Is single-port laparoscopy or vaginal natural orifice transluminal endoscopic surgery the better option for salpingo-oophorectomy?

AIM: To compare postoperative pain and recovery in patients undergoing oophorectomy with single-port laparoscopic surgery (SPLS) versus vaginal natural orifice transluminal endoscopic surgery (vNOTES). METHOD: Patients who underwent salpingo-oophorectomy with SPLS or vNOTES between 2016 and 2023 were analyzed retrospectively. Oophorectomy was performed based on the presence of an adnexal mass or breast cancer susceptibility gene mutation. RESULTS: Fifty-two patients underwent oophorectomy with SPLS and 35 underwent vNOTES. Although the mean mass size was slightly larger in the SPLS group than in the vNOTES group (8.0 ± 4.1 vs. 6.8 ± 3.3 cm), the difference was not significant. There was no difference in operating times between SPLS and vNOTES. The mean visual analog scale and faces pain scale scores 2 and 6 h postoperatively were lower in the vNOTES group. The mean quality of recovery-40 (QoR-40) score was higher in the vNOTES group (156 ± 14 vs. 148 ± 11; p = 0.009). This analysis identified vNOTES as an independent predictor of a high QoR-40 score. CONCLUSION: The vNOTES group experienced less pain during the early postoperative period than the SPLS group. Although the operating and removal times were similar, the port setup time was longer for the vNOTES group.

A Novel Sliding Knot Technique Without a Knot Pusher for Laparoscopic Pelvic Floor Surgery.

INTRODUCTION AND HYPOTHESIS: Challenges in intracorporeal knot tying can be addressed with extracorporeal slip knots, simplifying the process of tying and managing tissue tension using a knot pusher. However, existing extracorporeal knot techniques are difficult owing to their complexity, the finesse required with thin yarns, and extensive training needs. We developed a new laparoscopic extracorporeal slip knot technique that can be used with a conventional needle driver or standard clamps, offering the advantages of being cost-effective and easy to learn. METHODS: The technique involves passing the active strand over another loop and securing it with the nondominant hand. A Kelly clamp is then wound around both loops three times in a tornado-like motion, passing the instrument over the active loop and under the passive one, and grasping the active strand. The passive strand is pulled to approximate the knot to the tissue and is tightened by the tension of the passive strand. RESULTS: This method has proven effective in various laparoscopic procedures such as sacrocolpopexy, colposuspension, pectopexy, myomectomy, and hysterectomy, facilitating surgeries without complications. CONCLUSIONS: The tornado knot technique is a feasible and safely locked sliding extracorporeal knot that can be easily learned, especially by surgeons who are accustomed to open surgery.

Open versus laparoscopic completion cholecystectomy in patients with previous open partial cholecystectomy: a retrospective comparative study.

Background: Some patients report recurrence or persistence of their manifestations after cholecystectomy, and retained gallstones may be a relevant etiology for their complaint. Completion cholecystectomy is advised for these cases to alleviate their manifestations. No previous studies have compared the outcomes of open versus laparoscopic outcomes in these patients, especially in patients who had initial open partial procedures. That is why we performed this study to report the perioperative outcomes of the two approaches in such patients. Methodology: This is a retrospective analysis of 80 patients who had a completion cholecystectomy in the authors' center (40 open and 40 laparoscopic cases) after initial open partial cholecystectomy. Results: The duration elapsed since the primary procedure had an average of 18 months in the open group and 21 months in the laparoscopic group. Abdominal pain and dyspepsia were the most common presentations. Some patients had stump cholecystitis or jaundice. The intraoperative assessment revealed either the residual gallbladder or a long cystic duct stump. Laparoscopy yielded shorter operative time, earlier oral intake, and shorter hospitalization periods compared to the open approach (P<0.05). The latter was associated with a 20% wound infection rate that was never encountered after laparoscopy (P =0.003). Conclusion: Previous open partial cholecystectomy does not hinder subsequent laparoscopic completion cholecystectomy. Additionally, laparoscopy is associated with better perioperative outcomes than the open approach.

