JSLS : Journal of the Society of Laparoendoscopic Surgeons

BACKGROUND AND OBJECTIVES: Important safety requirements for forceps used in surgical procedures are the ability to stably grasp fine tissue and to cause minimal tissue damage. Shark skin has the structural feature of circumpolar scales, which increase the frictional force of the scales by roughening their surface. We have developed and patented medical forceps with a shark skin pattern placed on the tip surfaces. The aim of this study was to examine the safety and efficacy of the shark skin forceps compared with existing forceps, both fundamentally and clinically...

BACKGROUND: As the population continues to age, the number of elderly patients affected by obesity is rising. Metabolic and bariatric surgery (MBS) can benefit elderly patients seeking treatment for obesity and its related diseases. We aimed to quantify percent excess weight loss (%EWL) for elderly patients (≥ 65) undergoing MBS at a single institution and compare our results to %EWL previously reported for general and elderly populations. Additionally, we believe the safety and effectiveness of MBS is repeatable in our community setting...

BACKGROUND: Intraoperative ureteral injury (IUI) during colorectal surgery can have devastating consequences. This study aimed to assess the clinical and economic impact of pre-operative ureteral stenting in colorectal surgeries. METHODS: A retrospective cohort study was conducted using United States hospital data (October 2015 - December 2019). IUI incidence was examined across selected inpatient surgery types (elective colectomy, enterectomy, proctectomy, enterostomy, other colorectal procedures; emergency colectomy)...

BACKGROUND AND OBJECTIVES: Most thermal energy-induced distal ureter injuries are missed intraoperatively as they are caused by delayed ischemia-induced necrosis of the affected part leading to fistula, and a delayed presentation. The injuries of the distal ureter are commonly managed by ureteroneocystostomy, which has long-term complications related to vesico-ureteric reflux (VUR). We present our experience of management of distal ureter injury due to thermal energy by laparoscopy ureteroureterostomy and the role of various methodologies for its diagnosis...

BACKGROUND AND OBJECTIVES: Robotic surgical technology may obviate the need for an assistant surgeon when performing hysterectomy. In rural communities where physician shortages remain a major barrier to healthcare access, reducing the number of surgeons necessary to complete a hysterectomy would be of significant consequence. We sought to investigate the impact of robotic surgery on both the presence of an assistant surgeon and route of hysterectomy following implementation of a robotic surgery program at a single-site community hospital...

BACKGROUND AND OBJECTIVES: This is a prospective trial of the endo-stapler application for vaginal closure before colpotomy in cases of carcinoma endometrium and carcinoma cervix, managed by minimally invasive surgery with due consideration of its surgical technique and short-term oncologic follow-up outcomes. METHODS: This was a prospective, single center study completed between March 1, 2020 and December 31, 2022. A total of 62 patients (43 cases of carcinoma endometrium and 19 cases of carcinoma cervix) were recruited for the study...

OBJECTIVE: Determine the difference in microbial growth from the vagina and uterine manipulator among patients undergoing laparoscopic hysterectomy after randomization to one of three vaginal preparation solutions (10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine). METHOD: This was a prospective randomized controlled trial in an academic community hospital. Patients were ≥ 18 years old and scheduled for laparoscopic hysterectomy for benign and malignant indications...

BACKGROUND AND OBJECTIVES: The objectives of this study were to determine carbon dioxide (CO2 ) emissions generated from nonreusable waste and compare across different types of hysterectomies for benign and malignant indications. Overall greenhouse gas emissions were not examined. METHODS: This is a prospective cohort study that identified women undergoing a robotic assisted, laparoscopic, vaginal, or abdominal hysterectomy for any indication. The amount of waste generated was collected for each case, along with patient demographics, and details of the procedure...

BACKGROUND: The surgical procedure One Anastomosis Gastric Bypass (OAGB) has become widely used worldwide. Since its inception, many modifications have been introduced to improve results. OBJECTIVES: The primary aim of this study was to share the modifications that we have introduced to our OAGB technique after reflecting on the problems and complications we have faced during the evolution of this procedure in our unit. METHOD: A total of 850 patients who underwent OAGB under the same surgical team at two different hospitals in the United Kingdom were displayed according to demography and comorbidities...

BACKGROUND: The aim of the present study is to evaluate the possible advantages of the Robo-Lap (parenchymal transection by laparoscopic ultrasonic dissector and robotic bipolar forceps and scissors) compared with pure robotic technique (parenchymal transection by use of robotic bipolar forceps and scissors) in major anatomical liver resections with specific focus on intraoperative outcomes. METHODS: Major liver resections performed by robotic approach between February 1, 2021 and March 31, 2023 were stratified into two groups according to the approach used to address the phase of liver transection; Pure Robotic Group (n = 21) versus Robo-Lap Group (n = 48)...

