RESUMO
BACKGROUND: This study aims to prove the feasibility and safety of robotic gastrectomy using the hinotori™ Surgical Robot System (Medicaroid Corporation, Kobe, Japan). METHODS: We retrospectively enrolled the 16 patients who underwent gastrectomy by the hinotori™ Surgical Robot System for gastric cancer at our hospital between June 2023 and January 2024. Console surgeons performed almost all lymphadenectomies, including the clipping of vessels. Assistant surgeons supported the lymphadenectomy using vessel sealing devices and during reconstruction. RESULTS: Thirteen patients were cStage I, one patient was cStage II, and two patients were cStage III. Distal gastrectomy, proximal gastrectomy, and total gastrectomy were performed in 11, 1, and 4 patients, respectively. D1+ and D2 lymphadenectomies were performed in 11 and 5 patients, respectively. Billroth-I, Billroth-II, Roux-en-Y, and esophagogastrostomy were performed in three, six, six, and one patients, respectively. The median operation time was 282 (245-338) min, and the median console time was 226 (185-266) min. The median blood loss was 28 (12-50) mL, and the median amylase levels in drainage fluid were 280 (148-377) U/L on postoperative day 1 and 74 (42-148) U/L on postoperative day 3. There was anastomotic leakage (Clavien-Dindo [CD] IIIa) in one patient who underwent proximal gastrectomy. The median postoperative hospital stay was 12.5 (12-14) days. CONCLUSION: In this initial case series, the hinotori™ Surgical Robot System was found to be safe and feasible for patients with gastric cancer and is suggested to be appropriate for gastrectomy, including distal gastrectomy and total gastrectomy.
Assuntos
Estudos de Viabilidade , Gastrectomia , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas , Humanos , Gastrectomia/instrumentação , Gastrectomia/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Neoplasias Gástricas/cirurgia , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Duração da Cirurgia , Excisão de Linfonodo , Idoso de 80 Anos ou mais , Adulto , Resultado do TratamentoRESUMO
BACKGROUND: New platforms for robotic surgery have recently become available for clinical use; however, information on the introduction of new surgical robotic platforms compared with the da Vinci™ surgical system is lacking. In this study, we retrospectively determined the safe introduction of the new "hinotori™" surgical robot in an institution with established da Vinci surgery using four representative digestive organ operations. METHODS: Sixty-one patients underwent robotic esophageal, gastric, rectal, and pancreatic operations using the hinotori system in our department in 2023. Among these, 22 patients with McKeown esophagectomy, 12 with distal gastrectomy, 11 with high- and low-anterior resection of the rectum, and eight with distal pancreatectomy procedures performed by hinotori were compared with historical controls treated using da Vinci surgery. RESULTS: The console (cockpit) operation time for distal gastrectomy and rectal surgery was shorter in the hinotori group compared with the da Vinci procedure, and there were no significant differences in the console times for the other two operations. Other surgical results were almost similar between the two robot surgical groups. Notably, the console times for hinotori surgeries showed no significant learning curves, determined by the cumulative sum method, for any of the operations, with similar values to the late phase of da Vinci surgery. CONCLUSIONS: This study suggests that no additional learning curve might be required to achieve proficient surgical outcomes using the new hinotori surgical robotic platform, compared with the established da Vinci surgery.