Retrospective analysis of immediate and long-term results of NOSES technique and conventional laparoscopic-assisted resection in patients with colorectal cancer.

Introduction: The aim of research was to study the feasibility and safety of surgery providing specimen extraction through natural orifices in patients with colorectal cancer. Materials and methods: This study is a comparative retrospective analysis of findings obtained from 265 patients who underwent surgical treatment using NOSES technique and 275 patients who underwent laparoscopic-assisted (LA) resection. Data included preoperative patients' information, intraoperative findings, results of postoperative pathological examination of surgical specimens, early postoperative period analysis, and follow-up. Results: Both groups were comparable in terms of gender, age and BMI. The duration of surgery was similar in both groups (p = 0.94). Intraoperative blood loss under NOSES interventions was slightly lower than in laparoscopic-assisted surgeries (p < 0.001). There was no significant difference in the number of lymph nodes removed and anal function scores between the two groups (p > 0.05). It was revealed that in the NOSES group, the function of the gastrointestinal tract normalized at an earlier time, slightly the time to start liquid food intake and the duration of postoperative hospital stay were reduced (p < 0.001). A statistically significant difference between groups was found in complications, such as pneumonia (p = 0.03). The absolute number of complications was observed more often in the LA surgery group (10.4%) than in the NOSES group (5.8%). Local recurrence was less common in the NOSES group (p = 0.01). There were no statistically significant differences in disease progression (p = 0.16). When analyzing disease-free and overall survival rate in this study, there was no statistically significant difference between the two surgical techniques in terms of their effect on postoperative survival (p > 0.05). Conclusion: The results of this study demonstrate that NOSES technique is a relatively safe and effective surgical option in patients with colorectal cancer. It has high surgical efficiency providing no increased risk of surgical intervention, reducing total number of postoperative complications, reducing duration of postoperative hospital stay, reducing the time for gastrointestinal function recovery and the start of food intake. This study supports that NOSES has clear advantages over conventional laparoscopic-assisted surgery.

A Retrospective Study of Routine Preoperative Blood Grouping and Saving in Laparoscopic Surgeries: A Minimally Utilized Expenditure.

Introduction Patients scheduled for laparoscopic cholecystectomy and laparoscopic appendicectomy typically undergo routine preoperative blood grouping and saving (G&S). Despite the low incidence of blood transfusion in this context, the acquisition and processing of G&S samples incur a cost of £31 ($40) per sample. This study aims to review blood transfusion usage in these procedures to determine whether routine G&S sampling is clinically necessary or represents an avoidable expense. Methods A retrospective case note analysis was conducted on patients who underwent laparoscopic cholecystectomy and laparoscopic appendicectomy from January 2019 to June 2020. Collected data included the timing of G&S, preoperative and postoperative hemoglobin levels, timing of blood transfusions, and the number of units transfused. Results Six hundred and thirteen patients were involved in the study. Among the 323 patients who had laparoscopic cholecystectomy, 256 (78.8%) underwent preoperative G&S sampling. Of the 290 patients who had laparoscopic appendicectomy, 190 (65.5%) received preoperative G&S sampling. Notably, none of the 613 patients required a blood transfusion within 30 days of their surgery. The total cost of G&S for the cohort amounted to £22,196 ($28,425). Conclusions The findings suggest that routine G&S sampling is an unnecessary expenditure for patients undergoing elective laparoscopic appendicectomy or cholecystectomy. It is recommended that G&S sampling be reserved for high-risk groups to optimize resource allocation and reduce unnecessary costs.

A Scoping Review of the Clinical Utility of Laparoscopic Vasectomy.

