Center for Special Minimally Invasive and Robotic Surgery

Background/Objectives: Fallopian tube endometriosis is frequently underreported due to its nonspecific presentation, limitations in imaging detection, and the fact that histologic diagnosis often requires the submission of the entire fallopian tube for microscopic analysis, which is not routinely performed. This study investigates the prevalence of fallopian tube endometriosis on histologic evaluation in patients undergoing laparoscopic salpingectomy for benign gynecologic conditions, and evaluates its association with intraoperative findings such as endometriomas, hydrosalpinx, and peri-tubal adhesions. Methods: A prospective cohort study was conducted from September 2021 to December 2024 at NYU Grossman Long Island School of Medicine, including 80 women ages 18-65 years undergoing unilateral or bilateral salpingectomy. Fallopian tubes were entirely submitted for histologic examination and were evaluated in cross-sections for presence of endometriosis. The association between the presence of fallopian tube endometriosis, the stage of endometriosis, the presence of endometriomas, hydrosalpinx, and tubal adhesions was analyzed, with significance defined as p < 0.05. Results: 47 women were found to have biopsy-proven pelvic endometriosis (58.75%). The prevalence of fallopian tube endometriosis was 42.50% (34/80) in the total study population and 72.34% (34/47) among patients with pelvic endometriosis. The most commonly involved layer was the serosa (75.5%), followed by the muscularis (46.9%) and mucosa (18.4%). Fallopian tube endometriosis was significantly associated with endometriomas (p < 0.0001), hydrosalpinx (p < 0.0001), and tubal adhesions (p < 0.0001). It was also strongly correlated with disease severity, with 92.9% of patients with stage 4 endometriosis exhibiting tubal involvement. Conclusions: Fallopian tube endometriosis is more prevalent than previously recognized and shows a strong association with advanced-stage endometriosis, endometriomas, hydrosalpinx, and tubal adhesions.

Abstract Introduction Scientific research on cancer biology in the past few decades has enabled the development of multiple different types of new anticancer drugs. These therapeutic agents include tyrosine kinase inhibitors, monoclonal antibodies, and immunotherapies. They are significantly more precise than classical chemotherapies, but frequently induce adverse effects. Cutaneous side effects are the most frequently observed ones, and when they are severe or prolonged in time, they eventually lead to morbidity, dose modification or drug discontinuation. They significantly affect the quality of life in patients, medication adherence, elevate infection risk, resulting in high economic burden and many hospital visits for cancer patients. Case Presentation We report a case of severe acute asteatotic dermatitis in a 54-year-old male patient induced by pazopanib and nivolumab for the treatment of clear cell renal cell carcinoma. After treatment, the erythema faded, desquamation and xerosis were significantly reduced. Systemic oncology therapy was switched to M-TOR inhibitor everolimus. The patient maintains mild generalized skin xerosis, but is using topical emollient cream daily and topical corticosteroids occasionally for maintenance. The patient is being followed up. Conclusion The use of tyrosine kinase inhibitors and immunotherapy is constantly increasing, and dermatologists care for a growing number of cancer patients with cutaneous adverse events with different pathogenesis and complexity in comparison to the classical dermatoses. This leads to the need for a collaboration between dermatologists and oncologists.

Percutaneous image-guided thermal ablation (IGTA) is increasingly utilized for the management of primary and metastatic lung tumors. Several academic societies across various countries have issued clinical practice guidelines, opinion statements, and recommendations for IGTA in the treatment of lung tumors. However, unresolved conceptual and practical challenges persist, underscoring the need for a more comprehensive consensus on the safe and effective application of IGTA, particularly in Asian countries. Consequently, the guideline committee of the Asian Conference on Tumor Ablation (ACTA) established a dedicated working group to develop recommendations for the clinical use of IGTA in lung tumors. Through a thorough analysis of current literature and key clinical questions, the ACTA working group identified 10 critical issues, including indications, modality selection, technical considerations, and management of complications. Following extensive discussions and iterative revisions, experts from Asia-Pacific countries have formulated a consensus to guide clinical practice.

