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Special Issue "Clinical Advances in Minimally Invasive Surgery"

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

Deadline for manuscript submissions: 28 November 2023 | Viewed by 5494

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Special Issue Editors

Prof. Dr. Giovanni Conzo

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Guest Editor

Department of Traslational Medical Sciences, Division of General, Mininvasive, Oncologic and Bariatric Surgery University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
Interests: thyroid cancer; thyroidectomy; complications; neck dissection; local relapse; differentiated; neuromonitoring vocal folds; palsy
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Dr. Renato Patrone

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Guest Editor

1. PhD ICTH, University of Federico II of Naples, 80131 Napoli, Italy
2. Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy
Interests: thyroid cancer; endocrine surgery; thyroid surgery; oncological surgery; pancreatic surgery; pancreatic cancer, HPB surgery
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Prof. Dr. Ludovico Docimo

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Guest Editor

Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy
Interests: bariatric surgery; general surgery; colorectal surgery; oncological surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is for us a great honor to present this Special Issue of JCM: “Clinical Advances in Minimally Invasive Surgery”.

This monograph is meant to provide an overview of current principles and future directions in minimally invasive surgery (MIS) in general, gastrointestinal (GI) and endocrine surgery.

More and more papers in the literature have considered the issue and investigated novel technologies, but the debate is still open.

This Special Issue will publish articles written by expert Italian surgeons, members of the Italian Society of Digestive System Pathologies (SIPAD), the Neapolitan Society of Surgery (SnAC) and the United Italian Society of Endocrine Surgery (SIUEC) with a deep knowledge in this field.

Their work will be an inspiration for future research.

This Special Issue will be published on behalf of these three important Italian scientific societies (SIPAD, SnAC and SIUEC), and we wish to thank their boards.

Special thanks go to Dr. Emmanuel Andrès and Prof. Dr. Michael G. Hennerici, Editors-in-Chief of JCM, for allowing the publication of this Special Issue, and to Amy Lu for the editorial assistance.

In recent years, MIS reached a large diffusion worldwide for the treatment of benign and malignant diseases, especially in GI and endocrine pathologies, demonstrating safety and feasibility.

MIS has provided indisputable benefits over traditional approaches in a large number of surgical operations, with similar operative time and cost. Rapid recovery is very useful for patients in comparison to the large skin incisions with a long hospital stay and complex post-operative mobilization that are typical of open surgery.

The incidence of gastrointestinal and endocrine neoplasms remains high, and the scientific literature shows an increasing interest in this topic, with a mounting article production.

Evolutions of surgical technique, the growth of team expertise, the support of data from the literature, and necessity for hospitals to increase patient turnover have allowed minimally invasive approaches to have an increasingly predominant role in general, GI and endocrine surgery.

The ERAS program and its diffusion have given a further boost.

In this Special Issue, we aim to deepen and explore new surgical techniques to improve minimally invasive surgery, its applications in the treatment of gastrointestinal and endocrine cancers, investigate the outcomes and hospital implications, the role of robotic surgery, future perspectives, and finally cost analysis.

We will also evaluate MIS oncological outcomes.

Limitations of MIS, such as reduced maneuverability, loss of depth perception and sometimes longer operative time are also considered.

Finally, an accurate literature review will offer readers the more recent international trends and evidence in general gastrointestinal and endocrine surgery, current limitations and future directions.

Thanks to expert opinions, we have summarized more common MIS operative techniques and evaluated the evidenced advances.

Special thanks go to the authors who collaborated to drafting this Special Issue, and to the Board Members of SIPAD, SIUEC, and SnAC who accepted our invitation.

In conclusion, we wish to express our gratitude to the reviewers that allowed the publication of this Issue with their support.

