-
Surgical Endoscopy May 2024Ultrasound has been nicknamed "the surgeon's stethoscope". The advantages of laparoscopic ultrasound beyond a substitute for the sense of touch are considerable,... (Review)
Review
INTRODUCTION
Ultrasound has been nicknamed "the surgeon's stethoscope". The advantages of laparoscopic ultrasound beyond a substitute for the sense of touch are considerable, especially for robotic surgery. Being able to see through parenchyma and into vascular structures enables to avoid unnecessary dissection by providing a thorough assessment at every stage without the need for contrast media or ionising radiation. The limitations of restricted angulation and access within the abdominal cavity during laparoscopy can be overcome by robotic handling of miniaturised ultrasound probes and the use of various and specific frequencies will meet tissue- and organ-specific characteristics. The aim of this systematic review was to assess the reported applications of intraoperative ultrasound-guided robotic surgery and to outline future perspectives.
METHODS
The study adhered to the PRISMA guidelines. PubMed, Google Scholar, ScienceDirect and ClinicalTrials.gov were searched up to October 2023. Manuscripts reporting data on ultrasound-guided robotic procedures were included in the qualitative analysis.
RESULTS
20 studies met the inclusion criteria. The majority (53%) were related to the field of general surgery during liver, pancreas, spleen, gallbladder/bile duct, vascular and rectal surgery. This was followed by other fields of oncological surgery (42%) including urology, lung surgery, and retroperitoneal lymphadenectomy for metastases. Among the studies, ten (53%) focused on locating tumoral lesions and defining resection margins, four (15%) were designed to test the feasibility of robotic ultrasound-guided surgery, while two (10.5%) aimed to compare robotic and laparoscopic ultrasound probes. Additionally two studies (10.5%) evaluated the robotic drop-in probe one (5%) assessed the hepatic tissue consistency and another one (5%) aimed to visualize the blood flow in the splenic artery.
CONCLUSION
The advantages of robotic instrumentation, including ergonomics, dexterity, and precision of movements, are of relevance for robotic intraoperative ultrasound (RIOUS). The present systematic review demonstrates the virtue of RIOUS to support surgeons and potentially reduce minimally invasive procedure times.
Topics: Robotic Surgical Procedures; Humans; Ultrasonography, Interventional; Laparoscopy
PubMed: 38512350
DOI: 10.1007/s00464-024-10772-4 -
Surgical Endoscopy May 2024Pancreatic fluid collections (PFCs) may recur after resolution with endoscopic transmural drainage (ETD) and standard stent removal (SSR). Herein, we compared the... (Meta-Analysis)
Meta-Analysis Review
Efficacy and safety of long-term indwelling plastic stents after resolution of pancreatic fluid collections with endoscopic transmural drainage: a systematic review and meta-analysis.
BACKGROUND
Pancreatic fluid collections (PFCs) may recur after resolution with endoscopic transmural drainage (ETD) and standard stent removal (SSR). Herein, we compared the efficacy and safety of leaving long-term indwelling plastic stents (LTIS) vs. standard stent removal after PFC resolution with ETD.
METHODS
We performed a systematic review of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from inception to September 2022. Full-text articles comparing long-term (> 6 months) outcomes of LTIS and SSR were eligible, as well as single-arm studies with ≥ 10 patients with LTIS. Two independent reviewers selected studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale. Measured outcomes included the following: (A) PFC recurrence; (B) interventions for PFC recurrence; (C) technical success; and (D) adverse events (AEs). Meta-analysis was carried out using random-effects models.
RESULTS
We included 16 studies, encompassing 1285 patients. Compared to SSR after PFC resolution with ETD, LTIS was associated with significantly lower risk of PFC recurrence (3% vs. 23%; OR 0.22 [95%CI 0.09-0.52]; I = 45%) and need for interventions (2% vs. 14%; OR 0.35 [95%CI 0.16-0.78]; I = 0%). The superiority of LTIS on reducing PFC recurrence was found with walled-off necrosis, with or without disconnected pancreatic duct, and with placement of ≥ 2 LTIS. When using LTIS, the pooled proportion of AEs was 8% (95%CI 4-11%) and technical success was 93% (95%CI 86-99%).
CONCLUSIONS
Our results show that LTIS after PFC resolution with ETD is feasible, safe, and superior to SSR in reducing the risk of PFC recurrence and need for interventions.