Vasectomy is a common procedure performed for family planning. Traditionally, this has been via a scrotal approach. In contrast, laparoscopic vasectomy is a documented but rarely described procedure that may minimise anaesthetic risk, surgical risk, and healthcare expenditure in patients undergoing elective laparoscopic procedures for concurrent pathology such as hernia repair. This scoping review evaluates the clinical utility of laparoscopic vasectomy. It was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Articles were identified with keywords related to laparoscopy and vasectomy. Six peer-reviewed, full-text articles published in English were included in this review. These studies encompass eight individual patient cases of laparoscopic vasectomy performed in the 1990s and early 2000s. All the cases included laparoscopy for concurrent pathology, the most common of which was inguinal hernia. There were no complications associated with laparoscopic vasectomy. For patients requiring laparoscopic surgery for alternate pathologies, synchronous laparoscopic vasectomy improves surgical efficiency by minimising anaesthetic time, operative time, and risk, in addition to lower associated healthcare costs. However, consideration is given to the limitations of this approach, and a note is made of the lack of evidence regarding safety and efficacy given the paucity of cases described in the literature.

Transumbilical single-site laparoscopic treatment of primary splenic cyst in child: a rare case report and review of literature.

Background: Splenic cysts are relatively rare benign tumors that are asymptomatic in most patients and are usually discovered incidentally by imaging. In our case, we report a splenic cyst in a child who underwent laparoscopic partial splenectomy. Case description: A 13-year-old boy was admitted to the hospital after an incidental finding of a splenic cyst on an abdominal ultrasound conducted 4 days prior. He was asymptomatic before admission. Upon admission, abdominal ultrasound and CT revealed a cystic lesion in the spleen, highly suspicious for a splenic cyst. Then, we used transumbilical single-site laparoscopic exploration and found a cyst measuring approximately 12 cm × 11 cm × 10 cm at the upper pole of the spleen, so we performed a partial splenectomy and diagnosed a primary epithelioid splenic cyst via postoperative pathology. Conclusions: Splenic cysts in children are very rare and can be treated conservatively in asymptomatic patients with a diameter of less than 5 cm, while surgery is required in symptomatic patients or those with a diameter greater than or equal to 5 cm. Transumbilical single-site laparoscopic partial splenectomy is a minimally invasive and effective treatment, especially for children.

Effect of enhanced recovery after surgery on postoperative outcomes in children undergoing robot-assisted laparoscopic pyeloplasty.

OBJECTIVE: To assess the effects of the enhanced recovery after surgery (ERAS) perioperative protocol on the outcomes of robot-assisted laparoscopic pyeloplasty (RALP) in pediatric patients. METHODS: A total of 57 children who underwent RALP at our center between November 2021 and December 2023 were included in the study. They were randomly assigned to either the ERAS (intervention) group or the non-ERAS (control) group. The analysis focused on comparing the length of hospital stay, recovery of gastrointestinal function, incidence of complications within 90 days post-surgery, postoperative extubation time (urinary tube and double-J tube), postoperative auxiliary examinations, and readmission rates within 30 days. Additionally, the patients were divided into two age groups: <4 years old and ≥4 years old, to assess pain severity. RESULTS: There were no significant differences in preoperative general information, preoperative auxiliary examination findings, or intraoperative conditions between the ERAS and non-ERAS groups. The ERAS group had a significantly shorter postoperative hospital stay compared to the non-ERAS group. Furthermore, the time to the first postoperative bowel movement was shorter, and the incidence of postoperative complications was significantly lower in the ERAS group. Among children <4 years old, there was no significant difference in pain severity between the two groups. However, in children ≥4 years old, the ERAS group experienced significantly lower pain levels at 6 and 24 h post-surgery compared to the non-ERAS group. DISCUSSION: The findings of this prospective randomized controlled trial should determine if ERAS is superior to traditional perioperative management in children undergoing RALP, particularly regarding postoperative hospital stay, intestinal function recovery, pain response, and complication rates. We anticipate that our data will offer valuable clinical insights and guidance for the implementation of ERAS in pediatric robotic surgery for urinary diseases. CONCLUSION: The ERAS protocol can reduce the length of hospital stay, aid in the recovery of gastrointestinal function, and lower postoperative complication rates. It also has the potential to lessen postoperative pain to varying degrees in certain pediatric patients. ERAS is a safe and effective protocol for pediatric patients undergoing RALP.