Prof. Dr. Giovanni Conzo
Dr. Renato Patrone
Prof. Dr. Ludovico Docimo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

MIS
laparoscopic surgery
advanced surgical technique
oncological surgery
general surgery
endocrine surgery
gastrointestinal surgery

Published Papers (7 papers)

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Research

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Open AccessArticle

Role of Absorbable Polysaccharide Hemostatic Powder in the Prevention of Bleeding and Wound Events after Thyroid Surgery

Giovanni Docimo

Marcello Filograna Pignatelli

Francesco Saverio Lucido

and

J. Clin. Med. 2023, 12(17), 5684; https://doi.org/10.3390/jcm12175684 - 31 Aug 2023

Viewed by 346

Abstract

Background: Bleeding is one of the most fearsome and life-threatening complications after thyroid surgery. Several medical devices and haemostatic agents have been proposed to improve haemostasis during total and hemi-thyroidectomy. Resorbable polysaccharide powder (HaemoCer™) is a plant-based polymer that is helpful in terms of the coagulation cascade becoming a gel and forming a barrier to prevent further bleeding, having tested for haemostasis in different districts. The aim of the current study was the evaluation of drain output, the presence of significant postoperative blood loss and complications in patients treated with or without resorbable polysaccharide powder during thyroid surgery. Methods: From January to December 2022, postoperative bleeding, drainage output and the postoperative wound events of patients undergoing thyroid surgery, in a tertiary centre, with haemostasis completion with resorbable polysaccharide powder (Group A) or not (Group B), were retrospectively analysed. Results: Eighty-one patients in Group A received a haemostasis improvement with the use of reabsorbable polysaccharide powder, and 96 patients in Group B received thyroid surgery alone. Patients in Group A presented lower drainage output (0.005), lower incidence of neck haematoma (0.005) and seroma (0.021), confirmed also by multivariate analysis. Conclusions: The resorbable polysaccharide powder, in the current series, appeared to be an effective agent in achieving haemostasis in thyroidectomies, reducing the postoperative drainage output, and also neck events such as neck haematoma and seroma, improving the postoperative comfort of the patients. Further larger comparative studies are needed to address this issue. Full article

(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Surgery)

Open AccessArticle

Advances in Endoscopic Management of Endobronchial Carcinoid

Francesco Panini D’Alba

Giovanni Conzo

Tecla Della Posta

Noemi Maria Giorgiano

and

J. Clin. Med. 2023, 12(16), 5337; https://doi.org/10.3390/jcm12165337 - 16 Aug 2023

Viewed by 532

Abstract

Introduction: Bronchial carcinoid (BC) tumors represent between 1% and 5% of all lung cancers and about 20–30% of carcinoid tumors; they are classified into two groups: typical and atypical bronchial carcinoids. The aim of the present study was to review the results of endoscopic treatments as an alternative to surgical treatment in selected patients. Materials and methods: The present study was a retrospective and multicentric study, in which all data were reviewed for patients with BC in the central airways, referred to the Thoracic Surgery Units of Luigi Vanvitelli University of Naples and Sant’Andrea Hospital in Rome between October 2012 and December 2022 Overall, 35 patients, 13 of whom were female, were included in the study (median age, 53 years; range, 29–75 years). All patients underwent rigid bronchoscopy combined with flexible bronchoscopy. Tumor clearance was mostly performed by use of Argon Plasma Coagulation or Thulep Laser, mechanical debridement and excision with the use of forceps and aspirator through the working channel of the 8.5 mm-sized rigid bronchoscope. There were no complications during the treatment. Results: Endobronchial treatment provided complete tumor eradication in all patients; two patients had controlled bleeding complications; however, bleeding was well controlled without patient desaturation, and only one patient died of renal failure during the follow-up period. We found two recurrences in the left and right main bronchus, in patients with atypical carcinoma during fiberoptic bronchoscopy follow-up. Only one patient died of renal failure. At the first analysis, there were no significant differences between the patients receiving endobronchial treatment and patients receiving surgical treatment in the present study (p-value > 0.05—it means statistically insignificant). Conclusions: Endobronchial treatment is a valid and effective alternative for patients with BC unsuitable for surgery. Full article

(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Surgery)

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Open AccessArticle

Advanced Localization Technique for Non-Palpable Breast Cancer: Radiofrequency alone VS Combined Technique with Ultrasound

