Robot-assisted nephroureterectomy (RANU) has been more and more applied since 21st century. However, the high cost limits the widespread use of robot system. A relatively low-cost new robotic surgical system (KD-SR-01™) has recently been developed in China. To assess the safety and efficacy of the KD-SR-01™ Surgical System in RANU. Patients with upper-tract urothelial tumor and undergoing RANU with the KD-SR-01™ Robotic System were prospectively included. Surgeries were all performed by a single surgeon. Patients' demographic and clinical characteristics, perioperative data, pathology findings, and follow-up data were collected. Key Findings. 9 patients were enrolled in this study, and the surgeries went smoothly with no conversion to open. The 1st docking time, the 2nd docking time, and the operation time were 222 s, 169 s, and 202 min respectively. No equipment-related adverse events occurred. All patients were followed up for at least 3 months, and one patient experienced bladder recurrences. Conclusions and Clinical Implications. This study is the first to verify that the KD-SR-01™ robot system is effective and safe in RANU and has advantages in terms of its rotation boom during redocking and its price. This trial is registered with ChiCTR2200056672.

Surgical procedures have undergone a paradigm shift in the last 3 decades, with minimally invasive surgery becoming standard of care for a number of surgeries, including the treatment of benign gallbladder diseases. By providing a thorough and impartial summary of the earlier published systematic reviews, the current systematic review is the first to present comparison results. This review illustrates the data of intraoperative and postoperative results of each laparoscopic cholecystectomy technique. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was meticulously followed to conduct the present systematic review. MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, and Web of Science were searched for eligible publications, and a total of 14 systematic reviews were included. A newly developed extraction table was utilized to obtain the predefined parameters from eligible systematic reviews, including operative time, conversion rate, estimated blood loss, bile leak, length of hospital stay, postoperative pain, and cosmetic results. All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) software, version 26.0. The analysis of dichotomous results was summarized using relative risks and 95% confidence intervals (95% CI), and continuous results were summarized using mean differences and 95% CIs. The proportions were compared using a single proportion z-test. The analysis of our primary and secondary outcomes revealed a statistically significant improvement in aesthetic results after single-incision laparoscopic cholecystectomy (SILC) in comparison to the multiport approach of laparoscopic cholecystectomy. This, however, is accompanied by extended operative timing and subsequently, prolonged exposure to anesthesia. Patients should be carefully selected for SILC to minimize technical difficulties and prevent complications both intraoperatively and shortly after the procedure. This trial is registered with CRD42023392037.

Background: Perforated peptic ulcer (PPU) is one of the common complications of peptic ulcers. Open repair (OR) is the traditional surgical treatment for this condition, but with advances in laparoscopic and minimally invasive surgery, laparoscopic repair (LR) has gained popularity. Many studies have compared the effectiveness of OR vs. LR for PPU. However, the superiority of one method over the other remains a topic of debate. We conducted this review to investigate the advantages and disadvantages of LR over OR.Methods: PubMed, Scopus, Google Scholar, and Web of Science were searched from 2000 to 2022 for systematic reviews and meta-analyses comparing OR and LR for PPU. Previous studies included seven postoperative outcomes, including mortality, reoperation, postoperative ileus, intra-abdominal abscess, leakage, pneumonia, and wound infection. Two researchers independently extracted data and assessed the quality of the eligible studies using the AMSTAR 2 tool.Results: Five systematic reviews and meta-analyses were included, involving 36 studies. The pooled estimate showed that the risks for mortality, postoperative ileus, and wound infection were significantly lower with LR. In comparison, the risks for reoperation and leakage were less with OR. Based on the pooled estimate, no significant relationship was noted between the surgical method and intraabdominal abscess or postoperative pneumonia.Conclusion: Evidence suggests that in stable patients with PPU, LR is better than OR in terms of mortality. However, more high-quality evidence is needed to determine which is more appropriate for different circumstances (e.g., unstable or high-risk patients).

