Analysis of aborted bariatric surgeries and potential opportunities.

BACKGROUND: Aborted bariatric surgeries are an undesirable experience for patients as they are subjected to potential physical harm and emotional distress. A thorough investigation of aborted bariatric surgeries has not been previously reported. This information may allow the discovery of opportunities to mitigate the risk of aborting some bariatric operations. METHODS: Data from the Michigan Bariatric Surgery Collaborative, a statewide bariatric surgery registry, were used to identify all aborted primary bariatric operations from June 2006 through January 2023. The reasons for aborting surgery were divided into seven categories. Stepwise logistic regression was performed to identify independent predictors of aborted procedures for potentially modifiable factors. RESULTS: A total of 115,004 patients underwent bariatric surgery with 555 (0.48%) procedures aborted. Of those having an aborted operation the mean age was 52 years and mean BMI was 49.8 with females accounting for 72%. Sleeve gastrectomy had the lowest aborted rate (0.38%) as compared to gastric bypass, adjustable gastric banding, and biliopancreatic diversion (p < 0.0001). The most common aborted surgery reason categories included adhesions and hernias, tumors and anatomic anomalies, and inadequate visualization due to either hepatomegaly or abdominal wall thickness. The most significant (p < 0.0001) independent predictors of aborted surgeries due to hepatomegaly or abdominal wall thickness were BMI ≥ 60 (OR 10.7), BMI 50 to 59 (OR 3.1) and diabetes mellitus (OR 2.7). Preoperative weight loss was a protective factor for aborting surgery due to hepatomegaly or abdominal wall thickness (OR 0.9; p < 0.0001). CONCLUSIONS: Aborted surgeries are uncommon and occur in approximately 1 in 200 primary bariatric operations with the lowest rate identified in sleeve gastrectomy. Nearly 20% of operations are aborted due to hepatomegaly or abdominal wall thickness and targeting patients with elevated BMIs and diabetes mellitus for preoperative weight loss might reduce the risk of these types of aborted procedures.

LigLAP: Encirclement and Ligation of Vessels in Laparoscopic Surgery: A Double-Layer Suture Sealing Approach.

This article proposes a potential automatic ligation (LigLAP) method to occlude vessels and ducts in several laparoscopic surgical procedures. Currently, stapling devices are widely used for this purpose. However, there are some complications associated with stapling devices, including biliary leak and tissue damage. In this article, we examine the feasibility of an alternative method that uses a double-layer suture to encircle and occlude a vessel. A heating element melts the outer layer of the suture at the cross-point of the suture to create a seal. Several electromechanical mechanisms have been proposed to carry out this ligation process. In addition, some parts have been prototyped for experimental verification and visualization. Several double-layered sutures have been created, and their tensile strength and sealing capabilities have been measured. Moreover, a simple leakage experiment has been performed to verify experimentally the idea of using the double-layer suture. The results show that the new suture and the thermal sealing method provide the required strength to occlude balloons filled with water. Although the results suggest that the proposed method and the double-layer suture may be used in surgical ligation processes, much more rigorous testing of leakage is required.

A rare case report of pancreatic low-grade fibromyxoid sarcoma (LGFMS).

BACKGROUND: Low-grade fibromyxoid sarcoma (LGFMS) is an uncommon neoplasm generally affecting muscle tissue. It presents rarely in abdominal viscera and even more rarely occurs in the pancreas. All types of pancreatic sarcomas are uncommon, and LGFMS is a rarer still. We present the case of an LGFMS in the pancreas. Because of its rarity, there are no guidelines for appropriate treatment or summations of the natural course of this illness. CASE PRESENTATION: We present the case of a 49-year-old female who presented with epigastric pain. She had a prior history of three episodes of acute pancreatitis many years earlier. A CT revealed a pancreatic body mass, which was biopsied. Pathology returned LGFMS. The patient underwent a distal pancreatectomy and splenectomy. She did well after the case and did not require further intervention. CONCLUSION: Though it is exceedingly rare, cases of pancreatic LGFMS should be reported in order to guide clinical decisions. LGFMS has been shown to have high malignant potential in other tissues, and there is no reason to think pancreatic masses will be different. By building a body of evidence about these rare tumors, patient care will benefit.