Comparative analysis of retro vs. transperitoneal laparoscopic pyelolithotomy for large renal stones.

The objective of this study is to compare the outcomes and complications of retroperitoneal and transperitoneal laparoscopic pyelolithotomy (RLP and TLP, respectively) in the treatment of large kidney stones. In this retrospective cohort effort, data of all patients who underwent laparoscopic pyelolithotomy for renal pelvic stone (N = 273) in three referral urology hospitals were retrieved. Operation duration, length of hospital stay, postoperative stone-free rate, hemoglobin (Hb) and creatinine (Cr) changes and complications were compared between the two groups before and after propensity score matching. A total of 199 TLP and 74 RLP cases were examined. Stone size was significantly higher in the TLP vs. RLP group (29.8 ± 10.9 vs. 26.5 ± 8.8 mm; P = .022). Length of operation and hospital stay were comparable (P = .672 and P = .396, respectively). Rate of conversion to open surgery, postoperative blood transfusion rate, postoperative urinary leakage, postoperative stone-free rate, Hb drop and Cr change were similar between the two groups (P = .348, 0.190, 0.828, 0.411, 0.780 and 0.134, respectively). Postoperative fever was significantly more prevalent in TLP compared to RLP (21.6% vs. 0.0%, respectively; P < .001). Propensity score matched analyses showed similar results in all aspects; particularly demonstrating higher postoperative fever in TLP compared to RLP (18.9% vs. 0.0%, respectively; P < .001). RLP can be considered as an alternative to TLP; especially owing to a lower chance of postoperative fever.

Laparoscopic Radical Prostatectomy: Assessing the Impact of Residency Training on Early Surgical Experience.

BACKGROUND: Transferring the intricate laparoscopic radical prostatectomy (LRP) technique poses a considerable challenge for novice surgeons. Fellowship programs, typically lasting three to twelve months, remain the primary avenue for acquiring laparoscopic skills. This study proposes that residency-based laparoscopy training confers distinct advantages over fellowship programs during the initial stages of LRP. METHODS: The study analyzed retrospectively collected data and operation videos from the first and second sets of fifty operations (Group 1 and Group 2) out of a total of 553 performed by the "fellow" surgeon between August 2009 and December 2022, and the first fifty operations by the "resident" surgeon from January 2022 to June 2023. Parameters examined included patient demographics, preoperative prostate-specific antigen (PSA) levels, grades, stages, operation durations, complications, postoperative outcomes, and short-term (6-month) oncological and functional results. RESULTS: No statistically significant differences were observed in prostate volume, age, body mass index, or PSA levels between Groups 2 and 3 or 1 and 3 (p > 0.05). Nevertheless, Group 3 exhibited significantly more International Society of Urological Pathology grade 3 and 4 cases than Group 1 (p = 0.004) and Group 2 (p = 0.006). Additionally, Group 3 had a shorter anastomosis time (AT) (25 min vs. 35 min, p < 0.001) and reduced estimated blood loss (EBL) (275 mL vs. 385 mL, p = 0.008) compared to Group 1. No significant differences were found among the groups regarding intraoperative complications, nerve sparing, or lymph node dissection rates. While Group 2's anastomosis time was comparable to that of Group 3 (24 min vs. 25 min, p = 0.144), it demonstrated a significantly shorter insufflation duration (150 min vs. 170 min, p < 0.001). Functional outcomes, including continence and erectile function at six months, showed no significant differences across the groups. CONCLUSIONS: This study underscores the potential benefits of integrating LRP training into a surgeon's residency, particularly in the early stages of their learning curve (LC), by reducing anastomosis and operation times and EBL in the first fifty cases. Initial findings suggest that implementing modular training in residency programs could enhance LRP proficiency, benefiting both surgeons and patients.