Assuntos
Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos , Humanos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Gastrectomia/métodos , Gastrectomia/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Curva de Aprendizado , Pancreatectomia/métodos , Pancreatectomia/instrumentação , Esofagectomia/métodos , Esofagectomia/instrumentação , AdultoRESUMO
INTRODUCTION: Accurate tumor localization and resection margin acquisition are essential in gastric cancer surgery. Preoperative placement of marking clips in laparoscopic gastrectomy as well as intraoperative gastroscopy can be used for gastric cancer surgery. However, these procedures are not available at all institutions. We conducted a prospective clinical trial to investigate the diagnostic performance of near-infrared fluorescent clips (ZEOCLIP FS) in laparoscopic gastrectomy. MATERIALS AND METHODS: Patients with gastric cancer or neuroendocrine tumor in whom laparoscopic distal, pylorus-preserving, or proximal gastrectomy was planned were enrolled (n = 20) in this study. Fluorescent clips were placed proximal and/or distal to the tumor via gastroscopy on the day before surgery. During surgery, the clips were detected using a fluorescent laparoscope, and suturing was performed where fluorescence was detected. The clip locations were then confirmed via gastroscopy, and the stomach was transected. The primary endpoint was the detection rate of the marking clips using fluorescence, and the secondary endpoints were complications and distance between the clips and stitches. RESULTS: Among the 20 patients enrolled, distal and pylorus-preserving gastrectomies were performed in 18 and 2 patients, respectively. All clips were detected in 15 patients, indicating a detection rate of 75.0% (90% confidence interval: 54.4%-89.6%). Furthermore, no complications related to the clips were observed. The median distance between the clips and stitches was 5 (range, 0-10) mm. CONCLUSIONS: We report the feasibility and safety of preoperative placement and intraoperative detection of near-infrared fluorescent marking clips in laparoscopic gastrectomy.
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Gastrectomia , Laparoscopia , Neoplasias Gástricas , Humanos , Gastrectomia/métodos , Gastrectomia/instrumentação , Feminino , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/diagnóstico por imagem , Masculino , Laparoscopia/métodos , Laparoscopia/instrumentação , Idoso , Pessoa de Meia-Idade , Estudos Prospectivos , Gastroscopia/métodos , Gastroscopia/instrumentação , Margens de Excisão , Instrumentos Cirúrgicos , Idoso de 80 Anos ou mais , Adulto , Estudos de ViabilidadeRESUMO
Introduction: The use of robotic platform for gastrectomy for gastric cancer is rapidly increasing. This study aimed to describe the perioperative outcomes of 12 patients who underwent robotic gastrectomy for gastric cancer using the hinotori™ surgical robot system (hinotori), a novel robot-assisted surgical platform, and compare the outcomes with the existing system, the da Vinci® Surgical System (DVSS). Methods: This study included 12 consecutive patients with gastric cancer who underwent robotic gastrectomy for gastric cancer using the hinotori between March 2023 and September 2023 at our institution. The comprehensive perioperative outcomes of these patients were retrospectively analyzed and compared to 11 patients who underwent robotic gastrectomy using the DVSS during the same period. Results: The median age and body mass index were 71 years (range: 56-86) and 22.7 kg/m2 (range: 16.1-26.7). Distal and total gastrectomy were performed in 8 and 4 patients, respectively. The median console time and operation times were 187 (range: 112-270) and 252 minutes (range: 173-339), respectively. The median blood loss was 3 mL (range: 2-5). No intra- or postoperative complications were observed. There were no significant differences in perioperative outcomes between the hinotori and the DVSS. Conclusions: Robotic gastrectomy for gastric cancer using the hinotori is a feasible procedure and achieved perioperative outcomes similar to that using the DVSS. Clinical Trial Registration number: 114167-1.
Assuntos
Gastrectomia , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirurgia , Gastrectomia/métodos , Gastrectomia/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Pessoa de Meia-Idade , Feminino , Masculino , Idoso , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Duração da Cirurgia , Resultado do TratamentoRESUMO
The standard size of bougie for laparoscopic sleeve gastrectomy (LSG) is not yet established. Therefore, a systematic review and network meta-analysis were conducted to assess the weight loss effects and associated complications of LSG for patients with morbid obesity, based on different bougie sizes. A total of 15 studies were reviewed in this systemic review and network meta-analysis (2,848 participants), including RCTs and retrospective studies in PubMed, and Embase until September 1, 2020. The effectiveness of different bougie calibration sizes was assessed based on excess weight loss (EWL), total complications, and staple line leak. Within this network meta-analysis, S-sized (≤ 32 Fr.) and M-sized (33-36 Fr.) bougies had similar effects and were associated with the highest EWL improvement among all different bougie sizes (S-sized: standardized mean difference [SMD], 10.52; 95% confidence interval [CI] - 5.59 to - 26.63, surface under the cumulative ranking curve [SUCRA], 0.78; and M-sized: SMD, 10.16; 95% CI - 3.04-23.37; SUCRA, 0.75). M-sized bougie was associated with the lowest incidence of total complications (M-sized: odds ratio, 0.43; 95% CI, 0.16-1.11; SUCRA, 0.92). Based on our network meta-analysis, using M-sized bougie (33-36 Fr.) is an optimal choice to balance the effectiveness and perioperative safety of LSG in the clinical practice.
