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  • Review Article 2024-06-15

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    Propensity score matching for comparative studies: a tutorial with R and Rex

    Bora Lee , Nam-eun Kim , Sungho Won , Jungsoo Gim

    Journal of Minimally Invasive Surgery 2024; 27(2): 55-71 https://doi.org/10.7602/jmis.2024.27.2.55
    Abstract

    Recently, there has been considerable progress in developing new technologies and equipment for the medical field, including minimally invasive surgeries. Evaluating the effectiveness of these treatments requires study designs like randomized controlled trials. However, due to the nature of certain treatments, randomization is not always feasible, leading to the use of observational studies. The effect size estimated from observational studies is subject to selection bias caused by confounders. One method to reduce this bias is propensity scoring. This study aimed to introduce a propensity score matching process between two groups using a practical example with R. Additionally, Rex, an Excel add-in graphical user interface statistical program, is provided for researchers unfamiliar with R programming. Further techniques, such as matching with three or more groups, propensity score weighting and stratification, and imputation of missing values, are summarized to offer approaches for more complex studies not covered in this tutorial.

  • Editorial 2024-06-15

    0 89 36

    Comments on “Impact of nasogastric tube exclusion after minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study in India”

    Sin Hye Park , Dong Jin Kim

    Journal of Minimally Invasive Surgery 2024; 27(2): 72-73 https://doi.org/10.7602/jmis.2024.27.2.72
  • Editorial 2024-06-15

    0 84 36

    Is liquid skin adhesive safe and feasible for skin closure in single-port laparoscopic appendectomy?

    Hyun Gu Lee

    Journal of Minimally Invasive Surgery 2024; 27(2): 74-75 https://doi.org/10.7602/jmis.2024.27.2.74
  • Original Article 2024-06-15

    0 130 65

    Effect of prophylactic abdominal drainage on postoperative pain in laparoscopic hemicolectomy for colon cancer: a single-center observational study in Korea

    Sung Seo Hwang , Heung-Kwon Oh , Hye-Rim Shin , Tae-Gyun Lee , Mi Jeong Choi , Min Hyeong Jo , Hong-min Ahn , Hyeonjeong Park , Hyun Hee Sim , Eunjeong Ji , Anuj Naresh Singhi , Duck-Woo Kim , Sung-Bum Kang

    Journal of Minimally Invasive Surgery 2024; 27(2): 76-84 https://doi.org/10.7602/jmis.2024.27.2.76
    Abstract

    Purpose: This study aimed to evaluate the effect of prophylactic abdominal drainage (AD) in laparoscopic hemicolectomy, focusing on assessing postoperative pain outcomes.
    Methods: Patients were categorized into two groups: those with and without AD (AD group vs. no-AD group). A numerical rating scale (NRS) was used to assess postoperative pain on each postoperative day (POD). Further, the inverse probability of treatment weighting (IPTW) method was used to reduce intergroup bias.
    Results: In total, 204 patients who underwent laparoscopic hemicolectomies by a single surgeon between June 2013 and September 2022 at a single institution were retrospectively reviewed. After adjusting for IPTW, NRS scores on POD 2 were significantly lower in the no-AD group (3.2 ± 0.8 vs. 3.4 ± 0.8, p = 0.043). Further examination of postoperative outcomes showed no statistically significant differences in complications between the AD (17.3%) and no-AD (12.4%) groups (p = 0.170). The postoperative length of hospital stay was 7.3 ± 2.8 days in the AD group and 6.9 ± 3.0 days in the no-AD group, with no significant difference (p = 0.298). Time to first flatus was 3.0 ± 0.9 days in the AD group and 2.7 ± 0.9 days in the no-AD group, with no significant difference (p = 0.078). Regarding readmission within 1 month, there were four cases each in the AD (2.3%) and no-AD (1.7%) groups, with no significant difference (p = 0.733).
    Conclusion: Laparoscopic hemicolectomy without AD resulted in no significant differences in postoperative clinical outcomes, except for postoperative pain. This finding suggests that prophylactic AD may exacerbate postoperative pain.