Laparoscopic excision of an incidental vascular tumor.

Anastomosing hemangioma (AH) is an exceedingly rare benign vascular tumor, often mistaken for malignant neoplasms due to its histological features. First described in 2009, AH has been documented in various sites, including the kidney, liver, and adrenal gland. This report presents a 64-year-old man who, following a bicycle accident, underwent imaging that revealed a nodule suspicious for a paraganglioma in the right para-caval region. Despite the high radiotracer uptake on 68Ga-DOTANOC PET scan, which suggested paraganglioma, the patient remained asymptomatic and laboratory tests ruled out excessive catecholamine secretion. Surgical excision led to a diagnosis of AH, distinguished by its unique anastomosing vascular pattern and histological similarity to angiosarcoma. This case underlines the diagnostic challenges and potential for overtreatment of AH, highlighting the need for heightened awareness and careful histopathological and imaging evaluation to avoid misdiagnosis and ensure appropriate management.

Extensive Peritoneal and Pelvic Granulomatous Inflammation Due to Syphilis Infection Manifesting as Primary Infertility: A Case Report.

Infertility affects millions of couples worldwide and can result from various factors, including sexually transmitted infections. Although syphilis is known to contribute to a small number of infertility cases through chronic pelvic inflammatory disease, which ultimately impairs fertility, detailed descriptions of such cases are limited. In this report, we present a case of primary infertility caused by extensive peritoneal granulomatous inflammation, adhesions, and tubal obstruction resulting from syphilis.

Application value of opioid-free anesthesia in renal cyst decompression by laparoscopy.

Objective: The objective of the study was to analyze the application value of opioid-free anesthesia (OFA) in renal cyst decompression by laparoscopy. Method: A total of 124 patients undergoing renal cyst decompression by laparoscopy in our hospital were selected and divided into opioid anesthesia (OA) and OFA groups (n = 62). Fentanyl and remifentanil were used for anesthesia induction in the OA group, while lidocaine and dexmedetomidine were employed for anesthesia induction in the OFA group. The homeostasis indicators (cortisol [Cor], adrenocorticotropic hormone [ACTH], C-reactive protein [CRP], and interleukin-6 [IL-6]) were also compared 10 min before anesthesia (Ta), at the end of operation (Tb), and 24 h after operation (Tc). Results: At T1-T3, heart rate, mean arterial pressure, mean airway pressure, and partial pressure of end-tidal carbon dioxide were all lower in OFA group than those in OA group (p < 0.05). At Tb-Tc, the levels of Cor, ACTH, CRP, and IL-6 were all higher in both groups than those at Ta (p < 0.05), while they were lower in OFA group than those in OA group (p < 0.05). Conclusion: OFA is more beneficial to the respiratory and circulatory system and homeostasis of patients, and has higher anesthetic safety.

Retroperitoneal vs transperitoneal laparoscopic pyelolithotomy; a single surgeon's experience.

OBJECTIVE: To compare the outcomes of transperitoneal and retroperitoneal laparoscopic pyelolithotomy procedures. METHODS: A total of 104 consecutive laparoscopic pyelolithotomy surgeries performed by a single surgeon on patients with staghorn or renal pelvic calculi larger than 20 mm were evaluated. Intraoperative and postoperative clinical parameters from two groups, transperitoneal (TLPL) (N = 55) and retroperitoneal (RLPL) (N = 49), were compared. The surgeon performed TLPL for the first five years and then switched to the RLPL approach for the next five years. RESULTS: There were no significant differences in general demographic variables and stone size (26.55 vs. 24.73 mm, P = 0.8). Operation time and change in serum creatinine levels did not significantly differ between the two approaches. However, patients who underwent TLPL had longer hospital stays than RLPL (3.23 ± 1.21 vs. 2.36 ± 1.10 days, P = 0.0001). Additionally, TLPL was associated with a greater drop in hemoglobin levels (1.53 ± 1.04 vs. 1.17 ± 0.68, P = 0.04), higher rates of postoperative fever (12.7% vs. 0.0%, P = 0.01). CONCLUSIONS: The retroperitoneal approach in laparoscopic pyelolithotomy for large renal pelvic stones resulted in fewer postoperative fevers, reduced hemoglobin drops, and shorter hospital stays than the transperitoneal approach. However, the stone-free rates were similar for both groups.

