BACKGROUND: Schwannomas in the renal hilum are rare among retroperitoneal tumors. However, the possibility of malignant findings cannot be ruled out, and surgery is often indicated. This case was expected to be difficult to remove laparoscopically because the tumor was sandwiched between the arteriovenous veins of the renal portal. Sometimes, the tumor should be resected with a conservative approach to the kidney to preserve the renal function.
METHODS: Our patient was a 51-year-old Asian-Japanese man who was referred to our department for a retroperitoneal tumor in the renal hilum. Since malignancy could not be ruled out due to its size (45 × 48 × 55 mm) on imaging, the tumor was excised laparoscopically. Histopathology revealed schwannoma.
CONCLUSIONS: We herein report a case in which a renal hilar tumor between renal arteriovenous vessels was successfully resected laparoscopically.

Transthoracic access emerges as an innovative approach to reach lesions in the upper hepatic segments, especially in patients with prior surgeries. This study evaluates transthoracic access for these resections through a retrospective single-center analysis of demographic data, surgical techniques, and postoperative outcomes of 353 liver surgeries, revealing promising results with minimal complications. Transthoracic access and pneumoperitoneum establishment via the transthoracic route, combined with intercostal trocar insertion, offer a viable alternative for minimally invasive liver surgeries.

BACKGROUND: Pelvic organ prolapse (POP) is a common condition that can affect up to 30% of women over the age of 50. For a long time, open abdominal and laparoscopic sacrocolpopexy (LSCP) have been considered the gold standard in the treatment of apical pelvic organ prolapse (POP). Promontory dissection may expose patients to potential life-threatening intraoperative vascular injuries, as well as damage to sacral roots or the hypogastric nerve. Laparoscopic lateral suspension could be considered as an alternative to LSCP in the treatment of POP due to its favorable objective and subjective outcomes. The aim of this article is to demonstrate a step-by-step approach to laparoscopic lateral suspension for POP with the goal of standardizing this procedure. Technical key points and the latest progress are summarized to provide a reference for subsequent gynecological and urological surgeons.
METHODS: According to our surgical experience of our hospital, demonstrate a step-by-step approach and highlight technical key points for laparoscopic lateral suspension for POP with the aim of standardizing this procedure.
CONCLUSIONS: LLS with mesh is a safe alternative to laparoscopic sacropexy and is very well suited for uterine-preserving POP surgery. Nevertheless, this novel procedure lacks standardization. Standardization of procedures is necessary to reduce failure rates, generate impactful research data, and enhance patient safety. This article contributes to the standardization of this procedure, and we believe our article will be useful in assisting future gynecological and urological surgeons in performing this procedure.

BACKGROUND: This observation study aimed to differentiate between lobular endocervical glandular hyperplasia (LEGH) and gastric-type mucinous carcinoma (GAS) while evaluating the feasibility and efficacy of laparoscopic surgery in the preoperative diagnosis of cervical cystic lesions.
METHODS: A retrospective study was conducted to evaluate the diagnostic process and laparoscopic surgical management of cervical cystic lesions suspected to be LEGH or GAS. Preoperatively and postoperatively, MRI, cytology, histology, tumor marker analysis, and surgical outcomes (blood loss during surgery, operative time) were assessed. Six individuals were selected based on magnetic resonance imaging (MRI) results indicating a preoperative suspicion of LEGH or GAS. These patients underwent laparoscopic surgical treatment without indications of malignancy based on preoperative histology or cytology.
RESULTS: Initially, all individuals were suspected to have LEGH based on MRI findings. Postoperatively, two patients were diagnosed with LEGH, two with adenocarcinoma in situ (AIS) and minimal deviation adenocarcinoma (MDA), and two showed no notable findings on pathology (one diagnosed endometrioid carcinoma in endometrial tissue). Patients with malignancies exhibited longer surgical times and higher intraoperative blood loss. Preoperatively, no significant variation was observed in maximal lesion diameter between adenocarcinoma and LEGH. However, lesion diameter increased significantly over time in patients with GAS.
CONCLUSIONS: Laparoscopic surgery demonstrated feasibility and provided crucial diagnostic and therapeutic outcomes, with no postoperative recurrence observed in cases of malignancy, despite the challenges associated with preoperative differentiation. These findings underscore the potential of laparoscopic surgery in enhancing both diagnostic accuracy and therapeutic efficacy for cervical cystic lesions, offering promise for improved patient outcomes and management strategies in clinical practice.