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Cirurgia Bariátrica/instrumentação , Gastrectomia/instrumentação , Laparoscopia/instrumentação , Cirurgia Bariátrica/métodos , Calibragem , Gastrectomia/métodos , Humanos , Laparoscopia/métodosRESUMO
In Japan, the number of bariatric surgeries performed has remained low. Thus, concomitant laparoscopic cholecystectomy (LC) with laparoscopic sleeve gastrectomy (LSG) is still relatively uncommon, but is increasing. We developed new port-sharing techniques for LC and LSG, which we performed on 26 obese Japanese patients with gall bladder (GB) diseases, using the LSG trocar arrangement and one additional trocar. We performed LC first, and after exchanging a port for a liver retractor in the epigastrium, we then completed LSG. One patient with an anomalous extrahepatic bile duct required one additional port. The mean LC time was 55 min, and the transition to LSG just after LC was smooth in all the patients. One patient suffered postoperative intraperitoneal hemorrhage, which was managed conservatively. Concomitant LC with LSG using port-sharing techniques is feasible and safe for obese Japanese patients with GB diseases.
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Cirurgia Bariátrica/métodos , Colecistectomia Laparoscópica/métodos , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/cirurgia , Gastrectomia/métodos , Laparoscopia/métodos , Obesidade/complicações , Obesidade/cirurgia , Adulto , Cirurgia Bariátrica/instrumentação , Colecistectomia Laparoscópica/instrumentação , Estudos de Viabilidade , Feminino , Gastrectomia/instrumentação , Humanos , Japão , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , SegurançaRESUMO
PURPOSE: Video review is a reliable method for surgical education in laparoscopic gastrectomy (LG), but more objective methods are still needed. The purpose of this study was to determine whether the energy device records reflected surgical competency, and thereby may improve surgical education. METHODS: A total of 16 patients who underwent LG for gastric cancer using the Thunderbeat® device were preliminarily retrospectively analyzed. This device has the function of 'intelligent tissue monitoring' (ITM), a safety assist system stopping energy output, and can record ITM detections and firing time during surgery. The number of ITM detections and firings, and the total firing time during gastrocolic ligament dissection and infrapyloric dissection were compared between trainees (n = 9 by 5 surgeons) and experts (n = 7 by 5 surgeons). The non-edited videos (n = 16) were scored, and the correlations between the scores and the records were then analyzed. RESULTS: Significantly more ITM detections, firings, and a longer total firing time were observed in trainees than in experts. The number of ITM detections and firing had negative correlations with the scores of the operation speed, the use of the non-dominant hand, and the use of an energy device. CONCLUSIONS: Our preliminary study suggested that the above described energy device records reflected surgical competency, and thereby may improve surgical education.
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Competência Clínica , Educação Médica/métodos , Fontes Geradoras de Energia , Gastrectomia/educação , Gastrectomia/instrumentação , Laparoscopia/educação , Laparoscopia/instrumentação , Monitorização Intraoperatória/instrumentação , Neoplasias Gástricas/cirurgia , Instrumentos Cirúrgicos , Humanos , Estudos RetrospectivosRESUMO
INTRODUCTION: Single-incision laparoscopic gastrectomy can be difficult because of complex instrumentation and a limited working angle. We standardized a needle device-assisted single-incision laparoscopic gastrectomy (NA-SILG) procedure for early gastric cancer in 2013. Herein, we present our technique and evaluate it in comparison to the conventional laparoscopic gastrectomy CLG) technique. METHODS: We retrospectively reviewed medical records of 149 patients who underwent a NA-SILG or distal (CLG) for early gastric cancer between January 2013 and August 2016. We performed 1:1 propensity score matching between the two groups. RESULTS: Eighteen patients who underwent a NA-SILG and 131 who underwent a CLG were included. Almost all patients were in clinical stage IA. Operative times were 216 ± 29.7 minutes and 220 ± 51.7 minutes for the NA-SILG and CLG groups, respectively; the median intraoperative bleeding amounts were 5 mL and 10 mL for the NA-SILG and CLG groups, respectively. The median number of retrieved lymph nodes was 41.5 and 57 for the NA-SILG and CLG groups, respectively. The number of patients needing analgesics was significantly lower in the NA-SILG group (P = .003) than in the CLG group. Neither group had postoperative complications more severe than Clavien-Dindo classification III. CONCLUSION: Needle device-assisted SILG is safe and feasible for early gastric cancer treatment in slim figure patients. It has short and long-term outcomes comparable to the CLG but is less invasive and results in less postoperative pain.
