New Challenges in Laparoscopic, Robotic and Endoscopic Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 31 May 2024 | Viewed by 2434

Special Issue Editor


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Guest Editor
Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
Interests: bariatric surgery; metabolic surgery; flexible endoscopic surgery; foregut surgery; obesity; microbiome; minimally invasive surgery; gastrointestinal surgery
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Special Issue Information

Dear Colleagues,

Laparoscopic, robotic, and endoscopic surgery have revolutionized the field of surgery by enabling minimally invasive procedures. This Special Issue focuses on the latest research and technological advancements in these areas, exploring surgical procedures, innovative techniques, and clinical outcomes. It aims to provide valuable insights into the evolving landscape of minimally invasive surgery and address the complexities faced by surgeons.

Laparoscopic surgery presents a significant challenge due to the loss of depth perception and limited instrument motion. Surgeons must work with two-dimensional images and manipulate instruments from a distance, which adds complexity to delicate procedures. Similarly, robotic surgery, while offering enhanced dexterity and precision, faces obstacles such as high costs and the requirement of specialized training, making it less accessible. On the other hand, endoscopic surgery poses challenges related to visualization and access. Surgeons often have to rely on indirect visualization techniques, which can potentially increase the risk of complications.

Overall, while laparoscopic, robotic, and endoscopic surgery have transformed the field of surgery, there are still ongoing challenges that need to be addressed to further enhance patient care and surgical outcomes.

Dr. Jerry T. Dang
Guest Editor

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Keywords

  • laparoscopic surgery
  • robotic surgery
  • endoscopic surgery
  • minimally invasive surgery

Published Papers (3 papers)

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Research

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11 pages, 257 KiB  
Article
Pre-Operative Group and Save in Elective and Emergency Laparoscopic Cholecystectomy: Necessity, Cost-Effectiveness, and Own Experience
by Mohammed Hamid, Marie Kershaw, Resya Bhakthavalsalan, Rishika Shivamurthy, Sian Davies, Rishi Singhal, Rajwinder Nijjar, Tom Wiggins, Ricardo Camprodon and Zuhair Ahmed
J. Clin. Med. 2024, 13(10), 2749; https://doi.org/10.3390/jcm13102749 - 7 May 2024
Viewed by 477
Abstract
Background: Laparoscopic cholecystectomy is associated with a high safety profile. This study seeks to quantify the incidence of blood transfusion in both the elective and emergency settings, examine related patient outcomes, and investigate selection criteria for pre-operative Group and Save (G&S) sampling. [...] Read more.
Background: Laparoscopic cholecystectomy is associated with a high safety profile. This study seeks to quantify the incidence of blood transfusion in both the elective and emergency settings, examine related patient outcomes, and investigate selection criteria for pre-operative Group and Save (G&S) sampling. Methods: A prospective multi-centre observational study was conducted to investigate patients undergoing either elective or emergency laparoscopic cholecystectomy in the UK between January 2020 and May 2021. Multivariate logistical regression models were used to identify patient factors associated with the risk of transfusion and explore outcomes linked to pre-operative G&S sampling. Results: This study comprised 959 patients, with 631 (65.8%) undergoing elective cholecystectomy and 328 (34.2%) undergoing emergency surgery. The median age was 48 years (range: 35–59), with 724 (75.5%) of the patients being female. Only five patients (0.5%) required blood transfusions, receiving an average of three units, with the first unit administered approximately six hours post-operatively. Among these cases, three patients (60%) had underlying haematological conditions. In adjusted models, male gender was significantly associated with the need for a blood transfusion (OR 11.31, p = 0.013), while the presence of a pre-operative Group and Save sample did not demonstrate any positive impact on patient outcomes. Conclusions: The incidence of blood transfusion following laparoscopic cholecystectomy is very low. Male gender and haematological conditions may present as independent risk factors. Pre-operative G&S sampling did not yield any positive impact on patient outcomes and could be safely excluded in both elective and emergency cases, although certain population subsets will warrant further consideration. Full article
(This article belongs to the Special Issue New Challenges in Laparoscopic, Robotic and Endoscopic Surgery)
13 pages, 594 KiB  
Article
The Effects of Post-Surgical Pregnancy on Weight Loss Trajectories after Bariatric Surgery: Are Initial Weight and Age Prognostic Factors?
by Juan S. Barajas-Gamboa, Mohammed Sakib Ihsan Khan, Jerry T. Dang, Gustavo Romero-Velez, Gabriel Diaz Del Gobbo, Mohammed Abdallah, Juan Pablo Pantoja, Carlos Abril, Alfredo D. Guerron, Terrence Lee-St. John, Ricard Corcelles, John Rodriguez, Matthew Kroh and M. Jean Uy-Kroh
J. Clin. Med. 2024, 13(5), 1264; https://doi.org/10.3390/jcm13051264 - 23 Feb 2024
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Abstract
Introduction: A substantial percentage of patients undergoing bariatric surgery are of childbearing age. Pregnancy outcomes after bariatric surgery are known. However, there are limited data on the impact of pregnancy on weight loss after surgery. Objectives: This study aims to evaluate the effects [...] Read more.
Introduction: A substantial percentage of patients undergoing bariatric surgery are of childbearing age. Pregnancy outcomes after bariatric surgery are known. However, there are limited data on the impact of pregnancy on weight loss after surgery. Objectives: This study aims to evaluate the effects of pregnancy on post-bariatric surgery weight loss trajectories (WLTs) and to determine the association with age and initial weight. Methods: All who had primary bariatric surgeries (Roux-en-Y gastric bypass or sleeve) between September 2015 and July 2020 were classified into two groups: post-surgery gravid (GG) and post-surgery non-gravid (NG). WLTs were examined using a random intercept mixed-effects model with repeated measures nested within patients. The post-surgery/pre-gravid time phase (PoPG) was modelled using a third-degree polynomial. For GG, two third-degree spline functions modelled the post-surgery while gravid (PoWG) and post-partum (PoPP) time phases. Age and initial weight were used to control for pre-existing differences during PoPG. Weight differences at 6 months PoPP were examined by applying general linear hypothesis testing to the mixed-model results. Results: A total of 508 patients were included, 20 in GG and 488 in NG. The mean age at surgery was 33 years in GG and 37 years in NG. The mean initial BMI was 47 kg/m2 and 43 kg/m2, respectively. During PoPG, adjusted average weight in both groups follows the path across time. For GG, weight decreases and then increases during PoWG. For GG during PoPP, weight immediately decreases after delivery and then increases over time to levels similar to NG. Weight differences at 6 months PoPP for GG and NG were not statistically different. Older age was associated with reduced weight loss during PoPG by Baseline Age, while higher initial weight was associated with increased weight loss during PoPG by Baseline Weight. In both instances, these effects attenuate over time. Conclusions: This model indicates that pregnancy following bariatric surgery affects WLT during PoWG and PoPP, and no difference in weight is expected after 6 months post-gravid. Age and initial weight could be considered prognostic factors during PoPG. Patients wishing to conceive should undergo preconception counselling and be advised to avoid pregnancy during the period of rapid weight loss. They also should be informed that WLT may vary during pregnancy and early post-partum. Full article
(This article belongs to the Special Issue New Challenges in Laparoscopic, Robotic and Endoscopic Surgery)
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Review

