1,721,021 research outputs found
Tele-image-guided robotic surgery with multiple-console configuration: a vision towards remote precision surgical oncology
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ASO Author Reflections: Image-Guided Intraoperative Tissue Assessment for Guidance in Oncologic Surgery: From Frozen Section to Digital Surgery
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Wound Infiltration With Local Anesthetics Versus Transversus Abdominis Plane Block for Postoperative Pain Management in Gynecological Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
No full textObjective: Postoperative pain management significantly influences recovery speed, hospital stay duration, and healthcare costs. In light of inconsistencies in clinical trial outcomes, we conducted a systematic review and meta-analysis to assess the efficacy of the Transversus Abdominis Plane (TAP) block compared to local anesthetic wound infiltration (WI) for postoperative pain management in gynecological surgery. Data Sources: Systematic searches were conducted across PubMed/MEDLINE, ScienceDirect, the Cochrane Library, and Web of Science databases to identify all randomized controlled trials comparing TAP block and WI in adult patients undergoing gynecological surgical procedures. Additionally, the reference lists of the identified studies were manually reviewed. Only studies published in English were eligible for inclusion in the analysis. Methods of Study Selection: The Population, Intervention, Comparison, and Outcome framework for the review included: (1) adult patients who underwent gynecological surgical procedures; (2) postoperative TAP block as the intervention; (3) comparison with local anesthetic WI; (4) primary outcome: postoperative pain at 1, 4, 12, and 24 hours; secondary outcomes: postoperative opioid consumption, opioid-related side effects, and patient satisfaction. STATA software, version 18 (Stata Corp, College Station, TX, USA), was used for the analysis. Tabulation, Integration, and Results: A total of 213 papers were initially identified. Of these, 10 randomized controlled trials encompassing a total of 604 patients met the inclusion criteria. The meta-analysis studying minimally invasive surgery showed that TAP block was associated with lower pain scores at rest and 1, 4, 12, and 24 hours compared to the WI group. Furthermore, the TAP block resulted in a reduction in opioid consumption at 24 hours, although there was no significant difference in opioid-related adverse effects. Two studies presented data on patient-reported satisfaction, and a pooled analysis was not feasible due to heterogeneity. Conclusion: TAP block seems to provide better postoperative pain control after laparoscopic gynecologic procedures and reduces opioid use compared to WI in gynecologic surgery
Is vaginal hysterectomy outdated? A systematic overview of reviews with future perspectives
No full textBackground: Hysterectomy is the second most common surgical procedure in women. Vaginal hysterectomy (VH) historically represents the preferred approach for benign conditions due to its minimally invasive nature. However, with advances in endoscopic techniques, the role of VH has been questioned. This review aims to systematically summarize existing evidence coming from currently available systematic reviews and meta-analyses which compare VH with other techniques such as laparotomy, laparoscopy and robotics. Methods: We systematically searched Pubmed, Scopus, EMBASE and Cochrane library from 1st January 1996 to 31st July 2024. We conducted a systematic overview of reviews to compare VH with abdominal, laparoscopic, and robotic hysterectomy, focusing on procedural parameters, complications and patient outcomes. The quality of evidence and certainty of findings were critically assessed. Results: Our findings suggest that VH has shorter operative time compared to all the other approaches. Compared to laparotomy, VH is associated with reduced time from hospital admission to recovery. No differences were found concerning intra- and post-operative complications demonstrating VH as a safe superimposable technique. The quality of the evidence ranged from critical to moderate, with high heterogeneity among the studies, requiring cautious interpretation. Conclusion: VH offers reduced operating times and faster recovery in comparison to alternative techniques, with comparable complication rates. These data support the clinical relevance of VH as a valuable option for benign gynecological conditions. However, a nuanced comparison with alternative and innovative techniques are essential for personalized surgical decisions and a potential renaissance of this approach
Uterus Didelphys with Hematocervix in the Unilateral Obstructed Hemivagina and Ipsilateral Renal Agenesis: A Case Report of Herlyn–Werner–Wunderlich Syndrome
Full text linkBackground: Mullerian duct anomalies include a broad spectrum of genital tract defects that arise from developmental abnormalities of the genital tract. Herlyn–Werner–Wunderlich syndrome (HWWS) refers to the combination of uterus didelphys, blind hemivagina and ipsilateral renal agenesis. In the literature, the syndrome often appears as a few sporadic case reports. Case: We report a case of symptomatic Herlyn–Werner–Wunderlich syndrome diagnosed by transavaginal scan and MRI and successfully treated with a laparoscopic-assisted hysteroscopic vaginal septum resection. The postoperative course was without complications, and clinical symptoms completely resolved the surgery. Summary and Conclusions: Combination of laparoscopy and hysteroscopy was found to be an easy, safe, effective and appropriate approach for patients with HWWS
Full-field optical coherence tomography imaging for intraoperative microscopic extemporaneous lymph node assessment
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“Gerontosurgery”: Evaluation of Multidimensional Assessment Scales for Elderly Patients Undergoing Major Abdominal Surgery. What Is the Best Prediction Model?
