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Innovative Surgical Researches
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Innovative Surgical Researches

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

Deadline for manuscript submissions: closed (6 August 2023) | Viewed by 24476

Special Issue Editors

Prof. Dr. Vito D'Andrea

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Guest Editor
Department of Surgery, Sapienza University of Rome, Rome, Italy
Interests: general surgery; abdominal surgery; surgical oncology; minimally invasive surgery; cancer surgery; gastrointestinal surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Andrea Mingoli

E-Mail Website
Guest Editor
Department of General Surgery, Università degli Studi di Roma La Sapienza, Rome, Italy
Interests: general surgery; digestive surgery; endocrine surgery; emergency surgery; oncological surgery; vascular surgery; trauma
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

“Innovative Surgical Research” is a Special Issue of JCM which is dedicated to innovative diagnostic and operating technologies used in general surgery, urology, and otorynolaryngoiatrics. We welcome original papers and reviews focused on neoplastic diseases and placing emphasis on pathophysiological conditions induced by surgical intervention. As regards diseases of surgical interest, issues of basic research, including knowledge of molecular genetics, neuroendocrine, and immune mechanisms will be addressed, as well as new therapeutic strategies and the development of innovative surgical and minimally invasive methodologies.

We welcome research aimed at identifying etiological factors and novel prevention and diagnostic and therapeutic targets through original studies of tumors and their microenvironment. Sampling of human cancer using minimal invasive diagnostics (i.e. liquid biopsies), knowledge on cancer progression, studies of evidence-based risk, predictive biomarkers of early diagnosis, treatment and disease monitoring, and translation research in prevention, diagnostics, and care will be considered.

For this Special Issue, potential topics include but are not limited to:

  • Minimally invasive surgical treatment;
  • Endoscopic digestive surgery;
  • Endovascular surgery;
  • Minimally invasive urology;
  • Minimally invasive head and neck surgery;
  • Early diagnosis of cancers;
  • Near-infrared/indocyanine green (NIR/ICG) technology imaging
  • Fluorescence imaging
  • Surgical robotics
  • 3D bioprinting
  • Machine learning
  • Artificial Intelligence

In light of these new advancements and needs, the Journal of Clinical Medicine has launched a Special Issue on innovative surgical research. We are prioritizing high-quality original studies but also welcome well-designed meta-analyses and reviews. We look forward to your contribution.

Prof. Dr. Vito D'Andrea
Prof. Dr. Andrea Mingoli
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

  • General Surgery
  • Digestive Surgery
  • Endocrine Surgery
  • Emergency Surgery
  • Bariatric Surgery
  • Breast Surgery
  • Oncological Surgery
  • Vascular Surgery
  • Laparoscopic Surgery
  • Robotic Surgery

Related Special Issue

Published Papers (8 papers)