  • Original Article 2024-06-15

    0 95 32

    A retrospective noninferiority study of laparoscopic inguinal hernia repair feasibility for recently graduated surgeons in Thailand

    Thanat Tantinam , Tawadchai Treeratanawikran , Pattiya Kamoncharoen , Ekawit Srimaneerak , Metpiya Siripoonsap , Thawatchai Phoonkaew

    Journal of Minimally Invasive Surgery 2024; 27(2): 85-94 https://doi.org/10.7602/jmis.2024.27.2.85
    Abstract

    Purpose: The feasibility of starting laparoscopic surgery among newly graduated surgeons lacking extensive experience in open approaches remains a topic of interest. We aimed to evaluate the safety and efficacy of laparoscopic inguinal hernia repair (LHR) compared to open inguinal hernia repair (OHR) in this population.
    Methods: This retrospective cohort study was conducted on inguinal hernia surgeries performed by a single recently graduated surgeon during the learning phase. Patient data were collected from July 2021 to November 2022 with a focus on demographics, intraoperative details, and 1-year postoperative outcomes. Noninferiority testing was employed with a predetermined margin of 15% to compare the complication rates, recurrence rates, and other secondary outcomes between LHR and OHR.
    Results: The study cohort comprised 66 patients (OHR group, n = 45 and LHR group, n = 21). Patient characteristics were similar between groups. No significant differences were observed in the complication rates (OHR, 26.7% and LHR, 19.0%; p = 0.50) or recurrence rates (OHR, 2.2% and LHR, 4.8%; p = 0.54). The LHR group demonstrated noninferior outcomes compared with the OHR group in terms of complication, recurrence, readmission, and reoperation rates. Except for the operative time, secondary outcomes did not differ significantly between the groups.
    Conclusion: LHR is a feasible initiation for recently graduated surgeons, demonstrating noninferior outcomes compared with open repair. Therefore, the belief that one must master open surgery before beginning laparoscopy may be untrue.

  • Original Article 2024-06-15

    0 128 73

    Incidence of clinically relevant postoperative pancreatic fistula in patients undergoing open and minimally invasive pancreatoduodenectomy: a population-based study

    Jenny H. Chang , Rasha T. Kakati , Chase Wehrle , Robert Naples , Daniel Joyce, Toms Augustin , Robert Simon, R Matthew Walsh , Fadi S. Dahdaleh, Philip Spanheimer , Isabella Salti, Alessandro Parente , Samer A. Naffouje

    Journal of Minimally Invasive Surgery 2024; 27(2): 95-108 https://doi.org/10.7602/jmis.2024.27.2.95
    Abstract

    Purpose: Postoperative pancreatic fistula (POPF) remains a devastating complication of pancreatoduodenectomy (PD). Minimally invasive PD (MIPD), including laparoscopic (LPD) and robotic (RPD) approaches, have comparable POPF rates to open PD (OPD). However, we hypothesize that the likelihood of having a more severe POPF, as defined as clinically relevant POPF (CR-POPF), would be higher in an MIPD relative to OPD.
    Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted pancreatectomy dataset (2014–2020) was reviewed for any POPF after OPD. Propensity score matching (PSM) compared MIPD to OPD, and then RPD to LPD.
    Results: Among 3,083 patients who developed a POPF, 2,843 (92.2%) underwent OPD and 240 (7.8%) MIPD; of these, 25.0% were LPD (n = 60) and 75.0% RPD (n = 180). Grade B POPF was observed in 45.4% (n = 1,400), and grade C in 6.0% (n = 185). After PSM, MIPD patients had higher rates of CR-POPF (47.3% OPD vs. 54.4% MIPD, p = 0.037), as well as higher reoperation (9.1% vs. 15.3%, p = 0.006), delayed gastric emptying (29.2% vs. 35.8%, p = 0.041), and readmission rates (28.2% vs. 35.1%, p = 0.032). However, CR-POPF rates were comparable between LPD and RPD (56.8% vs. 49.3%, p = 0.408).
    Conclusion: The impact of POPF is more clinically pronounced after MIPD than OPD with a more complex postoperative course. The difference appears to be attributed to the minimally invasive environment itself as no difference was noted between LPD and RPD. A clear biological explanation of this clinical observation remains missing. Further studies are warranted.

  • Case Report 2024-06-15

    0 96 65

    Mesh migration into esophagogastric junction after laparoscopic hiatal hernia repair; how to prevent it? A case report

    Moon-Soo Lee , Dong Kyu Lee , Hyun-Young Han , Joo Heon Kim

    Journal of Minimally Invasive Surgery 2024; 27(2): 109-113 https://doi.org/10.7602/jmis.2024.27.2.109
    Abstract

    Although the use of mesh reinforcement during large hiatal hernia repair may reduce the rate of recurrence, various mesh-related complications have been reported. A 65-year-old woman presented with dysphagia. The patient was diagnosed with a large hiatal hernia and treated with laparoscopic fundoplication and Collis gastroplasty with mesh repair. Six months after surgery, the patient presented with dysphagia and vomiting. Esophagogastroduodenoscopy showed migration of mesh material into the esophagogastric junction. We performed a proximal gastrectomy with mesh removal. The patient was discharged without any postoperative complications. Herein, we encountered a rare case requiring surgical treatment to resolve mesh-induced esophagogastric perforation after hiatal hernia repair. Mesh-associated complications, such as erosion or migration, should be considered as they may be more common than previously reported. Additionally, these complications are currently underscored in clinical practice. Regarding mesh applications, symptoms of mesh-related complications, such as dysphagia, should be carefully monitored for early detection.