BACKGROUND: This study compares the effect of positive end-expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in patients with obesity undergoing laparoscopic bariatric surgery (LBS) under general anesthesia with mechanical ventilation.
METHODS: A comprehensive search was conducted in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Internet, Wanfang database, and Google Scholar for studies published up to July 29, 2023, without time or language restrictions. The search terms included \"PEEP,\" \"laparoscopic,\" and \"bariatric surgery.\" Randomized controlled trials comparing different levels of PEEP or PEEP with zero-PEEP (ZEEP) in patients with obesity undergoing LBS were included. The primary outcome was a composite of PPCs, and the secondary outcomes were intraoperative oxygenation, respiratory compliance, and mean arterial pressure (MAP). A fixed-effect or random-effect model was selected for meta-analysis based on the heterogeneity of the included studies.
RESULTS: Thirteen randomized controlled trials with a total of 708 participants were included for analysis. No statistically significant difference in PPCs was found between the PEEP and ZEEP groups (risk ratio = 0.27, 95% CI: 0.05-1.60; p = 0.15). However, high PEEP ≥ 10 cm H2O significantly decreased PPCs compared with low PEEP < 10 cm H2O (risk ratio = 0.20, 95% CI: 0.05-0.89; p = 0.03). The included studies showed no significant heterogeneity (I2 = 20% & 0%). Compared with ZEEP, PEEP significantly increased intraoperative oxygenation and respiratory compliance (WMD = 74.97 mm Hg, 95% CI: 41.74-108.21; p < 0.001 & WMD = 9.40 ml cm H2O- 1, 95% CI: 0.65-18.16; p = 0.04). High PEEP significantly improved intraoperative oxygenation and respiratory compliance during pneumoperitoneum compared with low PEEP (WMD = 66.81 mm Hg, 95% CI: 25.85-107.78; p = 0.001 & WMD = 8.03 ml cm H2O- 1, 95% CI: 4.70-11.36; p < 0.001). Importantly, PEEP did not impair hemodynamic status in LBS.
CONCLUSIONS: In patients with obesity undergoing LBS, high PEEP ≥ 10 cm H2O could decrease PPCs compared with low PEEP < 10 cm H2O, while there was a similar incidence of PPCs between PEEP (8-10 cm H2O) and the ZEEP group. The application of PEEP in ventilation strategies increased intraoperative oxygenation and respiratory compliance without affecting intraoperative MAP. A PEEP of at least 10 cm H2O is recommended to reduce PPCs in patients with obesity undergoing LBS.
BACKGROUND: CRD42023391178 in PROSPERO.

UNASSIGNED: Laparoscopic cholecystectomy is one of the common surgeries occurring worldwide and the gold standard for the management of gallstone disease. The non-absorbable surgical clips may slip and can migrate causing a variety of problems as such, choledocholithiasis.
UNASSIGNED: The authors report a case of 43-year-old female who presented with the complaint epigastric pain. She had undergone cholecystectomy 7 years back for symptomatic cholelithiasis. Ultrasonography of the abdomen showed a dilated common bile duct following which endoscopic retrograde cholangiopancreatography was done. A single black-colored stone with the metal clip was retrieved.
UNASSIGNED: Post-cholecystectomy clip migration should be considered as one of the differentials for choledocholithiasis. Ultrasonography of the abdomen shows the dilated common bile duct. Further management is done by endoscopic retrograde cholangiopancreatography.
UNASSIGNED: Surgical clips acting as nidus for choledocholithiasis is rare these days but should be considered as one of the differentials for pain abdomen.

BACKGROUND: Conventional fascial plane block approaches for upper abdominal surgeries spare the lateral cutaneous nerve. An external oblique intercostal block (EOIB) may be suitable for upper abdominal incisions as it blocks the lateral and anterior branches of the intercostal nerves T6-T10. However, there is a paucity of studies evaluating this block in clinical settings. The study aimed to compare the analgesic efficacy of combined EOIB and rectus sheath block with local infiltration analgesia (LIA) in laparoscopic cholecystectomy (LC).
METHODS: After obtaining written informed consent, 70 patients were randomly allocated to undergo right-sided EOIB with 20 ml and left-sided RSB with 10 ml of 0.25% bupivacaine at the end of surgery (group ER, n = 35). Patients in the LIA group (n = 35) underwent local infiltration at the port site using 20 ml of the same solution (group LIA, n=35).
RESULTS: The visual analog scale scores with combined EOI and RSB were significantly lower than those with LIA at 1, 2, 4, 8, and 12 h (P < 0.001). Rescue analgesics were required by 65.7% and 14.3% of the patients in the LIA and block groups, respectively (P < 0.001). The time to first rescue analgesic was significantly greater in the ER group than that in the LIA group (2.8 ± 1.10 vs. 1.6 ± 0.50 h; P = 0.012). The number of times rescue analgesia was required was significantly lower in the ER group than that in the LIA group (1.00 ± 0.00 vs. 1.83 ± 0.72; P = 0.015). Nausea and vomiting scores were higher in the LIA group than those in the ER group (P < 0.001). Patient satisfaction scores were higher in the ER group than those in the LIA group.
CONCLUSIONS: EOIB combined with RSB provides superior analgesia compared with LIA and should be considered for LC.