Since laparoscopy has been proposed in the management of the nonpalpable testis (NPT), this technique has been widely diffused among pediatric surgeons and urologists, but its application is still debated. We conducted a retrospective review to highlight how diagnostic and surgical indications for laparoscopy are selective and should be targeted to individual patients. From 2015 to 2019, 135 patients with NPT were admitted to our surgical division. Of these, 35 were palpable on clinical examination under anesthesia and 95 underwent laparoscopy. The main laparoscopic findings considered were: intra-abdominal testis (IAT), cord structures that are blind-ending, completely absent, or entering the abdominal ring. The patients' mean age was 22 months. In 48 cases, an IAT was found, and 42 of these underwent primary orchidopexy while 6 had the Fowler–Stephens (FS) laparoscopic procedure. Of the first group one patient experienced a testicular atrophy while two a reascent of the testis. In the FS orchidopexy group, one patient had testicular atrophy. Cord structures entering the internal inguinal ring were observed in 35 children, and all were surgically open explored. In 3 cases of these, a hypotrophic testis was revealed and an open orchidopexy was executed. In the remaining the histological examination revealed viable testicular cells in four patients and fibrosis, calcifications, and hemosiderin deposits in the others. Eleven patients presented with intrabdominal blind-ending vessels and one a testicular agenesia. A careful clinical examination is important to select patients to submit to laparoscopy. Diagnostic laparoscopy, and therefore, the anatomical observation of the testis and cord structures are strictly related to develop a treatment plan. In IAT, many surgical strategies can be applied with good results. Laparoscopy offers a concrete benefit to the patient.

Background Totally extraperitoneal herniorrhaphy (TEP) is a therapeutic challenge because of its complex anatomical location in inguinal region. The aim of this study was to describe the related surgical anatomy through laparoscopic observation and share the lessons learned from a review of 250 primary inguinal hernia repair procedures performed at our hospital from January 2013 to November 2019. Patients and Methods. There were 245 men and 5 women (median age: 63.2 years). Right hernia (60.2%) was the most common site. Indirect hernia (60.5%) was the most common abnormality. The classification of type II (65.0%) was the most common form. Surgical techniques comprised retromuscular approach using cauterized dissection, management of variations of arcuate line, Retzius space and Bogros space dissection, hernia sac reduction, and mesh positioning. Results The incidence of peritoneum injury was in 27 (10.1%). No epigastric vessels were injured. There were 8 (3%) hematoma and 18 (6.8%) seroma. No mesh infection, chronic pain, and recurrence were found after follow-up of an average of 35 months. Conclusion A good understanding of the anatomically complex nature in the inguinal region can make it easier and safer to learn the TEP approach. Early and midterm outcomes after TEP are satisfactory.

Objectives Upper abdominal symptoms are common in both gallstone disease and inflammatory disorders of gastroduodenum. To differentiate the causes of upper gastrointestinal symptoms due to gallstone and gastroduodenal disorders, upper gastrointestinal (UGI) scopy is a useful diagnostic tool. Our aim of study is to determine the efficacy of the preoperative UGI scopy and concurrent treatment of associated esophageal and gastric pathologies with symptomatic cholelithiasis in view of postoperative symptom reduction. Materials and Methods This is a prospective study comprising 400 symptomatic cholelithiasis patients admitted in our institution. All patients underwent upper GI endoscopy (1–4 days) prior to cholecystectomy, and the findings were noted. Then, based on findings in UGI scopy, patients were grouped as group A (endoscopy normal) and group B (endoscopy with some findings). Group B patients were treated with medication, and both groups were operated with laparoscopic cholecystectomy. Pain and other symptoms in the preoperative period and postoperative period were measured and compared in both groups. Results After excluding 7 patients with significant endoscopy findings, we have included 400 patients who underwent laparoscopy cholecystectomy. In a total of 400 patients, median age of presentation was 47.3 and female to male ratio was 2.2 : 1. Endoscopy showed some pathological findings in 75.5% patients, and the commonest endoscopy finding was gastritis. On comparison of pain score in preoperative patients, pain score was high in group B patients (p < 0.05). Pain reduction was significant in postoperative 1st, 4th, and 6th weeks in both groups (p < 0.0005). In the same way, other symptoms other than pain were compared which shows postoperative symptom reduction is highly significant in group B patients. Conclusion Clinical presentation of cholelithiasis and other upper GI diseases resemble each other. It is difficult to discriminate between upper GI symptoms due to cholelithiasis or any other upper GI conditions. Although UGI scopy is not recommended for all patients with cholelithiasis, it may be beneficial to do UGI scopy in certain cholelithiasis patients with atypical presentation to prevent atypical symptoms after surgery.