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10 pages, 7156 KiB  
Article
Emergency, ABO-Incompatible Living Donor Liver Re-Transplantation for Graft Failure Complicated by Pneumonia-Associated Sepsis
by Seoung Hoon Kim and Young-Kyu Kim
J. Clin. Med. 2023, 12(3), 1110; https://doi.org/10.3390/jcm12031110 - 31 Jan 2023
Cited by 1 | Viewed by 2330
Abstract
Although liver re-transplantation is the only therapeutic option for acute and chronic graft failure, few studies have addressed the use of ABO-incompatible living donors in the emergency setting. Here, based on our experience, we report a successful case of emergency, ABO-incompatible, adult-to-adult, living [...] Read more.
Although liver re-transplantation is the only therapeutic option for acute and chronic graft failure, few studies have addressed the use of ABO-incompatible living donors in the emergency setting. Here, based on our experience, we report a successful case of emergency, ABO-incompatible, adult-to-adult, living donor liver re-transplantation (LDLT) for late graft failure from chronic rejection complicated by pneumonia-related sepsis. A fifty-five-year-old man had undergone LDLT for hepatocellular carcinoma accompanied by hepatitis C virus (HCV)-related cirrhosis in 30 September 2013. The voluntary donor was his 56-year-old wife, who was also a carrier of HCV. The donor and recipient blood types were the same: O and Rh positive. She underwent a right hepatectomy and was discharged on postoperative day (POD) seven. The patient was also discharged without complications on POD eleven and was followed up with on an outpatient basis. Abdominal distension and jaundice were developed at 6 months after LDLT, when the serum total bilirubin level was 2.7 mg/dL. The serum total bilirubin levels increased rapidly to 22.9 mg/dL over the next 4 months. Chronic rejection was diagnosed via liver biopsy. On 3 October 2014, he developed pneumonia-related sepsis and showed the progressive deterioration of liver function. Liver re-transplantation using the right liver from his ABO-incompatible, 20-year-old nephew was performed as an emergency in 15 October 2014. The donor blood type was A and Rh positive. The resection of the failed graft and the implantation of a new graft was performed by the intragraft dissection technique to re-use previously transplanted graft vessels in order to cope with severe adhesions. The recipient went through a gradual recovery process and was finally discharged on POD 50 with normal liver function, while the donor had an uneventful recovery and was discharged on POD 7. Biloma due to bile leak was detected three months after re-transplantation and was cured by percutaneous interventional procedures. Since then, the postoperative course has been event-free at regular outpatient follow-ups. The patient has so far had normal laboratory findings and no signs of complications. It has been 98 months since the re-transplantation, and the recipient and two donors are still in good condition with normal liver function, having complete satisfaction with the results obtained from this re-transplantation. In conclusion, long-term, satisfactory outcomes can be achieved in emergency, ABO-incompatible, adult-to-adult, living donor liver re-transplantation for graft failure complicated by pneumonia-related sepsis in selected patients. Full article
(This article belongs to the Special Issue Innovative Surgical Researches)
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11 pages, 1217 KiB  
Article
Extraperitoneal Laparoscopic Approach in Inguinal Hernia—The Ideal Solution?
by Bogdan Barta, Marina Dumitraș, Ștefana Bucur, Camelia Giuroiu, Raluca Zlotea, Maria-Magdalena Constantin, Victor Mădan, Traian Constantin and Cristina Raluca Iorga
J. Clin. Med. 2022, 11(19), 5652; https://doi.org/10.3390/jcm11195652 - 25 Sep 2022
Cited by 4 | Viewed by 6041
Abstract
Background: After more than 20 years since laparoscopy was proposed as a solution for one of the most common surgical pathologies, inguinal hernia, the choice of an intra- or extraperitoneal approach has remained a highly debated topic. Purpose and objectives: This study aimed [...] Read more.
Background: After more than 20 years since laparoscopy was proposed as a solution for one of the most common surgical pathologies, inguinal hernia, the choice of an intra- or extraperitoneal approach has remained a highly debated topic. Purpose and objectives: This study aimed at analyzing the feasibility of the extraperitoneal approach, by routine for this team/ and answering the question of whether this type of approach can be considered a safe one. Although indications for an intra- or extraperitoneal approach largely overlap, it may also be a matter of surgeon preference in choosing one technique. Methods: The study was retrospective, conducted on a group of 493 patients operated on for inguinal hernia in the clinic, by a single operating team, between January 2012 and March 2022. Results: It was proven that out of the 493 surgeries for inguinal hernia, 95.1% (n = 469) were operated upon by laparoscopic TEP (total extra peritoneal patch plasty approach); 1.62% (n = 8) by laparoscopic TAPP (transabdominal intraperitoneal); and 3.24% (n = 16) by the open, anterior approach (Lichtenstein). There were no intraoperative complications recorded in any of the procedures, while postoperative complications were found in 10.23% of cases (n = 48) in the extraperitoneal approach, and recurrences after the TEP approach were recorded in 0.40% of cases (n = 2). Conclusions: For correctly selected cases, TEP hernia surgery can be considered a safe and reliable approach. Full article