Francesco Saverio Lucido

and

J. Clin. Med. 2023, 12(15), 5076; https://doi.org/10.3390/jcm12155076 - 02 Aug 2023

Viewed by 437

Abstract

Breast conservative surgery is the primary therapeutic choice for non-aggressive early breast cancers, and a minimally-invasive approach is strongly recommended. The breast localization represents a modern challenge for surgery. Wire-guided localization is still the gold standard technique, but new wireless systems have been proposed, such as radiofrequency identification with LOCalizer^TM (Hologic, Santa Carla, CA, USA), which reports encouraging results. The current study aimed to evaluate the accuracy and efficacy of the combined use of LOCalizer^TM and ultrasound compared with the results obtained using LOCalizer^TM alone for the detection of non-palpable breast cancer. Ninety-six patients who were candidates for breast localization were enrolled. Group A received a combined localization with LOCalizer^TM and US, while group B underwent only LOCalizer^TM identification. Oncological radicality was reached in 100% of the patients in Group A and in 89.2% of the patients in Group B, with p = 0.006. The mean specimens’ volume was 13.2 ± 0.6 cm³ for Group A and 16.1 ± 1.4 cm³ for Group B, while mean specimen weights were 21.8 ± 2.2 and 24.4 ± 1.8 g, respectively (p = 0.003 and p = 0.004, respectively). LOCalizer^TM with ultrasound, in the current series, has resulted in the preferred option for the localization of non-palpable breast cancer, allowing limited resection (in weight and volume), guaranteeing excellent oncological outcomes, and great satisfaction for patients and physicians. Full article

(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Surgery)

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Open AccessArticle

Tentacle Mesh for Fixation-Free Spigelian Hernia Repair: Mini-Invasive Approach Granting Broad Defect Overlap

and

J. Clin. Med. 2023, 12(12), 3866; https://doi.org/10.3390/jcm12123866 - 06 Jun 2023

Viewed by 888

Abstract

Background: Compared to other types of abdominal protrusions, Spigelian hernias are not very common. In prosthetic repair of abdominal protrusions, mesh fixation and defect overlap are an open issue, as they are a source of complications. A newly developed tentacle-shaped mesh has been used to ensure a fixation-free repair with a broader defect overlap in the repair of abdominal hernias. This study describes the long-term results of a fixation-free repair of Spigelian hernias carried out with a tentacle mesh. Methods: A proprietary mesh composed of a central body with integrated radiating arms was used for repairing Spigelian hernias in 54 patients. The implant was positioned in preperitoneal sublay, and the straps were delivered across the abdominal musculature with a needle passer, and then, after fascia closure, cut short in the subcutaneous layer. Results: The friction of the straps passing through the abdominal wall served to hold the mesh in place, guaranteeing a wide overlap over the defect without fixation. In a long-term follow-up of 6 to 84 months (mean 64 months), a very low rate of complications occurred, but no recurrence was reported. Conclusions: The tentacle strap system of the prosthesis allowed for an easy, fast and safe fixation-free placement granting a wide overlap, avoiding intraoperative complications. Greatly reduced pain and a negligible amount of postoperative complications characterized the postoperative outcome. Full article

(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Surgery)

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Open AccessArticle

Is There Indication for the Use of Biological Mesh in Cancer Patients?

and

J. Clin. Med. 2022, 11(20), 6035; https://doi.org/10.3390/jcm11206035 - 13 Oct 2022

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Abstract

Up to 28% of all patients who undergo open surgery will develop a ventral hernia (VH) in the post-operative period. VH surgery is a debated topic in the literature, especially in oncological patients due to complex management. We searched in the surgical database of the Hepatobiliary Unit of the National Cancer Institute of Naples “G. Pascale Foundation” for all patients who underwent abdominal surgery for malignancy from January 2010 to December 2018. Our surgical approach and our choice of mesh for VH repair was planned case-by-case. We selected 57 patients that fulfilled our inclusion criteria, and we divided them into two groups: biological versus synthetic prosthesis. Anterior component separation was used in 31 patients (54.4%) vs. bridging procedure in 26 (45.6%). In 41 cases (71.9%), we used a biological mesh while a synthetic one was adopted in the remaining patients. Of our patients, 57% were male (33 male vs. 24 female) with a median age of 65 and a mean BMI of 30.8. We collected ventral hernia defects from 35 cm² to 600 cm² (mean 205.2 cm²); 30-day complications were present in 24 patients (42.1%), no 30-day mortality was reported, and 21 patients had a recurrence of pathology during study follow-up. This study confirms VH recurrence risk is not related with the type of mesh but is strongly related with BMI and type of surgery also in oncological patients. Full article