Conservative Laparoscopic Approach for the Management of a 14-Week Viable Ectopic Cesarean Scar Ectopic Pregnancy.

Introduction: Cesarean scar ectopic pregnancy (CSEP) is a rare gynecological disorder that occurs at a rate of approximately 0.05% of pregnancies and less than 0.2% of cesarean scars. The ultimate goal in the management of CSEP cases is to remove pregnancy and reduce morbidity while preserving fertility. This case report highlights the successful application of a conservative laparoscopic approach in managing a 14-week viable CSEP. Case Presentation: A 35-year-old multiparous woman (G8P5A2L5) with five previous cesarean sections and five normal healthy children presented to the clinic with a viable CSEP of 14 weeks of gestation as revealed by abdominal and transvaginal ultrasound examination. The decision for a conservative laparoscopic approach was made in light of the patient's desire to preserve fertility. Intervention and outcome: The laparoscopic procedure included the following steps: extensive dissection of adhesions between the bladder and the uterus; identification of the ectopic pregnancy at the level of the lower segment; extraction of the product of conception in an endobag; and suturing of the lower segment defect. The successful execution of these steps resulted in the removal of the ectopic pregnancy while addressing associated structural concerns. This approach allowed for mitigating morbidity and, importantly, preserving the patient's fertility. Conclusion: This case highlights the importance of a conservative laparoscopic approach for CSEP in the second trimester. Imaging techniques play a pivotal role in accurate diagnosis, with minimally invasive technologies offering effective solutions. Individualized, patient-centered approaches are necessary to prioritize clinical outcomes and patient preferences.

Emphysematous Hemorrhagic Cystitis Discovered During Laparoscopy for Suspected Bowel Perforation: A Case Report and Review of Diagnostic Strategies.

Emphysematous hemorrhagic cystitis (EHC) represents an uncommon complicated urinary tract infection. The primary pathophysiology involves the inoculation of gas-producing bacteria or fungi in the bladder wall, leading to inflammation and ischemia. In this report, a case of EHC is presented, which was encountered in a 69-year-old male with multiple underlying comorbidities, highlighting the diagnostic challenges, clinical course, and management strategies employed. Through a review of the literature, the aim is to elucidate the patient presentation of EHC, emphasizing the importance of early recognition and multidisciplinary collaboration in optimizing patient outcomes. This case serves to contribute to the expanding body of knowledge surrounding this rare yet clinically significant condition, especially in at-risk populations.

A case of grade1 follicular lymphoma diagnosed by laparoscopic lymph node resection: differentiating from late lymph node recurrence of endometrial cancer.

Follicular lymphoma is a common hematologic malignancy; however, it is less common among all malignant diseases and is difficult to suspect in advance due to the lack of specific clinical findings. Here, we report a case in which a late recurrence of corpus cancer was first suspected and finally diagnosed as follicular lymphoma. A 67-year-old female presented to our department with enlarged pelvic lymph nodes. She was diagnosed with breast cancer (HER2-posiotive with lymph node metastasis) and corpus cancer (endometrioid carcinoma grade 2, stage IA) 16 years prior, received definitive therapy and was followed up. A positron emission tomography scan was performed, and an accumulation of 18F-fluorodeoxyglucose (FDG) was detected in multiple lymph nodes, including the lymph nodes with no change in size or enlargement. We performed laparoscopic resection of the enlarged and FDG-accumulated lymph nodes and a pathological examination. The patient was diagnosed with follicular lymphoma (FL) grade 1 and is currently under observation at the Department of Hematology. FL can be considered when there is a discrepancy between the change in lymph node size and the degree of FDG accumulation. A pathological examination is useful for accurate diagnosis. Therefore, it is important to consider tissue collection; however, care must be taken to minimize the invasiveness of the procedure for the patient.

