow-up at 12 months. The mean age was 62 years (range 60-74) with a mean body mass index of 43 kg/m 2 (range 34-70). All patients underwent an LGBRY. There was no 30-day mortality. Perioperative complications included: 13 strictures, one abscess, two wound infections, three ulcers, two small bowel obstructions, three bleeding episodes in patients who required coumadin, and atrial fibrillation in two patients. The five graded/measurable comorbid conditions (preop/postop) were diabetes mellitus type II (68/17), hypertension (86/10), obstructive sleep apnea requiring continuous positive airway pressure (CPAP; 48/3), hypercholesterolemia (106/18), and hypertriglyceridemia (60/5). LGBRY can be done safely in patients over 60 years of age in an experienced bariatric program, even in patients with relatively high risk based on their comorbid conditions preoperatively. Resolution of associated comorbidities far exceeds that found with any other treatment modality.

2025, Obesity Surgery

2025, Frontiers in Pediatrics

Conclusion: EPN is a serious condition that can occur after surgical treatment for urinary tract obstruction. Early detection of air in the kidney should be considered a sign of complicated urinary tract infection. Immediate aggressive... more

2025, Annals of Surgical Treatment and Research

Purpose: This study aimed to compare the clinical performance of Medisonic (Daiwha Corp.) to that of Harmonic HD 1000i (Ethicon Endo-Surgery Inc.) and Sonicision (Medtronic) in patients undergoing gastrectomy for gastric cancer. Methods: A total of 30 patients were enrolled in this prospective randomized study. The patients were randomly assigned to a Medisonic (M group, n = 10), Harmonic HD 1000i (H group, n = 10), or Sonicision (S group, n = 10) groups. Primary outcome was cutting speed and activation times during omentectomy. Other variables were visibility of surgical field, blade stickiness, and clinical outcomes, including operation-related complications. Results: Clinicopathologic characteristics, including age, sex, body mass index, or stage were not different between the 3 groups. Operative outcomes, including operation time, estimated blood loss, and postoperative hospital stay were not different between the 3 groups. There was no significant difference in 30-day postoperative complications. The running time of omentectomy was 7.3, 9.2, and 8.7 minutes in the H, S, and M groups, respectively, with no statistical difference (P = 0.589). We also looked at the activation times during the omentectomy, and there was no statistical difference between the groups (52.6 times vs. 58.9 times vs. 56.2 times in the H, S, and M groups, respectively; P = 0.860). Conclusion: Medisonic is safe and efficient to perform laparoscopic radical gastrectomy and is not inferior to Harmonic HD 1000i or Sonicision in terms of clinical outcomes and cutting/sealing function.

2025, Laparoscopic surgery

Background: Parastomal hernia is common and bothersome for patients. Parastomal hernia repair has become increasingly common, and although several different approaches exist, they all carry high risk of postoperative complications. Mesh fracture is a known, but rare complication in other types of hernia repair. We describe seven cases of mesh fracture as reason for recurrence in patients undergoing laparoscopic Sugarbaker parastomal hernia repair. Methods: This retrospective case series present seven patients with intraoperatively verified mesh fracture. All patients underwent primary laparoscopic Sugarbaker parastomal hernia repair between October 2014 and May 2016, using a monofilamentous composite polyester mesh (Parietex TM Composite Parastomal Mesh). All patients were diagnosed with hernia recurrence, and mesh fracture was confirmed during the surgical procedure for recurrence. Data on demography, perioperative findings and length of stay were presented. Results: During the inclusion period, a total of 41 patients underwent laparoscopic parastomal hernia repair in our department. Seven patients (17%) subsequently developed hernia recurrence requiring surgical intervention. Diagnosis of hernia recurrence occurred median 29 months (range, 20-36 months) after primary hernia surgery. Recurrence hernia surgery occurred median 32 months (range, 20-67 months) after primary hernia surgery. Three of these patients were emergencies due to hernia-related acute bowel obstruction. In all patients re-herniation was due to a fracture in the central part of the mesh. None of the patients with mesh fracture experienced postoperative complications at either primary or recurrence surgeries. Length of stay was median 7 days (3-8 days) after primary surgery and 4 days (3-9 days) after recurrence surgery. We describe seven cases of mesh fracture as reason for recurrence in patients undergoing primary laparoscopic parastomal Sugarbaker hernia repair. Our findings underline the importance of postmarketing surveillance of medical devices, and consideration should be given to centralization of these complicated procedures.