Assuntos
Gastrectomia , Laparoscopia , Neoplasias Gástricas , Idoso , Feminino , Gastrectomia/instrumentação , Gastrectomia/métodos , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Resultado do TratamentoRESUMO
By overcoming technical difficulties with limited access faced when performing reduced-port surgery for gastric cancer, reduced-port totally robotic gastrectomy (RPRDG) could be a safe alternative to conventional minimally invasive gastrectomy. An initial 100 consecutive cases of RPRDG for gastric cancer were performed from February 2016 to September 2018. Short-term outcomes for RPRDG with those for 261 conventional laparoscopic (CLDG) and for 241 robotic procedures (CRDG) over the same period were compared. Learning curve analysis for RPRDG was conducted to determine whether this procedure could be readily performed despite fewer access. During the first 100 cases of RPRDG, no surgeries were converted to open or laparoscopic surgery, and no additional ports were required. RPRDG showed longer operation time than CLDG (188.4 min vs. 166.2 min, p < 0.001) and similar operation time with CRDG (183.1 min, p = 0.315). The blood loss was 35.4 ml for RPRDG, 85.2 ml for CLDG (p < 0.001), and 41.2 ml for CRDG (p = 0.33). The numbers of retrieved lymph nodes were 50.5 for RPRDG, 43.9 for CLDG (p = 0.003), and 55.0 for CRDG (p = 0.055). Postoperative maximum C-reactive protein levels were 96.8 mg/L for RPRDG, 87.8 mg/L for CLDG (p = 0.454), and 81.9 mg/L for CRDG (p = 0.027). Learning curve analysis indicated that the overall operation time of RPRDG stabilized at 180 min after 21 cases. The incidence of major postoperative complications did not differ among groups. RPRDG for gastric cancer is a feasible and safe alternative to conventional minimally invasive surgery. Notwithstanding, this procedure failed to reduce postoperative inflammatory responses.
Assuntos
Gastrectomia/instrumentação , Excisão de Linfonodo/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Proteína C-Reativa/metabolismo , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas/metabolismo , Resultado do TratamentoRESUMO
INTRODUCTION: Robotic gastrectomy is performed worldwide as part of the treatment for gastric cancer and is associated with good clinical outcome. This review aims to describe the current issues, debates, and future directions associated with the use of robotic gastrectomy for gastric cancer. AREA COVERED: Here, we review the current evidence surrounding the safety and efficacy of robotic gastrectomy, including our institutional experience. Current issues associated with robotic gastrectomy, including feasibility, perioperative outcomes, and oncological outcomes, are described. EXPERT OPINION: Sophisticated movements, articulating instruments, and the rapid introduction of fast-developing novel technology make robotic gastrectomy use more frequent. However, the need for well-designed prospective randomized trials is warranted.
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Gastrectomia , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas/cirurgia , Previsões , Gastrectomia/efeitos adversos , Gastrectomia/instrumentação , Gastrectomia/métodos , Gastrectomia/tendências , Humanos , Invenções , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Resultado do TratamentoRESUMO
Introduction: The recurrence of the morbid obesity disease after laparoscopic sleeve gastrectomy is a well-known complication. The banded resleeve gastrectomy (ReSG) is considered an innovative procedure and an alternative restrictive option to other malabsorptive procedures. Materials and Methods: We present an edited video on the placement of a MIDCAL™ (MID, Dardilly, France) ring during a revised sleeve gastrectomy with the main steps of the procedure. The subject is a male patient with a body mass index of 44 kg/m2. After the fundus resection, the MIDCAL is placed and fixed to the stomach by two sutures. Results: We present the steps of the operation. The intervention is performed by posterior approach using a three-port technique. The dissection of the previous staple line of the sleeve was continued upward with the visualization of the left crura. The gastric tube was calibrated with a 36F bougie. The restapling of the previous sleeve was carried out by respecting the incisura angularis. The dissection of the pars flaccida allowed the posterior passage of the MIDCAL ring, which was locked and then fixed to the gastric wall with two nonabsorbable sutures. The operative outcome was favorable. The total body weight loss was 9% at 1 month and 27% at 2 years follow-up. Conclusion: Banded ReSG is a safe procedure with acceptable results at short term. Other comparative studies are suitable to provide with long-term follow-up results.