(This article belongs to the Special Issue Innovative Surgical Researches)
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11 pages, 1175 KiB  
Article
Outcomes of Laryngeal Cancer Surgery after Open Partial Horizontal Laryngectomies with Lateral Cervical Approach
by Andrea Colizza, Massimo Ralli, Arianna Di Stadio, Francesca Cambria, Federica Zoccali, Fabrizio Cialente, Diletta Angeletti, Antonio Greco and Marco de Vincentiis
J. Clin. Med. 2022, 11(16), 4741; https://doi.org/10.3390/jcm11164741 - 14 Aug 2022
Cited by 1 | Viewed by 1537
Abstract
Background: Open partial horizontal laryngectomies (OPHL) are one of the surgical techniques used for the conservative management of laryngeal cancers. The aims of this study are to analyze the oncological and functional results of a group of patients affected by laryngeal squamous cell [...] Read more.
Background: Open partial horizontal laryngectomies (OPHL) are one of the surgical techniques used for the conservative management of laryngeal cancers. The aims of this study are to analyze the oncological and functional results of a group of patients affected by laryngeal squamous cell carcinoma (LSCC) treated with OPHL, performed using a minimally invasive technique. Methods: This is a prospective case–control study. We enrolled 17 consecutive patients with LSCC treated with OPHL through a lateral cervical approach (LCA). Patients were evaluated using their Penetration Aspiration Scale score (liquid, semiliquid and solid) and Voice Handicap Index (VHI) at three different endpoints: 15 days (T1), 3 months (T2), and 6 months (T2) after surgery. Results: The functional outcomes of the LCA are stackable with that of the classical anterior cervical approach in terms of respiration, swallowing, and speech. One-way ANOVA was performed to evaluate the variances of PAS and VHI scores at the three different observation points. No statistically significant differences were observed between OPHL- PAS scores for liquid (p = 0.1) at the three different observation points. A statistically significant improvement was observed in the OPHL- PAS score for semisolids and solids (p < 0.00001) between T1 and T3 (p = 0.0001) and for solids between T2 and T3 (p < 0.00001). The improvement of VHI-10 was statistically significative (p < 0.00001) at the three different observation points (T1–T2 and T2–T3). Conclusion: The LCA is a potential approach for laryngeal surgery in selected cases. The preoperative staging and planning are of the utmost importance to ensure oncological radicality. The main advantage of this approach is the preservation of the healthy tissues surrounding the larynx and the functional and oncological outcomes are stackable with the classic anterior cervical approach. Full article
(This article belongs to the Special Issue Innovative Surgical Researches)
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12 pages, 900 KiB  
Article
Minimal Surgical Manpower for Living Donor Liver Transplantation
by Seoung Hoon Kim, Jang Ho Park and Byoung Ho An
J. Clin. Med. 2022, 11(15), 4292; https://doi.org/10.3390/jcm11154292 - 24 Jul 2022
Cited by 1 | Viewed by 3372
Abstract
Background: Living donor liver transplantation (LDLT) is widely performed with good outcomes in the current era of improved surgical techniques. However, few studies have addressed how many human resources are required in the surgery itself. This study aimed to introduce how to perform [...] Read more.
Background: Living donor liver transplantation (LDLT) is widely performed with good outcomes in the current era of improved surgical techniques. However, few studies have addressed how many human resources are required in the surgery itself. This study aimed to introduce how to perform LDLT with minimal manpower and evaluate the outcomes in adult patients. Methods: The main surgical procedures of donor and recipient operations of LDLT were performed by a single specialist surgeon who led a team of minimal manpower that only included one fellow, one resident, one intern, and three nurses. He also provided postsurgical care and followed up all the patients as a primary care physician. The outcomes were analyzed from the standpoints of the feasibility and acceptability. Results: Between November 2018 and February 2020, a total of 47 patients underwent LDLT. Ten patients had ABO-incompatible donors. The median age of the overall recipients was 57 years old (36–71); 37 patients (78.7%) were male. The MELD score was 10 (6–40), and the main etiologies were hepatic malignancy (38 patients or 80.9%) and liver failure (9 patients or 19.1%). The median age of the overall donors was 34 years old (19–62); 22 patients (46.8%) were male. All the graft types were right liver except for one case of extended right liver with middle hepatic vein. All donors had an uneventful recovery with no complications. There was one intraoperative mortality due to cardiac arrest after reperfusion in one recipient. Hepatic artery thrombosis was developed in 5 (10.6%) recipients. An acute rejection episode occurred in one patient. The median follow-up period for all the patients was 32.9 months (range, 24.7–39.8). Biliary complications were developed in 11 (23.4%) recipients. In total, 7 (15%) patients died, including 1 intraoperative mortality, 5 from cancer recurrence, and 1 from intracranial hemorrhage. The 1-, 2-, and 3-year overall survival rates in the recipient group were 91.5%, 87.2%, and 85.1%, respectively. Conclusions: LDLT with minimal surgical manpower is feasible under the supervision of a single expert surgeon who has the capacity for all the main surgical procedures in both donor and recipient operations without compromising the outcomes in the present era of advanced surgical management. Full article
