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Significant technical changes and a shift toward a transoral approach have occurred in the management of Zenker’s diverticulum over the past three decades. Transoral stapling is already an established and commonly performed procedure. Zenker peroral endoscopic myotomy (Z-POEM) and Zenker peroral endoscopy septotomy (Z-POES) are innovative techniques that are rapidly spreading and replacing more traditional therapeutic options. This review provides an overview of the current status of minimally invasive transoral management to assess whether a tailored approach is feasible and safe and may improve quality of life and reduce recurrence rates. LESS      Full article

The incorporation of magnetic fields into surgery to reduce the invasiveness of minimally invasive surgery led to the creation of magnetic-assisted surgery. External magnets coupled with their internal counterparts assist during surgical procedures, avoiding the need for additional trocars. Multiple advances have been made in this field in the past 15 years, with new promising technologies being developed. This review centers on the history of magnetic-assisted surgery and the available evidence of its safety, benefits and discusses the very promising combination of this new paradigm-shift technology with robotics. LESS      Full article

Over the past decades, the significant development in endoscopic imaging has revolutionized digestive endoscopy. Real-time optical diagnosis has become possible using different tools and techniques (dye-based and virtual chromoendoscopy) such as narrow band imaging, flexible spectral imaging color enhancement, i-Scan, blue-laser imaging and linked-color imaging. Polyp detection and characterization, and prediction of depth of invasion of colorectal cancers have improved remarkably. Confocal laser endomicroscopy and endocytoscopy have allowed the evaluation of lesions on a cellular level. Not far from the horizon are newer technological innovations such as artificial intelligence and texture and color enhancement imaging that are now being studied for their potential to further improve mucosal visualization, optical diagnosis and virtual histology. This review gives an overview of image-enhanced endoscopy (IEE) and discusses its clinical applications and future directions in the lower gastrointestinal (GI) tract. LESS      Full article

Laparoscopic sleeve gastrectomy (SG) has reached wide popularity during the last 15 years, owing to limited morbidity and mortality rates, very successful weight loss results, and impact on comorbidities. However, the postoperative development or worsening of gastroesophageal reflux disease (GERD) is one of the most important drawbacks of this surgical procedure. To date, there is great heterogeneity concerning the definition of GERD, the indication for SG in patients with GERD, and the standardization of pre and postoperative diagnostic pathways. In patients with severe obesity, a strictly symptom-based diagnosis of GERD is unreliable. In fact, a high rate of silent GERD (s-GERD, asymptomatic patients despite objective evidence of GERD) has been reported. Moreover, patients with preoperative s-GERD have a significantly higher risk of experiencing GERD symptoms after SG. For these reasons, the reflux burden and the competence of the anti-reflux barrier should be carefully assessed during the preoperative work-up of patients undergoing SG. Ambulatory pH monitoring (APM) and high-resolution manometry (HRM) are useful diagnostic tools that could provide valuable evidence in the guidance of surgical strategy. In this review, we evaluate the current literature concerning the use of APM and HRM in the diagnostic pathway before SG, as well as their predictive value for the evolution of GERD in the postoperative course. Moreover, we propose a diagnostic algorithm for preoperative GERD assessment, which includes validated symptom questionnaires, upper gastrointestinal endoscopy, APM, and HRM. LESS      Full article

The recent application of novel technologies to the robot-assisted radical prostatectomy (RARP) procedure has provided a new perspective and demonstrated potential usefulness in surgical planning, intraoperative navigation, and education of both patients and healthcare professionals, allowing for a patient-tailored prostate cancer (PCa) treatment. Integration of novel techniques into robotic surgery has improved the accuracy of surgery and has demonstrated a potential benefit in functional and oncological outcomes in patients with PCa. However, further randomized and prospective studies are needed to assess and validate the role of these technologies in clinical practice. The aim of this review is to summarize the current evidence on the new emerging techniques, such as three-dimensional (3D) imaging and printing, augmented reality (AR), and confocal microscopy (CM), and their impact on RARP and its oncological outcomes. LESS      Full article

Hybrid revascularization of multivessel coronary artery disease by combining coronary artery bypass grafting (CABG) and chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a relatively novel concept. Hybrid CABG-CTO PCI aims to combine the durable clinical benefits of a left internal mammary artery graft (ideally minimally invasively) with the durability of CTO PCI in non-left anterior descending vessels. This review assesses the current evidence for performing hybrid CTO PCI-CABG and pre-procedural planning considerations. LESS      Full article

Obesity is a growing epidemic affecting more than one third of the United States’ population. It has detrimental effects on an individual’s health and is associated with myriad negative outcomes including increased mortality. It also poses a substantial financial burden on the healthcare system. Weight loss surgery is an effective way of treating obesity with tremendous positive outcomes. Most patients who undergo bariatric surgery lose a significant amount of weight, reverse most of their comorbidities, and enjoy an improved quality of life. However, fewer than one percent of patients eligible for bariatric surgery actually undergo treatment. Furthermore, there exists a considerable gender disparity, with women comprising 80% of those patients who undergo bariatric surgery, despite equal obesity rates across genders. Many barriers exist between obese patients and weight loss surgery including misconceptions among patients and primary care providers regarding the perceived risk of surgery. This is in addition to numerous other psychosocial and cultural factors that may have contributed to and precipitated the existing gender imbalance. This review aims to highlight barriers to patients undergoing bariatric surgery and examine factors leading to the gender disparity that exists. LESS      Full article

This chapter is devoted towards analyzing the progress and barriers to the development of artificial intelligence (AI) and medical robotics in minimally-invasive surgery. The less invasive the surgical intervention and the further the surgeon is from the operating table, the greater the roles of decision support systems (AI) and performance of specific tasks (by medical robots). LESS      Full article

Aim: The aims of this study were to better understand the outcomes of Roux-en-Y gastric bypass (RYGB) surgery in patients across multiple hospitals in China along with patients with type 2 diabetes mellitus (T2DM) and to explore the potential preoperative predictors of diabetes outcomes after RYGB.Methods: This was a retrospective cohort study in Chinese patients who underwent laparoscopic RYGB at five Chinese hospitals from April 2009 to December 2014 and returned for follow-up approximately one-year post-surgery. The STROCSS guideline checklist was applied.Results: In total, 130 patients underwent RYGB: 85 males and 45 females; age, 43.4 ± 11.3 years; and preoperative body mass index (BMI), 33.1 ± 9.0 kg/m². Of those, 103 (79.2%) had T2DM duration of 6.6 ± 4.7 years and pre-RYGB HbA1c of 8.1 ± 1.9%. Among the patients with T2DM, glycemic control (HbA1c < 7.0%) increased from 28.7% before surgery to 79.3% at 12 months post-procedure, with a concurrent reduction in the use of anti-hyperglycemic agents, including a reduction in insulin requirement from 55.4% to 27.0%. The percentage of excess weight loss was -42.8 ± 44.2%. Among 71 patients with T2DM and data about remission status, 14 (19.7%) achieved T2DM remission at 12 months post-surgery. Age and duration of T2DM were lower in the remission group, while baseline BMI and weight were higher compared with the non-remission group.Conclusion: RYGB may be effective for weight loss and T2DM control in Chinese patients, and outcomes are consistent with the literature in Western populations. Younger patients with T2DM and with a higher BMI pre-surgery and shorter duration of T2DM were more likely to achieve T2DM remission. LESS      Full article