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Gastrectomia/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Gastrectomia/instrumentação , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Background: The Chinese minimally invasive surgical robot system "Micro Hand S" was developed in 2013. However, there was no bariatric surgery performed with the "Micro Hand S" surgical robot. We first aim to report our experience with the "Micro Hand S" robotic-assisted sleeve gastrectomy and evaluate the safety and feasibility of the "Micro Hand S" surgical robot. Methods: Between March 2018 and November 2019, sleeve gastrectomies were performed with the "Micro Hand S" robotic system on 7 consecutive patients by a trained surgeon-assistant team. Preoperative, intraoperative, and postoperative clinical data were collected. A questionnaire was used to investigate surgeons' satisfaction with the "Micro Hand S" robot platform. Results: All the patients underwent successful operations. There were no cases of perioperative mortality and complications. The intraoperative blood loss was 20.8 ± 3.6 mL. The average overall operating time was 166.4 ± 16.1 minutes. The weight, body mass index, waist circumference, and hip circumference decreased significantly at 3 months (all P < .01) and 6 months (all P < .01) postoperatively. The percentage excess weight loss was 62.6% ± 10.3% and 85.9% ± 13.3% at 3 and 6 months postoperatively. Surgeons were satisfied with the "Micro Hand S" surgical robot performance in sleeve gastrectomy. Eighty percent of surgeons would incline to use it again. Conclusions: The first use of the "Micro Hand S" robotic surgical platform in sleeve gastrectomy was carried out successfully. The perioperative outcomes are satisfying. Further comparative and large-sample studies are warranted to verify our preliminary outcomes.
Assuntos
Gastrectomia/instrumentação , Laparoscopia/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Obesidade Mórbida/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Adulto , Cirurgia Bariátrica , Perda Sanguínea Cirúrgica , Índice de Massa Corporal , Desenho de Equipamento , Feminino , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Segurança do Paciente , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgiões , Adulto JovemRESUMO
Sleeve gastrectomy is an effective tool for inducing sustainable weight loss in adolescents with obesity. It is a seemingly straight-forward procedure, and yet deceptive in technical nuances. This review highlights the technical preparation (equipment, patient positioning, pre-operative management), and conduct (anatomy, instruments, methodology, pitfalls) of the operation, and concludes with essentials for anticipating and managing complications of the operation. Throughout the discussion, we emphasize practical techniques to maintain patient safety while achieving maximum weight loss benefits.
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Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Obesidade Infantil/cirurgia , Adolescente , Cirurgia Bariátrica/instrumentação , Cirurgia Bariátrica/normas , Gastrectomia/instrumentação , Gastrectomia/normas , HumanosRESUMO
BACKGROUND: The common use of laparoscopic intervention produces impressive amounts of video data that are difficult to review for surgeons wishing to evaluate and improve their skills. Therefore, a need exists for the development of computer-based analysis of laparoscopic video to accelerate surgical training and assessment. We developed a surgical instrument detection system for video recordings of laparoscopic gastrectomy procedures. This system, the use of which might increase the efficiency of the video reviewing process, is based on the open source neural network platform, YOLOv3. STUDY DESIGN: A total of 10,716 images extracted from 52 laparoscopic gastrectomy videos were included in the training and validation data sets. We performed 200,000 iterations of training. Video recordings of 10 laparoscopic gastrectomies, independent of the training and validation data set, were analyzed by our system, and heat maps visualizing trends of surgical instrument usage were drawn. Three skilled surgeons evaluated whether each heat map represented the features of the corresponding operation. RESULTS: After training, the testing data set precision and sensitivity (recall) was 0.87 and 0.83, respectively. The heat maps perfectly represented the devices used during each operation. Without reviewing the video recordings, the surgeons accurately recognized the type of anastomosis, time taken to initiate duodenal and gastric dissection, and whether any irregular procedure was performed, from the heat maps (correct answer rates ≥ 90%). CONCLUSIONS: A new automated system to detect manipulation of surgical instruments in video recordings of laparoscopic gastrectomies based on the open source neural network platform, YOLOv3, was developed and validated successfully.