Topics: Humans; Device Removal; Drainage; Plastics; Recurrence; Stents; Treatment Outcome; Pancreatic Juice
PubMed: 38509392
DOI: 10.1007/s00464-024-10784-0 -
Chirurgia (Bucharest, Romania : 1990) Mar 2024intrahepatic cholangiocarcinoma (ICCA) are rare, aggressive cancers that develop in second order or smaller bile ducts. The aim of this review is to systematically...
intrahepatic cholangiocarcinoma (ICCA) are rare, aggressive cancers that develop in second order or smaller bile ducts. The aim of this review is to systematically review the most important prognostic factors affecting the long-term outcomes of these patients. articles conducted on this issue, written in English, published between from January 2000 to December 2023 in Cochrane Library, PubMed, Embase, MedLine, Web of Science, Elsevier, Google Scholar were systematically researched and reviewed. ICCA are usually late diagnosed cancers because of the asymptomatic character, and curative procedures are often not feasible, only 20 to 30% of patients being fit for surgery. With the prognostic of this aggressive malignancy being baleful, the most important risk factors but also prognosis factors seem to be represented by socioeconomic factors, morphological presentation, dimensions, number and extension of the tumor as well as resection margins. once these factors are widely recognized and identified in each case, the clinician will be able to find the best treatment for these patients in order to improve the long-term outcomes.
Topics: Humans; Prognosis; Treatment Outcome; Cholangiocarcinoma; Bile Duct Neoplasms; Bile Ducts, Intrahepatic
PubMed: 38484362
DOI: 10.21614/chirurgia.2945 -
Annals of Surgical Oncology May 2024Extended pelvic surgery with neurovascular or bony resections in gynecological oncology has significant impact on quality of life (QoL) and high morbidity. The objective...
BACKGROUND
Extended pelvic surgery with neurovascular or bony resections in gynecological oncology has significant impact on quality of life (QoL) and high morbidity. The objective of this systematic review was to provide an overview of QoL, morbidity and mortality following these procedures.
METHODS
The registered PROSPERO protocol included database-specific search strategies. Studies from 1966 onwards reporting on QoL after extended pelvic surgery with neurovascular or bony resections for gynecological cancer were considered eligible. All others were excluded. Study selection (Rayyan), data extraction, rating of evidence (GRADE) and risk of bias (ROBINS-I) were performed independently by two reviewers.
RESULTS
Of 349 identified records, 121 patients from 11 studies were included-one prospective study, seven retrospective studies, and three case reports. All studies were of very low quality and with an overall serious risk of bias. Primary tumor location was the cervix (n = 78, 48.9%), vulva (n = 30, 18.4%), uterus (n = 21, 12.9%), endometrium (n = 15, 9.2%), ovary (n = 8, 4.9%), (neo)vagina (n = 3, 1.8%), Gartner duct/paracolpium (n = 1, 0.6%), or synchronous tumors (n = 3, 1.8%), or were not reported (n = 4, 2.5%). Bony resections included the pelvic bone (n = 36), sacrum (n = 2), and transverse process of L5 (n = 1). Margins were negative in 70 patients and positive in 13 patients. Thirty-day mortality was 1.7% (2/121). Three studies used validated QoL questionnaires and seven used non-validated measurements; all reported acceptable QoL postoperatively.
CONCLUSIONS
In this highly selected patient group, mortality and QoL seem to be acceptable, with a high morbidity rate. This comprehensive study will help to inform eligible patients about the outcomes of extended pelvic surgery with neurovascular or bony resections. Future collaborative studies can enable the collection of QoL data in a validated, uniform manner.
Topics: Female; Humans; Quality of Life; Retrospective Studies; Prospective Studies; Pelvic Bones; Sacrum
PubMed: 38459419
DOI: 10.1245/s10434-023-14649-z -
Annals of the Royal College of Surgeons... Mar 2024Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres...
INTRODUCTION
Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres (PCs) and adult centres (ACs).
METHODS
A literature search was conducted, in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, for papers published between January 2000 and December 2020. Statistical analysis was performed using Stata version 16 (StataCorp, College Station, TX, US).
RESULTS
A total of 92 studies involving 74,852 paediatric LCs met the inclusion criteria. Over half (59%) of the LCs were performed at ACs. No significant differences were noted in the male-to-female ratio, mean age or mean body mass index between PCs and ACs. The main indications were cholelithiasis (34.1% vs 34.4% respectively, =0.83) and biliary dyskinesia (17.0% vs 23.5% respectively, <0.01). There was no significant difference in the median inpatient stay (2.52 vs 2.44 days respectively, =0.89). Bile duct injury was a major complication (0.80% vs 0.37% respectively, <0.01). Reoperation rates (2.37% vs 0.74% respectively, <0.01) and conversion to open surgery (1.97% vs 4.74% respectively, <0.01) were also significantly different. Meta-analysis showed no significant difference in overall complications (=0.92).