Full text linkBackground/Aim: The aging population poses unique challenges in oncogeriatric surgery, particularly regarding risk stratification and postoperative outcome prediction. The impact of frailty on surgical decision-making reports should be noted. Geriatric assessment scales are recommended for preoperative objective evaluations to optimize surgical outcomes, but their accuracy remains unclear. This study evaluates the effectiveness of five multidimensional geriatric assessment scales - Charlson Comorbidity Index (CCI), APACHE II, Cumulative Illness Rating Scale (CIRS), Identification of Seniors at Risk (ISAR), and G8 - in predicting postoperative complications in elderly patients undergoing major oncological surgery. Patients and Methods: A retrospective observational study was conducted on 69 patients aged≥75 years who underwent major abdominal surgery for neoplastic conditions between December 2018 and July 2020. Preoperative assessments using the five scoring systems were performed, and postoperative complications were classified according to the Clavien-Dindo system. The study compared the predictive validity of each scale through correlation analysis with postoperative outcomes.Results: The study found weak correlations between predictive scores and postoperative complications. The G8 scale showed the strongest association with Clavien-Dindo scores (ρ=0.267, p=0.027), while other scales exhibited limited predictive value. Despite the widespread use of these scales in clinical practice, none of them accurately predicted postoperative morbidity in this cohort of patients.Conclusion: This study highlights the limitations of existing geriatric assessment scales in predicting postoperative complications for elderly patients undergoing major oncological surgery. Among the evaluated tools, only the G8 score showed an association with complications. However, the results suggest a need for more tailored risk stratification models that incorporate comorbidities, frailty, nutritional status, and physiological reserves. Further research with larger sample sizes is necessary to validate these findings and improve preoperative decision-making in geriatric oncologic surgery
Enhancing Surgical Education Through Artificial Intelligence in the Era of Digital Surgery
No full textArtificial Intelligence (AI) is transforming surgical education, playing a pivotal role in the era of digital surgery. This review, conducted from January 2023 to December 2024, examines the integration of AI into surgical training, focusing on its benefits and limitations. Thirteen studies were included, with emphasis on AI's impact in General Surgery training. Digital surgery leverages AI-powered tools such as virtual reality (VR) and augmented reality (AR) to create immersive, simulated environments where residents can practice surgical techniques safely and effectively. These platforms improve technical skills, hand-eye coordination, and error reduction, while personalized AI-driven feedback systems enhance learning and skill assessment. Digital surgery also bridges the gap between theoretical knowledge and clinical application, fostering innovative training methodologies. Despite challenges such as financial constraints and ethical concerns, AI within digital surgery emerges as a transformative force, redefining surgical education and equipping trainees with the expertise needed for modern health care
The vaginal route for minimally invasive surgery: a practical guide for general surgeons
No full textVaginal approaches have become routine in the field of gynecologic surgery, whereas in general surgery vaginal wall transection is an infrequent practice typically reserved for extensive tumor resections. Approximately two decades ago, natural orifice transluminal endoscopic surgery ({NOTES}) revolutionized conventional boundaries by accessing the peritoneal cavity transorally, transrectally, or transvaginally, enabling general surgery without visible scars. Although transvaginal approaches have been successfully used for various abdominal procedures by general surgeons, a gap remains in comprehensive training to fully exploit the potential of this route. {PubMed}, Google Scholar, and Scopus databases were searched to retrieve relevant articles illustrating how general surgeons can adeptly manage vaginal approaches. The article presents a practical framework for general surgeons to execute a complete vaginal approach, addressing the management of vaginal specimen extraction and vaginal cuff closure, even in the absence of an experienced gynecologist. The evolution of abdominal surgery is moving towards less invasive techniques, emphasizing the importance of understanding the nuances and challenges associated with the vaginal route. This approach is linked to minimal oncological, sexual, and infective complications, and to the absence of pregnancy-related complications. Such knowledge becomes increasingly crucial, particularly with the renewed demand for transvaginal access in robot-assisted {NOTES} procedures
Minimally Invasive Rectal Surgery: Current Status and Future Perspectives in the Era of Digital Surgery
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