2025

Digestive Disease Center K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark Contributions: (I) Conception and design: KK Jensen, LN Jørgensen; (II) Administrative support: KK Jensen, LN Jørgensen; (III) Provision of study materials or patients: KK Jensen, LN Jørgensen, P Sparre; (IV) Collection and assembly of data: AL Ebbehøj, KK Jensen, P Sparre; (V) Data analysis and interpretation: AL Ebbehøj, KK Jensen, P Sparre; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Kristian K. Jensen, MD, PhD. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Nielsine Nielsens Vej 41A, DK-2400 Copenhagen, Denmark. Email: mail@kristiankiim.dk.

2025, BMJ Quality & Safety

AimWe evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to focus care on those at highest risk of emergency admission to hospital. The aim of this study was to evaluate the costs and effects of introducing PRISM into primary care.MethodsRandomised stepped wedge trial with 32 general practices in one Welsh health board. The intervention comprised: PRISM software; practice-based training; clinical support through two ‘general practitioner (GP) champions’ and technical support. The primary outcome was emergency hospital admissions.ResultsAcross 230 099 participants, PRISM implementation increased use of health services: emergency hospital admission rates by 1 % when untransformed (while change in log-transformed rate ΔL=0.011, 95% CI 0.010 to 0.013); emergency department (ED) attendance rates by untransformed 3 % (wh...

2025, Cureus

Malignant struma ovarii (MSO) is a rare and aggressive ovarian tumor that mostly affects adults but can occur in adolescents. Prompt recognition, accurate diagnosis, and multidisciplinary management are essential for favorable outcomes. Herein, we report the youngest case of an 11-year-old girl with a large MSO. First, conventional imaging revealed a large left ovarian mass, leading to a left oophorectomy. Subsequently, histopathological examination confirmed papillary thyroid carcinoma within MSO. Thyroid and fertility-preserving surgery were chosen after multidisciplinary consultation. Despite challenges, the patient had a positive outcome with no recurrence after 36 months. Therefore, the adoption of less invasive surgical approaches and vigilant follow-up can achieve remission, but more research is needed to further enhance our understanding of the disease's risk stratification and optimal treatment strategies.

2025, International journal of clinical obstetrics and gynaecology

Objective: To describe a case of omental implantation of gestational tissue following laparoscopic salpingectomy for ruptured tubal ectopic pregnancy, with large bilateral multiseptated clear ovarian cysts and a mesenteric defect in a... more

2025, Langenbeck's Archives of Surgery

2025, Porcine Health Management

Background Serosal inclusion cysts are thin walled-structures located on the peritoneal surface of the uterus, frequently observed as multiple cystic structures in aggregates or grape-like clusters containing a clear, non-viscous fluid. In human and veterinary medicine, they are thought to be developed under hormonal effects, or after manipulation or inflammation of the reproductive tract. However, they have not yet been described in swine. Case presentation A uterus of a 3-year-old crossbreed sow was condemned at slaughter due to the presence of multiples cystic cavities attached to the serosal surface. Microscopically, multiple cystic dilations emerging from the serosa were lined by a simple and flattened epithelium (cytokeratine positive and vimentin negative on immunohistochemistry) supported by a subepithelial layer of collagen. Grossly and histologically, they were diagnosed as serosal inclusion cysts. Conclusion To the authors’ knowledge, this report represents the first desc...

2025, Laparoscopic Surgery

2025, World Journal of Surgery

Background Randomized trials suggest that laparoscopic cholecystectomy should be performed on first admission for acute cholecystitis. However, this is not widely practiced, possibly because of a perceived high conversion rate. We hypothesized that delay from onset of symptoms may increase the conversion rate. Methods We performed a retrospective case note review of patients undergoing emergency cholecystectomy in a single institution between January 2002 and December 2005. We analyzed whether delay from onset of symptoms was related to the conversion rate in patients with a histopathological diagnosis of acute cholecystitis. Results Of patients who underwent emergency laparoscopic cholecystectomy in our institution, 32.4% (197/608) had acute cholecystitis on histopathology. The conversion rate of those with acute cholecystitis was considerably higher (24.4%) than for those with other pathologies (6.3%). For patients with acute cholecystitis, the conversion rates increased with duration of symptoms: 9.5%, 16.1%, 38.9%, and 38.6% for delays of 0-2 days, 3-4 days, 5-6 days, and > 6 days from symptom onset, respectively (chi-square for trend = 14.27, DF = 1, p = 0.00016). Most conversions were due to the presence of acute inflammatory adhesions. Conclusions Early intervention for acute cholecystitis (preferably within 2 days of onset of symptoms) is most likely to result in successful laparoscopic cholecystectomy; increasing delay is associated with conversion to open surgery.

2025, Neurourology and Urodynamics