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Gastrectomia/instrumentação , Laparoscopia/instrumentação , Redes Neurais de Computação , Gravação em Vídeo , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Estudos RetrospectivosRESUMO
Trocar injury to abdominal aorta is uncommon and even rare with optical trocars. Such injury, resulting from umbilical trocar insertion, is potentially fatal. It often causes on-table death due to torrential life-threatening haemorrhage and unavailability of expert vascular help. We present a rare case of an injury to infra-renal abdominal aorta, caused by optical trocar insertion for bariatric surgery. Immediate recognition of the injury, deployment of life-saving manoeuvres, timely resuscitation, followed by definitive repair of aorta by vascular surgeon was life-saving for this patient. The recovery phase was uneventful and patient had no residual clinical problems during follow-up.
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Aorta Abdominal/lesões , Gastrectomia/efeitos adversos , Gastrectomia/instrumentação , Complicações Intraoperatórias/etiologia , Lesões do Sistema Vascular/etiologia , Adulto , Evolução Fatal , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/cirurgiaRESUMO
BACKGROUND: Obesity is considered a chronic disease with an increasing prevalence worldwide during the last decades. Laparoscopic sleeve gastrectomy is the most commonly performed bariatric procedure, due to its relative safety and long-term efficacy. The use of bougie to ensure correct size of the gastric tube is part of the standard operation, usually placed by the anesthesiologist and with a very low rate of complications. We report the first case, to our knowledge, of a cervical esophageal perforation caused by the use of bougie during laparoscopic sleeve gastrectomy. CASE PRESENTATION: The complication occurred in a previously healthy 42-year old female patient who underwent laparoscopic sleeve gastrectomy for class 1 obesity (BMI 31 kg/m2) and was diagnosed the first post-operative day. She was subsequently treated with an emergency thoracoscopy and evacuation of a mediastinal fluid collection, with additional neck incision for primary closure of the esophageal defect which was reinforced with a sternocleidomastoid muscle flap. The post-operative course was uneventful. CONCLUSIONS: We made a literature review to better understand the options considering the diagnosis and treatment in case of very proximal iatrogenic esophageal perforations. The risks related to the use of bougie during surgery should not be underestimated, and its insertion must be done with extreme caution. Esophageal perforation is still a challenging, life threatening complication where prompt diagnosis and adequate treatment are essential.
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Perfuração Esofágica/etiologia , Gastrectomia/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Perfuração Esofágica/diagnóstico , Feminino , Gastrectomia/instrumentação , Humanos , Laparoscopia/instrumentação , Resultado do TratamentoRESUMO
BACKGROUND: The surgical efficacy of three-dimensional (3D) and two-dimensional (2D) laparoscopic gastrectomy for gastric cancer remains controversial. A meta-analysis with all eligible studies was conducted to explore the surgical efficacy of 2D versus 3D laparoscopic gastrectomy for gastric cancer. METHODS: A systematic search was performed. The weighted mean difference (WMD) or odds risk (OR) of patients with 2D or 3D laparoscopic gastrectomy were used to calculate surgical efficacy of 3D and 2D laparoscopic gastrectomy for gastric cancer. RESULTS: Ten studies involving 1478 patients who underwent 2D or 3D laparoscopic gastrectomy were identified. Three-dimensional laparoscopic gastrectomy decreases operation time (WMD: - 16.517, 95% CI - 25.550 to - 7.484, P = 0.000), intraoperative blood loss (WMD: - 21.060, 95% CI - 32.209 to - 9.911, P = 0.000) and number of retrieved lymph nodes (WMD: 3.699, 95% CI 1.838-5.560, P = 0.000) compared with 2D laparoscopic surgery. However, no differences in time to first postoperative flatus (WMD: - 0.119, 95% CI - 0.330 to - 0.092, P = 0.269), perioperative complications (OR: 0.901, 95% CI 0.649-1.251, P = 0.534), or hospital stay (WMD: - 0.624, 95% CI - 1.983 to 0.735, P = 0.368) were noted between 3D and 2D laparoscopic gastrectomy for gastric cancer. CONCLUSION: 3D laparoscopic gastrectomy decreases the operation time, intraoperative blood loss, and numbers of retrieved lymph nodes compared with 2D laparoscopic gastrectomy for gastric cancer.