Low-grade appendiceal mucinous neoplasm (LAMN) is principally characterized by low-grade cytology without evidence of invasion to other organs. We report a LAMN surgical case whose appendiceal tumor penetrated the sigmoid colon wall. An 87-year-old man was referred for endoscopic resection (ER) of a colon polyp. Despite four ERs over 5 years, the polyp recurred at the same site. Laparoscopic surgery revealed a dilated appendix firmly attached to the sigmoid colon. We performed en bloc resection of both the sigmoid colon and appendix without tumor exposure. The histopathological evaluation showed that the LAMN had penetrated the sigmoid colon wall, forming two polyps on the colonic mucosa. In cases where the appendiceal-colonic fistula is suspected, en bloc resection of the appendix and colon wall should be considered.

BACKGROUND: Clinical care pathways help guide and provide structure to clinicians and providers to improve healthcare delivery and quality. The Quality Improvement and Patient Safety Committee (QIPS) of the American Society for Metabolic and Bariatric Surgery (ASMBS) has previously published care pathways for the performance of laparoscopic sleeve gastrectomy (LSG) and pre-operative care of patients undergoing Roux-en-Y gastric bypass (RYGB).
OBJECTIVE: This current RYGB care pathway was created to address intraoperative care, defined as care occurring on the day of surgery from the preoperative holding area, through the operating room, and into the postanesthesia care unit (PACU).
METHODS: PubMed queries were performed from January 2001 to December 2019 and reviewed according to Level of Evidence regarding specific key questions developed by the committee.
RESULTS: Evidence-based recommendations are made for care of patients undergoing RYGB including the pre-operative holding area, intra-operative management and performance of RYGB, and concurrent procedures.
CONCLUSIONS: This document may provide guidance based on recent evidence to bariatric surgeons and providers for the intra-operative care for minimally invasive RYGB.

BACKGROUND: A meta-analysis was conducted on the perioperative and oncological outcomes of robot-assisted and laparoscopic lateral lymph node dissection in rectal cancer. There are few articles and reports on this topic, and a lack of high-quality research results in unreliable research conclusions. This study includes prospective and retrospective studies to obtain more reliable findings.
METHODS: Databases were searched, including PubMed, EMBASE, Cochrane, and Web of Science. The search was conducted from the time of database construction to March 2024. The quality of the literature was evaluated using the NOS scoring system. Meta-analysis was performed using R language software. Statistical heterogeneity was assessed using the I2 statistic, and sensitivity analysis was performed.
RESULTS: Six relevant literatures that met the criteria were finally included, and 652 patients were included, including 316 (48.5%) in the robot-assisted lateral lymph node dissection for rectal cancer group (RLLND) and 336 (51.5%) in the laparoscopic lateral lymph node dissection for rectal cancer group (LLLND). Analysis of the results showed that compared with the laparoscopic group, the robotic group had less mean intraoperative blood loss (MD = - 22, 95% CI - 40.03 to - 3.97, P < 0.05), longer operative time (MD = 51.57, 95%CI 7.69 to 95.45, P < 0.05), and a shorter mean hospital stay (MD = - 1.25, 95%CI - 2.46 to - 0.05, P < 0.05), a low rate of urinary complications (OR 0.39, 95%CI 0.23 to 0.64, P < 0.01), a low overall rate of postoperative complications (OR 0.6, 95%CI 0.42 to 0.87, P < 0.01), and a high number of lateral lymph node dissection (MD = 1.18, 95% CI 0.14 to 2.23, P < 0.05), and there was no statistically significant difference between the two groups in terms of postoperative anastomotic leakage, postoperative intestinal obstruction, and total number of lymph nodes obtained (P > 0.05).
CONCLUSIONS: Compared with laparoscopy, robotic lateral lymph node dissection for rectal cancer reduces intraoperative blood loss, shortens the average length of hospital stay, reduces urologic complications, decreases overall postoperative complications, and collects more lateral lymph nodes. However, the surgical time is prolonged.