CONCLUSIONS
The number of LCs performed, intraoperative cholangiography use and conversion rates were higher at ACs whereas bile duct injury and reoperation rates were higher at PCs. Despite a higher incidence of bile duct injury at PCs, the incidence at both PCs and ACs was <1%. In complex cases, a joint operation by both paediatric and adult surgeons might be a better approach to further improve outcomes. Overall, LC was found to be a safe operation with comparable outcomes at PCs and ACs.
PubMed: 38445605
DOI: 10.1308/rcsann.2023.0041 -
American Journal of Rhinology & Allergy May 2024The aim of this meta-analysis is to compare the outcomes of early endonasal dacryocystorhinostomy (DCR) with delayed DCR in the treatment of acute dacryocystitis (AD). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this meta-analysis is to compare the outcomes of early endonasal dacryocystorhinostomy (DCR) with delayed DCR in the treatment of acute dacryocystitis (AD).
METHODS
A comprehensive electronic search of PubMed, Embase, Web of Science, and the Cochrane Library databases was conducted up to November 11, 2023. Data synthesis was performed using Review Manager 5.4, and forest plots were generated for each outcome measure. Potential publication bias was assessed using funnel plots and Egger's test.
RESULTS
Six studies involving 288 patients were included in the meta-analysis. Overall, the success rate of early endonasal DCR was comparable to that in the delayed DCR group (odds ratio [OR] = 1.52, 95% confidence interval [CI]: 0.81-2.85, = .19). Furthermore, in comparison with the delayed DCR group, early endonasal DCR significantly reduced the time for medial canthus swelling resolution (mean differences [MD] = -4.92, 95% CI: -5.46 to 4-.37, < .00001) and complete resolution of symptoms (MD = -17.70, 95% CI: -23.88 to -11.52, < .00001).
CONCLUSION
Primary early endonasal DCR seems to be a promising and favorable approach for managing AD with comparable efficacy and faster relief of symptoms compared to conventional delayed DCR.
Topics: Humans; Dacryocystorhinostomy; Nasolacrimal Duct; Dacryocystitis; Nose; Lacrimal Apparatus; Treatment Outcome; Endoscopy
PubMed: 38444220
DOI: 10.1177/19458924241237009 -
Cureus Feb 2024Major bile duct injury during cholecystectomy often requires surgical reconstruction. The optimal timing of repair is debated. (Review)
Review
BACKGROUND
Major bile duct injury during cholecystectomy often requires surgical reconstruction. The optimal timing of repair is debated.
OBJECTIVES
To assess the association between the timing of hepaticojejunostomy and postoperative morbidity, mortality, and anastomotic stricture.
METHODS
Systematic review and meta-analysis of observational studies comparing early (<14 days), intermediate (14 days-6 weeks), and late (>6 weeks) repair. Primary outcomes were postoperative morbidity, mortality, and stricture rates. Pooled risk ratios were calculated. A generalized linear model was used to estimate odds per time interval.
RESULTS
20 studies were included in the systematic review. Of these, data from 15 studies was included in the meta-analyses. The 20 included studies comprised a total of 3421 patients who underwent hepaticojejunostomy for bile duct injury. Early repair was associated with lower morbidity versus intermediate repair (RR 0.73, 95% CI 0.54-0.98). Delayed repair had lower morbidity versus intermediate (RR 1.50, 95% CI 1.16-1.93). Delayed repair had a lower stricture rate versus intermediate repair (RR 1.53, 95% CI 1.07-2.20). Mortality was not associated with timing.
CONCLUSIONS
Reconstruction between 2 and 6 weeks after bile duct injury should be avoided given the higher morbidity and stricture rates. Delayed repair after 6 weeks may be beneficial.
PubMed: 38440011
DOI: 10.7759/cureus.53507 -
Journal of Medical Case Reports Mar 2024Anesthesiologists prefer ketamine for certain surgeries due to its effectiveness as a non-competitive inhibitor of the N-methyl-D-aspartate receptor in the brain....
BACKGROUND AND AIMS
Anesthesiologists prefer ketamine for certain surgeries due to its effectiveness as a non-competitive inhibitor of the N-methyl-D-aspartate receptor in the brain. Recently, this agent has also shown promise as an antidepressant. However, ketamine can cause hallucinogenic effects and is sometimes abused as an illicit drug. Ketamine abuse has been associated with liver and bile duct complications. This systematic study aims to better understand cholangiopathy in ketamine abusers by reviewing case reports.