(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Surgery)

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Review

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Open AccessReview

Impact of Current Technology in Laparoscopic Adrenalectomy: 20 Years of Experience in the Treatment of 254 Consecutive Clinical Cases

Federico Maria Mongardini

and

J. Clin. Med. 2023, 12(13), 4384; https://doi.org/10.3390/jcm12134384 - 29 Jun 2023

Viewed by 501

Abstract

Background: Laparoscopic adrenalectomy (LA), which avoids large abdomen incisions, is considered the gold standard technique for the treatment of benign small- and medium-size adrenal masses (<6 cm) and weighing < 100 g. A trascurable mortality and morbidity rate, short hospitalization and patient rapid recovery are the main advantages compared to traditional surgery. During the past decade, a new surgical technology has been developed that expedites a “clipless” adrenalectomy. Here, the authors analyze a clinical series of 254 consecutive patients who were affected by adrenal gland neoplasms and underwent LA by the transabdominal lateral approach over the two last decades. A literature review is also presented. Methods: Preoperative, intraoperative and postoperative data from 254 patients who underwent LA between January 2003 and December 2022 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in the case of pheochromocytoma (PCC) while spironolactone and potassium were employed to treat Conn’s disease. The same surgeon (CG) performed all the LA and utilized the same laparoscopic transabdominal lateral approach. Different dissection tools—ultrasonic, bipolar or mixed scissors—and hemostatic agents were used during this period. The following results were obtained: 254 patients were included in the study; functioning tumors were diagnosed in 155 patients, 52 patients were affected by PCCs, 55 by Conn’s disease, 48 by Cushing’s disease. Surgery mean operative time was 137.33 min (range 100–180 min) during the learning curve adrenalectomies and 98.5 min (range 70–180) in subsequent procedures. Mean blood loss was respectively 160.2 mL (range 60–280) and 96.98 mL (range 50–280) in the first 30 procedures and the subsequent ones. Only three conversions (1.18%) to open surgery occurred. No mortality or postoperative major complications were observed, while minor complications occurred in 19 patients (3.54%). In 153 out of 155 functioning neoplasms, LA was effective in the normalization of the endocrine profile. According to our experience, a learning curve consisting of 30 cases was identified. In fact, a lower operative time and a lower complication rate was reported following 30 LA. Conclusions: LA is a safe procedure, even for masses larger than 6 cm and PCCs. Undoubtedly, the development of surgical technology has made it possible reducing operative times, performing a “clipless” adrenalectomy and extending the indications in the treatment of more complex patients. A multidisciplinary team, in referral high-volume centers, is recommended in the management of adrenal pathology. A 30-procedure learning curve is necessary to improve surgical outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Surgery)

Other

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Open AccessSystematic Review

Predictive Factors for Anastomotic Leakage after Laparoscopic and Open Total Gastrectomy: A Systematic Review

Maria Michela Di Nuzzo

and

J. Clin. Med. 2022, 11(17), 5022; https://doi.org/10.3390/jcm11175022 - 26 Aug 2022

Cited by 3 | Viewed by 1227

Abstract

The aim of this systematic review is to identify patient-related, perioperative and technical risk factors for esophago-jejunal anastomotic leakage (EJAL) in patients undergoing total gastrectomy for gastric cancer (GC). A comprehensive literature search of PubMed/MEDLINE, Embase and Scopus databases was performed. Studies providing factors predictive of EJAL by uni- and multivariate analysis or an estimate of association between EJAL and related risk factors were included. All studies were assessed for methodological quality, and a narrative synthesis of the results was performed. A total of 16 studies were included in the systematic review, with a total of 42,489 patients who underwent gastrectomy with esophago-jejunal anastomosis. Age, BMI, impaired respiratory function, prognostic nutritional index (PNI), alcohol consumption, chronic renal failure, diabetes and mixed-type histology were identified as patient-related risk factors for EJAL at multivariate analysis. Likewise, among operative factors, laparoscopic approach, anastomosis type, additional organ resection, blood loss, intraoperative time and surgeon experience were found to be predictive factors for the development of EJAL. In clinical setting, we are able to identify several risk factors for EJAL. This can improve the recognition of higher-risk patients and their outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Surgery)

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