BACKGROUND AND OBJECTIVES: Robotic gynecologic surgery has outpaced data showing risks and benefits related to cost, quality outcomes, and patient safety. We aimed to assess how credentialing standards and perceptions of safe use of robotic gynecologic surgery have changed over time. METHODS: An anonymous, online survey was distributed in 2013 and in 2021 to attending surgeons and trainees in accredited obstetrics and gynecology residency programs. RESULTS: There were 367 respondents; 265 in 2013 and 102 in 2021...

BACKGROUND: Hysteroscopy is the gold standard for evaluating intrauterine pathology. The majority of physicians currently perform hysteroscopy in the operating room. Lack of training has been cited as a barrier to performing office hysteroscopy; however, resident training in office hysteroscopy has not yet been evaluated. METHODS: A prospective cross-sectional survey was performed. A validated 17 question survey tool was sent to 297 program directors of Accreditation Council for Graduate Medical Education accredited obstetrics and gynecology residency programs for distribution to their residents...

BACKGROUND AND OBJECTIVES: In order to avoid potential complications from incisional hernias in patients undergoing laparoscopic or robotic procedures with 10 mm or larger ports, a surgeon closes the fascial defects using various techniques. We compared several different techniques of port site closure, which uses the open technique that can be performed with or without laparoscopic visualization. We modified the technique initially described by Dr. H. Aziz. We are introducing a new surgical technique to close the larger port site using Graham's nerve-hook...

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a common procedure performed world-wide on patients with different comorbidities, with many indications and overall low morbidity. However, studies showed an elevated early mortality in patients undergoing PEG placement. In this systematic review, we review the factors associated with early mortality after PEG. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed...

BACKGROUND AND OBJECTIVES: Obesity has increased over the past decade, yet the correlation among body mass index (BMI), surgical outcomes, and the robotic platform are not well established. This study was undertaken to measure the impact of elevated BMI on outcomes after robotic distal pancreatectomy and splenectomy. METHODS: We prospectively followed patients who underwent robotic distal pancreatectomy and splenectomy. Regression analysis was utilized to identify significant relationships with BMI...

BACKGROUND: Excruciating generalized abdominal pain with features suggestive of shock, at the end of the first or early second week after laparoscopic cholecystectomy (LC), is a frightening and formidable diagnostic predicament. This is because the early known complications like biliary leak or vascular injuries are unlikely diagnoses. Hemoperitoneum, is not usually considered, but instead more common occurrences like acute pancreatitis, choledocholithiasis, and sepsis are suspected. A delay in diagnosis and subsequent management of hemoperitoneum could have disastrous consequences...

BACKGROUND AND OBJECTIVES: Laparoscopic inguinal hernia repair (LIHR) includes transabdominal preperitoneal repair (TAPP), standard totally extraperitoneal repair (TEP), and now extended TEP (eTEP). However, there is still a paucity of well conducted, peer reviewed comparative studies regarding the advantages, if any, of eTEP. This study aimed to compare the data of eTEP repair with that of TEP and TAPP repair. METHODS: Two hundred twenty patients were randomly assigned to one of three groups of eTEP (80), TEP (68), and TAPP (72) after matching for age, sex, and clinical extent of hernia...

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OBJECTIVE: To evaluate the efficacy of gasless reduced-port laparoscopic surgery (GRP-LS) using a subcutaneous abdominal wall lifting method for gynecological diseases. METHODS: This study included gasless laparoscopic surgeries performed at our hospital between September 1, 1993 and December 31, 2016. The new GRP-LS technique was compared with the conventional gasless three-port laparoscopic surgery (G3P-LS), based on patient background, operative results in patients treated for laparoscopic myomectomy (LM), laparoscopic ovarian cystectomy (LC), and laparoscopic salpingectomy (LT)...

BACKGROUND AND OBJECTIVES: We aimed to evaluate oncological and functional results of the ultrapreservation anterior-sparing technique in patients with localized prostate cancer. METHODS: In this single-center study, patients with low to intermediate risk prostate cancer, who were treated with the ultrapreservation anterior-sparing technique, were included retrospectively. The oncological and functional outcomes were recorded. After the functional and pathological evaluation in the first month, patients' prostate-specific antigen levels were followed, as well as continence and potency status bimonthly for one year...