Methods This is a prospective observational study involving patients of age ≥16 years who underwent laparoscopic cholecystectomy for uncomplicated gall stone at BPKIHS between May and July 2019. Result 230 cases were analyzed, and RS was present in 90.4%. Open sulcus type was the commonest (54%), followed by scar type (22.9%), closed sulcus type (12.5%), and slit type (10.6%), respectively. In 59.1% of cases, it was oblique to the anterior, inferior, and external edge of the liver, while in the remaining cases, it was transverse. The mean ± SD values for operative time and duration of hospital stay in the RS visible and the RS not visible groups were 29.16 ± 8.736 and 42.9 ± 23.646 minutes, and 1.26 ± 0.440 and 1.90 ± 0.910 days, respectively (p value ≤0.001). One minor complication occurred in each group: RS initially visible group and RS visible on the adhesion release group, while 3 minor complications occurred in the RS not visible group. Only one major complication occurred in the RS not visible group. Conclusion Identification of RS by operating surgeons is a predictor of safe laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) is widely used for treating early acute cholecystitis (AC) and substantially reduces hospital costs. This study aimed to identify and evaluate risk factors associated with long postoperative hospital stays (PHSs) in patients undergoing emergency LC for AC according to the 2013 Tokyo Guidelines (TG13). Clinical data of patients who underwent emergency LC for AC between 2011 and 2017 were retrospectively collected. Patients were divided into early discharge (ED, discharge in three days or less postoperatively) and late discharge (LD, discharge in more than three days postoperatively) groups based on clinical progression and PHS after LC. Preoperative characteristics and perioperative outcomes were analysed as potential risk factors for LD. Among 149 patients, 104 (69.8%) were discharged within 3 days postoperatively, whereas 45 (30.2%) had long PHSs. Main causes of LD were fever and inflammation. Univariate analysis of preoperative risk factors revealed significant differences in age, white blood cell count, C-reactive protein, total bilirubin (T-bil), and alkaline phosphatase (ALP) levels; anticoagulation therapy; and TG13 severity grade. Multivariate analysis revealed that TG13 severity grade II, age >65 years, and elevated T-bil and ALP levels are independent factors for long PHS. Older age, worse biliary function, and increased TG13 severity grade might predict prolonged PHSs in AC patients undergoing emergency LC.

Introduction Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. British Association of Day Case Surgery recommends at least 60% of LCs be performed as day cases. The aim of this study was to assess our rate of true day case LCs and review factors preventing same-day discharge. Methods We prospectively collected data of all elective LCs performed in a district general hospital over 32 months. Results 500 patients underwent LC during this period; 438 (88.2%) patients were planned day cases and 59 patients (11.8%) planned overnight stays. Of the planned day cases, 75.8% (n=332) were discharged on the same day and 106 (24.2%) had unexpected overnight stay (UOS). Most patients with BMI >35 and ASA3 planned day case patients were successfully discharged. Drain insertion, longer operations, and late recovery departure were the main reasons for UOS. There were more complications in this group compared to day cases. Conclusions This unit has a high ‘true day case' rate of 75.8%. High BMI and ASA3 should not be absolute contraindications to day case surgery. The majority of unexpected overnight stays are unavoidable but may be reduced by patient selection, stringent preoperative assessment, operation scheduling, and reduction in unnecessary drain insertion.

Objective To study temporal trends of hysterectomy routes performed for uterine cancer and their associations with body mass index (BMI) and perioperative morbidity. Methods A retrospective review of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2013 databases was conducted. All patients who were 18 years old and older with a diagnosis of uterine cancer and underwent hysterectomy were identified using ICD-9-CM and CPT codes. Surgical route was classified into four groups: total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopic assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) including both conventional and robotically assisted. Patients were then stratified according to BMI. Results 7199 records were included in the study. TLH was the most commonly performed route of hysterectomy regardless of BMI, with proportions of 50.9%, 48.9%, 50.4%, and 51.2% in ideal, overweight, obese, and morbidly obese patients, respectively. The median operative time for TAH was 2.2 hours compared to 2.7 hours for TLH (p < 0.01). The median length of stay for TAH was 3 days compared to 1 day for TLH (p < 0.01). The percentage of patients with an adverse outcome (composite indicator including transfusion, deep venous thrombosis, and infection) was 17.1 versus 3.7 for TAH and TLH, respectively (p < 0.01). Conclusion During the last decade, TLH has been increasingly performed in women with uterine cancer. The increased adoption of TLH was seen in all BMI subgroups.