METHODS AND MATERIAL
In this systematic review, a comprehensive literature search was conducted with the terms "biliary tract diseases" and "ketamine". Case reports and case series of adult patients with documented ketamine abuse and reported cholangiopathy or biliary tract disease were included. We extracted the data of relevant information and the results were reported through narrative synthesis and descriptive statistics.
RESULTS
A total of 48 studies were initially identified, and 11 studies were finally included in the review. The mean age of the patients was 25.88 years. Of the 17 patients, 64.7% were men. Symptoms often included abdominal pain, nausea, and vomiting. Most patients were discharged with improved symptoms and liver function. Common bile duct dilation and other findings were observed in imaging results and other diagnostic studies.
CONCLUSION
This review highlights the diverse presentations and diagnostic modalities used in ketamine-induced cholangiography. These patients tend to be young men with deranged liver function tests and abdominal pain, which should be taken into consideration. These patients often require a multidisciplinary approach in their management.
Topics: Humans; Abdominal Pain; Bile Ducts; Biliary Tract; Biliary Tract Diseases; Illicit Drugs; Ketamine; Substance-Related Disorders; Case Reports as Topic
PubMed: 38431685
DOI: 10.1186/s13256-024-04421-6 -
Acta Paediatrica (Oslo, Norway : 1992) Jun 2024To determine if children with neonatal cholestatic liver disease had concurrent and later findings on brain imaging studies that could be attributed and the cholestasis... (Review)
Review
AIM
To determine if children with neonatal cholestatic liver disease had concurrent and later findings on brain imaging studies that could be attributed and the cholestasis to contribute to the understanding of the impaired neuropsychological development.
METHODS
Ovid MEDLINE and EMBASE were searched on July 21, 2022, and updated on March 26, 2023. Studies with children under 18 years of age with neonatal cholestasis and a brain scan at the time of diagnosis or later in life were included. Excluded studies were non-English, non-human, reviews or conference abstracts. Data were extracted on demographics, brain imaging findings, treatment and outcome. The results were summarised by disease categories. Risk of bias was assessed using JBI critical appraisal tools.
RESULTS
The search yielded 12 011 reports, of which 1261 underwent full text review and 89 were eligible for inclusion. Haemorrhage was the most common finding, especially in children with bile duct obstruction, including biliary atresia. Some findings were resolved after liver transplantation.
CONCLUSION
Children with neonatal cholestasis had changes in brain imaging, which might play a role in impaired neuropsychological development, but longitudinal clinical research with structured assessment is needed to better qualify the aetiology of the impairment.
Topics: Humans; Cholestasis; Infant, Newborn; Brain; Neuroimaging; Infant; Child
PubMed: 38406880
DOI: 10.1111/apa.17177 -
The Saudi Dental Journal Jan 2024A sialolith is a salivary stone usually presenting with swelling and pain in the affected salivary gland, most commonly the submandibular gland. There have been... (Review)
Review
INTRODUCTION
A sialolith is a salivary stone usually presenting with swelling and pain in the affected salivary gland, most commonly the submandibular gland. There have been speculations about the association between this condition and other systemic diseases, especially those forming stones, such as nephrolithiasis and cholelithiasis. This systematic review and meta-analysis aimed to summarize the studies assessing the relationship between cholelithiasis and sialolithiasis.
METHODS
PubMed/MEDLINE, Scopus, Web of Science, and Embase electronic databases were searched according to the keywords related to both disorders without any publication date or language restriction. Case-control and cohort studies evaluating the relationship between salivary and biliary stones were considered eligible. Quality assessment was performed following Newcastle-Ottawa Scale (NOS) for quality assessment of case-control studies. All meta and statistical analyses were performed with Comprehensive Meta-Analysis software.
RESULTS
Two studies fully complied with the defined eligibility criteria and were included, both of which were case-control studies using national-scale databases. In both surveys, the prevalence of previous gallstones in patients with sialolithiasis was compared to that of a control group. Though one of the studies found that there is no relationship between sialolithiasis and cholelithiasis, the meta-analysis revealed that previous cholelithiasis is significantly more prevalent among patients with sialolithiasis (P = 0.000), with an odds ratio of 2.04.
CONCLUSION
It seems that cholelithiasis is significantly associated with an increase in salivary stone formation. Therefore, a thorough salivary examination in all patients declaring current or past cholelithiasis is recommended. However, more studies, especially prospective cohorts, are needed to make firmer conclusions.
PubMed: 38375399
DOI: 10.1016/j.sdentj.2023.08.010