[Complicated right Bochdalek hernia]. / Hernia de Bochdalek derecha complicada.

The clinical case of a 53-year-old woman diagnosed with a right Bochdalek hernia complicated by intestinal obstruction is presented. This type of diaphragmatic hernia is rare, especially those located on the right side, but is the most common non-hiatal hernia. Her diagnosis focused on the computed tomography of the chest and abdomen and the repair was performed using a laparoscopic approach. A primary closure was carried out associated with the placement of polypropylene mesh. Her evolution was favorable, with no complications associated with the procedure.

Se presenta el caso clínico de una mujer de 53 años diagnosticada con una hernia de Bochdalek derecha complicada con oclusión intestinal. Este tipo de hernias diafragmáticas son raras, especialmente las localizadas en lado derecho, pero constituyen aquellas no hiatales más frecuentes. El diagnóstico se centró en la tomografía computarizada de tórax y abdomen, y la reparación se realizó mediante una malla de polipropileno. La evolución fue favorable, sin complicaciones asociadas al procedimiento.

Association between body composition and incisional surgical site infection after laparoscopic appendectomy for complicated appendicitis.

PURPOSE: Surgical site infection (SSI) is common after laparoscopic appendectomy, resulting in prolonged hospital stay and increased costs. This study examined the relationship between body composition parameters and risk of incisional SSI in patients with complicated appendicitis. METHODS: We included 411 patients who underwent laparoscopic surgery for complicated appendicitis at a single institution between March 2015 and October 2023. Body composition parameters were derived from preoperative computed tomography (CT). A nomogram was constructed based on the independent predictors of incisional SSI. RESULTS: Overall, 45 (10.9%) patients developed incisional SSI. Visceral fat area (VFA) was independently associated with risk of incisional SSI (hazard ratio 1.015, 95% confidence interval 1.010-1.020, P < 0.001). A nomogram integrating VFA and two other independent predictors (diabetes and conversion) demonstrated high discriminative (area under the curve = 0.793) and calibration abilities. CONCLUSIONS: CT-derived VFA could be a valuable predictor of incisional SSI in patients with complicated appendicitis undergoing laparoscopic surgery. A VFA-based nomogram may help in identifying patients at high risk of SSI.

Construction and implementation of a laparoscopic skill training course based on a smartphone application and virtual reality.

BACKGROUND: To develop a laparoscopic training course that combines a smartphone application (APP) and virtual reality (VR), and initially evaluate the feasibility and effectiveness of its implementation. METHODS: The Exploring Laparoscopy (Ex-Lap) app was developed to meet training demands. The course was designed by integrating the app with a VR simulator (LapSim®) and animal organ perfusion simulators. From January 2021 to December 2023, 91 participants were enrolled in the study and then divided into 5 separate batches to undergo the first stage of the course. The performance of the participants was evaluated by rating scale, the overall Training and Assessment of Basic Laparoscopic Techniques (TABLT) scores, and pass rates. Statistical analyses were conducted using SPSS 26.0, employing Kruskal-Wallis tests, Chi-squared analysis, and Fisher's exact test, depending on the data type. RESULTS: The Staged Training and Assessment of Laparoscopic Skills (STALS) course was developed, consisting of three stages. The overall pass rates for the first stage across the five batches ranged from 85 to 100%, with no significant difference (P = 0.387). No significant differences were found in the scale scores or TABLT scores for the training tasks among students from different batches (all P > 0.05). CONCLUSIONS: The STALS course is applicable in residency training, demonstrating satisfactory teaching effectiveness and replicability.