Physical and Mental Impact of Laparoscopic Sleeve Gastrectomy on the Surgeon: French vs. American Positions. A Randomized and Controlled Study

Laparoscopic Sleeve Gastrectomy in Situs Inversus Totalis: A Case Report

Obesity prevalence is increasing with the modern lifestyle. Bariatric surgery is an excellent method to sustain weight reduction and the most commonly performed surgery is laparoscopic sleeve gastrectomy (LSG). The laparoscopic approach can be challenged in certain conditions such as situs inversus totalis (SIT). We report a 38-year-old gentleman with class II obesity known to have SIT. After complete preoperative preparation, we performed LSG with no complications. The main difficulty of performing any surgical procedure for SIT patients is the reversed anatomy. It is essential to highlight the importance of anatomy for surgeons. Proper preoperative anatomy assessment along with the surgeon's experience is the key element to perform LSG or any bariatric laparoscopic procedure in rare conditions such as SIT.

Microwave ablation versus laparoscopic resection as first-line therapy for solitary 3-5-cm HCC

BACKGROUND AND AIMS

The study objective was to compare the effectiveness of microwave ablation (MWA) and laparoscopic liver resection (LLR) on solitary 3-5-cm HCC over time.

APPROACH AND RESULTS

From 2008 to 2019, 1289 patients from 12 hospitals were enrolled in this retrospective study. Diagnosis of all lesions were based on histopathology. Propensity score matching was used to balance all baseline variables between the two groups in 2008-2019 (n = 335 in each group) and 2014-2019 (n = 257 in each group) cohorts, respectively. For cohort 2008-2019, during a median follow-up of 35.8 months, there were no differences in overall survival (OS) between MWA and LLR (HR: 0.88, 95% CI 0.65-1.19, p = 0.420), and MWA was inferior to LLR regarding disease-free survival (DFS) (HR 1.36, 95% CI 1.05-1.75, p = 0.017). For cohort 2014-2019, there was comparable OS (HR 0.85, 95% CI 0.56-1.30, p = 0.460) and approached statistical significance for DFS (HR 1.33, 95% CI 0.98-1.82, p = 0.071) between MWA and LLR. Subgroup analyses showed comparable OS in 3.1-4.0-cm HCCs (HR 0.88, 95% CI 0.53-1.47, p = 0.630) and 4.1-5.0-cm HCCs (HR 0.77, 95% CI 0.37-1.60, p = 0.483) between two modalities. For both cohorts, MWA shared comparable major complications (both p > 0.05), shorter hospitalization, and lower cost to LLR (all p < 0.001).

CONCLUSIONS

MWA might be a first-line alternative to LLR for solitary 3-5-cm HCC in selected patients with technical advances, especially for patients unsuitable for LLR.

Factors that make Bariatric Surgery Technically Challenging: A Survey of 370 Bariatric Surgeons

BACKGROUND

There is no published data on the factors bariatric surgeons think make bariatric surgery challenging. This study aimed to identify factors that bariatric surgeons feel and increase the technical complexity of bariatric surgery.

METHODS

Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey on Survey Monkey®. An Average Weighted Score was calculated for each factor. A score of < 1.0 meant that the factor was perceived to make surgery technically easier.

RESULTS

Three hundred seventy bariatric and metabolic surgeons from 59 countries completed the survey. The top 10 factors that our respondents felt were most important for determining the technical difficulty of a procedure were inappropriate trocar placement (AWS 3.44), BMI above 60 (AWS 3.41), open bariatric surgery (AWS 3.26), less experienced bariatric anesthetist (AWS 3.18), liver cirrhosis (AWS 3), large liver (AWS 2.99), less experienced bariatric assistant (AWS 2.97), lower surgeon total bariatric surgery volume (AWS 2.95), lower surgeon specific procedure volume (AWS 2.85) and previous laparotomy (AWS 2.83), respectively. Respondents also felt that the younger patients (AWS 0.78), dedicated operating team (AWS 0.67), BMI less than 35 (AWS 0.54), and French position (AWS 0.45) actually make the surgery easier.

CONCLUSION

This survey is the first attempt to understand the factors which make bariatric surgery more difficult. Knowing the factors made the operation more challenging, led to better scheduling the potentially difficult patients to reduce the complications.