(This article belongs to the Special Issue Innovative Surgical Researches)
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10 pages, 3963 KiB  
Article
Intracholecystic versus Intravenous Indocyanine Green (ICG) Injection for Biliary Anatomy Evaluation by Fluorescent Cholangiography during Laparoscopic Cholecystectomy: A Case–Control Study
by Lidia Castagneto-Gissey, Maria Francesca Russo, Alessandra Iodice, James Casella-Mariolo, Angelo Serao, Andrea Picchetto, Giancarlo D’Ambrosio, Irene Urciuoli, Alessandro De Luca, Bruno Salvati and Giovanni Casella
J. Clin. Med. 2022, 11(12), 3508; https://doi.org/10.3390/jcm11123508 - 17 Jun 2022
Cited by 6 | Viewed by 5223
Abstract
(1) Background: Fluorescence cholangiography has been proposed as a method for improving the visualization and identification of extrahepatic biliary anatomy in order to possibly reduce injuries and related complications. The most common method of indocyanine green (ICG) administration is the intravenous route, whereas [...] Read more.
(1) Background: Fluorescence cholangiography has been proposed as a method for improving the visualization and identification of extrahepatic biliary anatomy in order to possibly reduce injuries and related complications. The most common method of indocyanine green (ICG) administration is the intravenous route, whereas evidence on direct ICG injection into the gallbladder is still quite limited. We aimed to compare the two different methods of ICG administration in terms of the visualization of extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC), analyzing differences in the time of visualization, as well as the efficacy, advantages, and disadvantages of both modalities. (2) Methods: A total of 35 consecutive adult patients affected by acute or chronic gallbladder disease were enrolled in this prospective case–control study. Seventeen patients underwent LC with direct gallbladder ICG injection (IC-ICG) and eighteen subjects received intravenous ICG administration (IV-ICG). (3) Results: The groups were comparable with regard to their demographic and perioperative characteristics. The IV-ICG group had a significantly shorter overall operative time compared to the IC-ICG group (p = 0.017). IV-ICG was better at delineating the duodenum and the common hepatic duct compared to the IC-ICG method (p = 0.009 and p = 0.041, respectively). The cystic duct could be delineated pre-dissection in 76.5% and 66.7% of cases in the IC-ICG and IV-ICG group, respectively, and this increased to 88.2% and 83.3% after dissection. The common bile duct could be highlighted in 76.5% and 77.8% of cases in the IC-ICG and IV-ICG group, respectively. Liver fluorescence was present in one case in the IC-ICG group and in all cases after IV-ICG administration (5.8% versus 100%; p < 0.0001). (4) Conclusions: The present study demonstrates how ICG-fluorescence cholangiography can be helpful in identifying the extrahepatic biliary anatomy during dissection of Calot’s triangle in both administration methods. In comparison with intravenous ICG injection, the intracholecystic ICG route could provide a better signal-to-background ratio by avoiding hepatic fluorescence, thus increasing the bile duct-to-liver contrast. Full article
(This article belongs to the Special Issue Innovative Surgical Researches)
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10 pages, 523 KiB  
Article
Feasibility and Safety of Stentless Uretero-Intestinal Anastomosis in Radical Cystectomy with Ileal Orthotopic Neobladder
by Chung Un Lee, Jong Hoon Lee, Dong Hyeon Lee and Wan Song
J. Clin. Med. 2021, 10(22), 5372; https://doi.org/10.3390/jcm10225372 - 18 Nov 2021
Cited by 1 | Viewed by 1278
Abstract
Background: We evaluated the feasibility and safety of stentless uretero-intestinal anastomosis (UIA) during radical cystectomy (RC) with an ileal orthotopic neobladder. Methods: We retrospectively reviewed 403 patients who underwent RC for bladder cancer between August 2014 and December 2018. The primary objective was [...] Read more.
Background: We evaluated the feasibility and safety of stentless uretero-intestinal anastomosis (UIA) during radical cystectomy (RC) with an ileal orthotopic neobladder. Methods: We retrospectively reviewed 403 patients who underwent RC for bladder cancer between August 2014 and December 2018. The primary objective was to study the effect of stentless UIA on uretero-intestinal anastomosis stricture (UIAS), and the secondary objective was to evaluate the association between stentless UIA and other complications, including paralytic ileus, febrile urinary tract infection (UTI), and urine leakage. Kaplan–Meier survival analysis was used to estimate UIAS-free survival, and Cox proportional hazard models were applied to identify factors associated with the risk of UIAS. Results: Among 403 patients with 790 renal units, UIAS was identified in 39 (9.7%) patients and 53 (6.7%) renal units. Forty-four (83.0%) patients with UIAS were diagnosed within 6 months. The 1- and 2-year overall UIAS-free rates were 93.9% and 92.7%, respectively. Paralytic ileus was identified in 105 (26.1%) patients and resolved with supportive treatment. Febrile UTI occurred in 57 patients (14.1%). However, there was no leak of the UIA. Conclusions: Stentless UIA during RC with an ileal orthotopic neobladder is a feasible and safe surgical option. Further prospective randomized trials are required to determine the clinical usefulness of stentless UIA during RC. Full article