The surgical evaluation of pediatric liver tumors is challenging, especially in difficult cases that require precise surgery. Three-dimensional visualization (3D) based on two-dimensional CT (2D) has been widely used. However, virtual surgical simulation (VS), which can provide more procedural details for specific patients, is worthy of further exploration. Six pediatric liver tumor patients with the surgical difficulty increasing sequentially were selected. Recruited pediatric surgeons (15 junior and 15 senior) guided professional technicians in performing surgical evaluation using 2D, 3D, and VS sequentially. The patient-specific VS based on 3D can be constructed within the clinically permissible time window to meet clinical needs. For objective analysis, the scores in 3D Group and VS Group were significantly higher than those in 2D Group (P < 0.0001), and there was also a statistically significant difference between 3D Group and VS Group (P < 0.0001). As the difficulty increased, the 3D Group and VS Group consistently maintained higher scores. The scores of Junior Group using 2D were significantly lower than those of Senior Group (P < 0.0001), but there was no significant statistical difference in the scores of using 3D and VS. For subjective assessment, the scores of 3D Group and VS Group were significantly higher than those of 2D Group (P < 0.0001). VS was more aligned with clinical reality compared to 3D. 3D and VS offer significant advantages in surgical evaluation compared with 2D, particularly for difficult cases and junior surgeons. The novel perspective and realistic experience provided by VS have attracted attention, and future research will further validate its potential clinical value in preoperative rehearsals and advanced training.

Giant Hiatal Hernia (GHH) is defined as a hiatal hernia that includes at least 30–50% of stomach in the chest. Laparoscopic approach may be challenging with high recurrence rates. Robotic surgery may overcome some laparoscopic limits, but its role is still debated. We analysed a multicentric prospective database from 2011 to 2023 at General and Robotic Surgery Unit of San Giovanni Battista Hospital (Foligno-Spoleto, Italy) and General Surgery Unit of San Donato Hospital (Arezzo, Italy). A Robotic-Assisted Repair (RAR) was performed in all cases following a standardized surgical technique consisting of 6 steps. A literature review was carried out to identify surgical details linked to better outcomes. 47 consecutive patients underwent RAR. Four procedures were performed in emergency setting and 2 were redo-surgery. 1 (2%) conversion to open was required. Mean operative time was 158 min (range 90–235), and mean length of stay was 2.9 days (range 2–7). Fundoplication was performed in 97% of cases, while cruroplasty using pladgets in the 100%. Bioabsorbable mesh was used in 95% of patients. Anterior gastropexy or gastrostomy was made in the 85%. No patients were readmitted within 30 days, while 3 (6%) showed radiologic recurrences without clinical symptoms at long-term follow-up. A standardized surgical technique in GHH repair achieves lower postoperative complications and recurrence rates even in a long-term follow-up. Robotic platforms allow for safer and technically easier procedures, also in emergency scenarios. Higher costs may be balanced by better postoperative outcomes when compared to conventional literature laparoscopic outcomes.

Colonoscopists occasionally encounter mixed lesions with overlapping histological features. The frequency and combinations of such mixed colorectal polyps remain poorly understood. We comprehensively analyzed the frequencies and combinations of histologically mixed premalignant colorectal polyps. This study had a retrospective, single-center, cross-sectional design. Patients who underwent colonoscopy at the Toyoshima Endoscopy Clinic between March 2022 and July 2023 were eligible. We excised lesions diagnosed as conventional adenomas or clinically significant serrated polyps. Among these polyps, we focused on mixed lesions and analyzed their frequency and combinations. Among 9,682 resected colorectal lesions, 61 (0.63%) were classified as mixed lesions. The most common combination was microvesicular hyperplastic polyp (MVHP) + goblet cell-rich hyperplastic polyp (GCHP) (41.0%), followed by sessile serrated lesion (SSL) + traditional serrated adenoma (TSA) (21.3%), MVHP + conventional adenoma (9.8%), and TSA + conventional adenoma (9.8%). The mixed rates for MVHPs, GCHPs, SSLs, TSAs, and conventional adenomas were 2.3%, 3.7%, 2.9%, 53.5%, and 0.28%, respectively. Mixed MVHP + GCHP lesions were significantly larger than pure GCHPs (5.3 ‍mm vs 4.0 ‍mm, p<0.01). The frequencies and combinations of mixed premalignant colorectal lesions found in this study may reflect the histogenesis of neoplasia and genetic mutations.

This study tested the measurement of operator physiology during performance on robot-assisted surgery simulations to determine if these signals can identify errors and classify high and low performers. 57 participants performed digital simulations on da Vinci Xi system. Simulation videos, electrocardiogram (EKG), and electroencephalography (EEG) were analysed using linear mixed effects models. Relative to non-error intervals, errors elicited significant differences in EKG and EEG measures, including high-frequency power, interbeat interval and ratio of theta-to-alpha EEG power. High and low performers differed significantly in several of these measures, while classification models were accurate for the detection of errors (85.7%) and performance groups (96.3%), and using physiological signals leading up to errors, could accurately predict upcoming errors (85.7%). Noninvasive recording of physiology can differentiate error from non-error intervals and performance groups, leading to the possibility that online physiology can develop into training or early warning systems.