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Gastrectomia/métodos , Laparoscopia/métodos , Neoplasias Gástricas/cirurgia , Gastrectomia/instrumentação , Humanos , Laparoscopia/instrumentação , Neoplasias Gástricas/patologia , Resultado do TratamentoRESUMO
BACKGROUND: Sleeve gastrectomy is an effective surgical treatment for morbid obesity. The major technical risk of this procedure is staple line dehiscence. Some surgeons are reluctant to place a nasogastric tube (NGT) blindly due to the perceived risk of damage to the staple line. We sought to determine whether such concern was warranted. METHODS: A porcine tissue model (Animal Technologies, Inc., Tyler, TX) was used. Sleeve gastrectomy was performed using a flexible gastroscope as a guide for the Endo GIA stapler (Covidien, New Haven, CT) in an identical fashion used in our patients. The specimen was then placed in a plastic model of the thorax (VATS Trainers, LLC. Lansing, MI). The NGT was blindly advanced to 55 cm for a total of 50 passes, and to 75 cm for another 50 passes. Endoscopy with water submersion was performed to evaluate for injury or leak. RESULTS: After multiple passes of the NGT, no significant injuries, leaks, or perforations were observed to the gastric model, except for several small petechiae of the gastric mucosa, the largest measuring approximately 3 mm. None were of full thickness or penetrated the mucosa. The staple line showed no evidence of trauma. CONCLUSION: In this porcine model, blind NGT placement was not associated with significant mucosal injury or any damage to the sleeve gastrectomy staple line.
Assuntos
Gastrectomia , Intubação Gastrointestinal/métodos , Grampeamento Cirúrgico , Deiscência da Ferida Operatória/prevenção & controle , Animais , Gastrectomia/instrumentação , Gastrectomia/métodos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Deiscência da Ferida Operatória/etiologia , SuínosRESUMO
BACKGROUND: To avoid excessive sacrifice of the tissue surrounding the submucosal tumor in gastric wedge resection with a stapling device, we perform a "combined laparoscopic and endoscopic approach for neoplasia with a nonexposure technique" (CLEAN-NET). Herein the operative technique of CLEAN-NET is described and its short-term outcomes in 50 patients are evaluated. PATIENTS AND METHODS: Between December 2015 and July 2017 CLEAN-NET was performed in 50 patients with gastric submucosal tumors. During the operation, the seromuscular layer above the tumor is dissected, while the mucosa is kept unbroken. When seromuscular layer is dissected all around the tumor, the full layer is lifted, and the mucosa is stretched. The mucosa is then transected with a stapling device to execute full-thickness resection of the specimen. Finally, the seromuscular defect is repaired by hand-sewn suture. The hospital records of the 50 patients were reviewed to assess the outcomes. The margin width was compared with those measured in another group with 19 patients, who underwent conventional wedge resection with a stapling device. RESULTS: The operation was completed as CLEAN-NET and the tumor was resected en-bloc without rupture in all patients. The average operation time ranged from 50 to 220 min with an average of 105.4 min. The post-operative course was uneventful. Microscopically the surgical margin was tumor-negative (R0 resection) in all cases. The margin width in the CLEAN-NET group was smaller than that in the wedge resection group (5.4 mm ± 2.5 vs. 33.1 mm ± 14.7). CONCLUSIONS: CLEAN-NET can be performed safely with an acceptable operation time. CLEAN-NET can be a useful option in the laparoscopic surgical treatment of gastric submucosal tumors, when excessive sacrifice of the healthy gastric wall surrounding the endophytic tumor should be avoided.