The learning curve with single-port cholecystectomy.

OBJECTIVES: Single-port surgery is a rapidly advancing technique in laparoscopic surgery. Currently, there is limited evidence on the learning curve and practicality of performing single-port laparoscopic cholecystectomy. METHODS: Single-port cholecystectomy was performed on 20 consecutive patients for biliary dyskinesia, symptomatic cholelithiasis, or acute cholecystitis. The Tri-Port was placed in the umbilicus, and a combination of straight and articulating instruments were utilized. Patient characteristics and outcomes were reviewed, and a comparison was made with the prior 20 consecutive laparoscopic cholecystectomies performed using the 3-port technique. RESULTS: Characteristics were similar in both groups. The 3-port cholecystectomy had a mean time of 65.7 minutes, and patients had an average body mass index of 28.16. The first single-port cholecystectomy took 160 minutes with sequential improvement to the sixth case of 66 minutes with a mean of 68.2 minutes for the last 15 single-port cases. The average patient body mass index was 30.24. No major complications occurred. CONCLUSION: The largest series to date of single-port cholecystectomy for multiple degrees of biliary disease is presented. This study validates that this technique can be applied effectively and performed in comparable operative times to traditional 3-port cholecystectomy with a learning curve of approximately 5 cases.

Providing haptic feedback in robot-assisted minimally invasive surgery: a direct optical force-sensing solution for haptic rendering of deformable bodies.

This paper presents an enhanced haptic-enabled master-slave teleoperation system which can be used to provide force feedback to surgeons in minimally invasive surgery (MIS). One of the research goals was to develop a combined-control architecture framework that included both direct force reflection (DFR) and position-error-based (PEB) control strategies. To achieve this goal, it was essential to measure accurately the direct contact forces between deformable bodies and a robotic tool tip. To measure the forces at a surgical tool tip and enhance the performance of the teleoperation system, an optical force sensor was designed, prototyped, and added to a robot manipulator. The enhanced teleoperation architecture was formulated by developing mathematical models for the optical force sensor, the extended slave robot manipulator, and the combined-control strategy. Human factor studies were also conducted to (a) examine experimentally the performance of the enhanced teleoperation system with the optical force sensor, and (b) study human haptic perception during the identification of remote object deformability. The first experiment was carried out to discriminate deformability of objects when human subjects were in direct contact with deformable objects by means of a laparoscopic tool. The control parameters were then tuned based on the results of this experiment using a gain-scheduling method. The second experiment was conducted to study the effectiveness of the force feedback provided through the enhanced teleoperation system. The results show that the force feedback increased the ability of subjects to correctly identify materials of different deformable types. In addition, the virtual force feedback provided by the teleoperation system comes close to the real force feedback experienced in direct MIS. The experimental results provide design guidelines for choosing and validating the control architecture and the optical force sensor.

Single port cholecystectomy: the pathway back to a standardized technique.

INTRODUCTION: A novel multi-port (Triport+) and methodology were designed for single port cholecystectomy (SPC) to replicate the principles found in the gold standard 4-port laparoscopic cholecystectomy. We present the first case series utilizing the Triport+, and methodology through a single 15-mm periumbilical fascial incision. METHODS: The 4 lumen multi-channel port was placed in the umbilicus through a measured 15-mm fascial incision. Instrument design and placement in the port is specific to the performance of the SPC. Retrospective review of the cases was performed. RESULTS: 15 SPCs were performed without complications. No conversions or additional ports were required. Fascial defect size measured was 15 mm. Visualization of the critical view was obtained in each case. The mean total operative time was 36 minutes. CONCLUSION: The Triport+ and novel SPC methodology successfully replicate the standard of retraction and exposure in traditional 4-port laparoscopic cholecystectomy. This novel technique eliminates both instrument and hand conflict.