(This article belongs to the Special Issue Innovative Surgical Researches)
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21 pages, 6171 KiB  
Systematic Review
Systematic Review and Meta-Analysis of the Variants of the Obturatory Artery
by Gioia Brachini, Matteo Matteucci, Paolo Sapienza, Roberto Cirocchi, Alessandro Favilli, Stefano Avenia, Isaac Cheruiyot, Giovanni Tebala, Piergiorgio Fedeli, Justin Davies, Justus Randolph and Bruno Cirillo
J. Clin. Med. 2023, 12(15), 4932; https://doi.org/10.3390/jcm12154932 - 27 Jul 2023
Cited by 2 | Viewed by 725
Abstract
Background: Knowledge of vascular anatomy and its possible variations is essential for performing embolization or revascularization procedures and complex surgery in the pelvis. The obturator artery (OA) is a branch of the anterior division of the internal iliac artery (IIA), and it has [...] Read more.
Background: Knowledge of vascular anatomy and its possible variations is essential for performing embolization or revascularization procedures and complex surgery in the pelvis. The obturator artery (OA) is a branch of the anterior division of the internal iliac artery (IIA), and it has the highest frequency of variation among branches of the internal iliac artery. Possible anomalies of the origin of the obturator artery (OA) should be known when performing pelvic and groin surgery, where its control or ligation may be required. The purpose of this systematic review and meta-analysis, based on Sanudo’s classification, is to analyze the origin of the obturator artery (OA) and its variants. Methods: Thirteen articles published between 1952 and 2020 were included. Results: The obturator artery (OA) was present in almost all cases (99.8%): the pooled prevalence estimate for the origin from the IIA axis was 77.7% (95% CI 71.8–83.1%) vs. 22.3% (95% CI 16.9–28.2%) for the origin from EIA axis. In most cases, the obturator artery (OA) originated from the anterior division trunk of the internal iliac artery (IIA) (61.6%). Conclusions: Performing preoperative radiological examination to determine the pelvic vascular pattern and having the awareness to evaluate possible changes in the obturator artery can reduce the risk of iatrogenic injury and complications. Full article
(This article belongs to the Special Issue Innovative Surgical Researches)
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10 pages, 809 KiB  
Case Report
The Risk of Malignant Degeneration of Müllerian Derivatives in PMDS: A Review of the Literature
by Federica Gagliardi, Augusto Lauro, Livia De Anna, Domenico Tripodi, Anna Esposito, Flavio Forte, Daniele Pironi, Eleonora Lori, Patrizia Alba Gentile, Ignazio R. Marino, Ernesto T. Figueroa and Vito D’Andrea
J. Clin. Med. 2023, 12(9), 3115; https://doi.org/10.3390/jcm12093115 - 25 Apr 2023
Cited by 1 | Viewed by 1272
Abstract
Persistent Müllerian Duct Syndrome (PMDS) is a rare autosomal recessive disorder of sex development characterized by the presence of fallopian tubes, uterus and upper one-third of the vagina in individuals with XY genotype and normal male phenotype. The main complications of PMDS are [...] Read more.
Persistent Müllerian Duct Syndrome (PMDS) is a rare autosomal recessive disorder of sex development characterized by the presence of fallopian tubes, uterus and upper one-third of the vagina in individuals with XY genotype and normal male phenotype. The main complications of PMDS are infertility and the rare risk of malignant degeneration of both testicular and Müllerian derivatives. We report the case of a 49-year-old man who, during repair of an incisional hernia, was incidentally found to have a uterine-like structure posterior to the bladder. In the past at the age of 18 months, he had undergone bilateral orchidopexies for bilateral cryptorchidism. The intraoperative decision was to preserve the uterine-like structure and make a more accurate diagnosis postoperatively. Evaluation revealed an XY chromosome and imaging consistent with PMDS. The patient was informed about the risk of neoplastic transformation of the residual Müller ducts and was offered surgical treatment, which he declined. Subsequent follow-up imaging studies, including testicular and pelvic ultrasound, were negative for findings suggestive of malignant testicular and Mullerian derivative degeneration. A review of the international literature showed that, when a decision is taken to remove the Mullerian derivatives, laparoscopy and especially robotic surgery allow for the successful removal of Müllerian derivatives. Whenever the removal of these structures is not possible or the patient refuses to undergo surgery, it is necessary to inform the patient of the need for adequate follow-up. Patients should undergo regular pelvic imaging examination and MRI might be a better method for that purpose. Full article
(This article belongs to the Special Issue Innovative Surgical Researches)
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