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16 pages, 311 KiB  
Review
The Trajectory of Revisional Bariatric Surgery: Open to Laparoscopic to Robotic
by Noura Jawhar, Jack W. Sample, Marita Salame, Katie Marrero, Daniel Tomey, Suraj Puvvadi and Omar M. Ghanem
J. Clin. Med. 2024, 13(7), 1878; https://doi.org/10.3390/jcm13071878 - 25 Mar 2024
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Abstract
Metabolic and bariatric surgery (MBS) is the most effective therapeutic intervention for patients with obesity, with sleeve gastrectomy (SG) being the most commonly performed primary MBS procedure. Long-term studies have demonstrated that 15–20% of patients require revisional bariatric surgery (RBS) due to weight-related [...] Read more.
Metabolic and bariatric surgery (MBS) is the most effective therapeutic intervention for patients with obesity, with sleeve gastrectomy (SG) being the most commonly performed primary MBS procedure. Long-term studies have demonstrated that 15–20% of patients require revisional bariatric surgery (RBS) due to weight-related issues or surgical complications. Despite the gold standard being laparoscopic revision, there are other available approaches such as open or robotic-assisted. An extensive literature review was performed for articles from their inception to February 2024. A descriptive review of MBS procedures (SG, Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileostomy (SADI) and biliopancreatic diversion-duodenal switch (BPD-DS)) was carried out to report and compare outcomes between primary and revisional bariatric surgery. A similar review was conducted to compare outcomes of revisional approaches (open, laparoscopic, robotic). RYGB remains the dominant RBS with a similar safety profile compared to revisional SADI and BPD-DS. In terms of the RBS surgical approach, all three options showed comparable short and long-term outcomes, with robotic RBS being associated with longer operative time and variable length of stay. Additional long-term studies are required to further validate our conclusions. Full article
(This article belongs to the Special Issue New Challenges in Laparoscopic, Robotic and Endoscopic Surgery)
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