  • Video/Multimedia Article 2024-06-15

    0 115 58

    The method of using robotic Harmonic ACE curved shears for parenchymal transection in robotic hepatectomy

    Eun Jeong Jang , Sung Hwa Kang , Kwan Woo Kim

    Journal of Minimally Invasive Surgery 2024; 27(2): 114-117 https://doi.org/10.7602/jmis.2024.27.2.114
    Abstract

    Robotic liver surgery is emerging as a minimally invasive surgery to overcome the disadvantages of laparoscopy. The two biggest barriers to the uptake of robotic hepatectomy are the high cost and instrument limitations. Transection of the liver parenchyma is the main issue in robotic hepatectomy. Nonetheless, with adequate experience and the aid of reliable and enhanced three-dimensional visualization, many robotic surgeons have successfully used robotic Harmonic ACE curved shears (Intuitive Surgical Inc.) for parenchymal transection of the liver. Herein, we share a method of using robotic Harmonic ACE curved shears for parenchymal transection using a video clip.

  • Video/Multimedia Article 2024-06-15

    0 115 68

    Various retraction techniques for laparoscopic pancreaticoduodenectomy

    Kwang Hyun Kim , Eui Hyuk Chong , Incheon Kang , Sung Hwan Lee , Seok Jeong Yang

    Journal of Minimally Invasive Surgery 2024; 27(2): 118-124 https://doi.org/10.7602/jmis.2024.27.2.118
    Abstract

    The laparoscopic pancreaticoduodenectomy (LPD), introduced by Gagner and Pomp in 1994, is typically done in high-volume centers due to its technical demands. Our methods aim to provide effective traction, enabling efficient surgery despite limited staffing. A retrospective analysis of 29 patients undergoing LPD by a single surgeon between September 2021 and December 2022 showed promising outcomes: median intraoperative bleeding of 425 mL, operation time of 505 minutes, and postoperative hospital stay of 10 days. With only one case requiring open conversion, our external retraction techniques demonstrate efficacy in overcoming challenges associated with manpower constraints, highlighting potential utility for surgeons in similar settings. We share LPD external retraction techniques and outcomes.

  • Video/Multimedia Article 2024-06-15

    0 141 73

    Robotic subtotal left pancreatectomy with preservation of the bile duct and spleen for multifocal pancreatic metastases: a video vignette of organ-sparing pancreatectomy for tumors that do not require regional lymphadenectomy

    Charnwit Assawasirisin , Wethit Dumronggittigule , Prawej Mahawithitwong , Chutwichai Tovikkai

    Journal of Minimally Invasive Surgery 2024; 27(2): 125-127 https://doi.org/10.7602/jmis.2024.27.2.125
    Abstract

    Pancreatectomy for pancreatic metastases (PM) yields acceptable survival outcomes in selected renal cell carcinoma (RCC) patients. We describe a technique for robotic subtotal left pancreatectomy with preservation of the common bile duct (CBD) and spleen in a patient with multifocal RCC-PM. The patient, who had RCC and underwent nephrectomy 20 years ago, presented with a pancreatic mass. Computed tomography and endoscopic ultrasonography demonstrated one mass at the head of pancreas (HOP), and other three lesions at neck, body, and tail. HOP lesion located near CBD. Subtotal left pancreatectomy was more preferred option than total pancreatectomy due to better endocrine function. The ultrasound-guided CBD and uncinate-preserving resection started at HOP, and then continued with distal pancreatectomy. The pathology revealed metastatic RCC with a negative margin. The patient experienced only biochemical pancreatic leakage. One month after surgery, the patient only required oral medication for diabetes treatment. In conclusion, the robot-assisted technique is helpful in increasing the success rate of organ-sparing pancreatectomy.

JMIS
Jun 15, 2024 Vol.27 No.2
pp. 55~127

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pISSN 2234-778X
eISSN 2234-5248