Background: To compare anatomical, functional, and safety outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy (SCP) and vNOTES sacrospinous ligament fixation (SSLF) for apical pelvic organ prolapse (POP). Methods: Single-centre, single-surgeon, retrospective comparative cohort study conducted in accordance with the STROBE statement. Allocation to vNOTES SSLF (n = 24) or vNOTES SCP with a lightweight polypropylene Y-mesh (n = 32) was based on prespecified intra-operative feasibility criteria rather than randomisation. The primary outcome was composite apical anatomical success at 12 months (point C <= -5 cm and absence of apical POP-Q stage >= II). Secondary outcomes included perioperative parameters, visual analogue scale (VAS) pain scores, Quality-of-Recovery-40 (QoR-40), Prolapse Quality-of-Life (P-QOL), ICIQ-UI SF (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form) and PGI-I scores, and complications classified with the Clavien-Dindo and IUGA/ICS Category-Time-Site systems. Results: Baseline characteristics were balanced. Composite apical success at 12 months was achieved in 22/24 (91.7%) SSLF patients and 30/32 (93.8%) SCP patients (risk difference -2.1 percentage points; 95% CI, -17.6 to +13.5); this interval is compatible with clinically meaningful differences in either direction and does not support an inference of equivalence. Suspension time was shorter with SSLF (40.2 +/- 11.8 vs 54.6 +/- 12.7 min; p < 0.001), as was total operative time (89.7 +/- 15.2 vs 104.9 +/- 17.6 min; p = 0.001). Estimated blood loss, VAS pain, QoR-40, P-QOL, ICIQ-UI SF and PGI-I showed no statistically detectable difference. No intra-operative injuries, conversions to laparotomy, or mesh-related events (IUGA/ICS classification) were detected during a median follow-up of 21 months (range 6-36) for SSLF and 20 months (8-35) for SCP. Conclusions: In this hypothesis-generating single-surgeon cohort, vNOTES SSLF and vNOTES SCP showed no statistically detectable difference in short- to mid-term anatomical and patient-reported outcomes, with shorter suspension time favouring SSLF.
Background Laparoscopic training is essential for developing safe and effective surgical skills. While most training tasks are performed in static environments, intra-abdominal conditions are inherently dynamic due to physiological motion. Although dynamic training may therefore enhance skill acquisition and transfer, its effects on force-based laparoscopic tasks remain unclear.Methods In this randomized controlled study, 18 novices performed a force-based wire chaser task in a laparoscopic box trainer. Participants were assigned to a Static or Dynamic training group. The Dynamic group trained on a moving platform, while the Static group trained without movement. All participants completed four training trials, followed by a dynamic test and a static test. Four key objective performance metrics (time, mean non-zero force, maximum force, and path length) were recorded. Primary analyses compared between-group differences. Secondary analyses assessed within-group learning (trial 1 vs 4) and transition effects (trial 4 vs dynamic and static tests).Results No significant differences between groups were observed at the predefined primary assessment points and both groups demonstrated significant learning effects during training. Transition analyses showed that participants trained statically exhibited increased force application and movement when performing the dynamic test, whereas no significant transition effects were observed in the Dynamic group. Conversely, limited improvements were observed when transitioning to the static task. Data distribution suggested that a subset of participants in the Dynamic group achieved relatively high performance during the dynamic test.Conclusions In this study, dynamic training did not result in superior overall performance compared to static training in this force-based task. However, it may influence learning strategies and adaptability, particularly for a subset of learners. Dynamic training may therefore serve as a complementary modality to increase task complexity and adaptability. Future research should investigate long-term effects on skill acquisition and explore the urgency for dynamic tasks in laparoscopic training curricula.
Background This interim analysis evaluated the safety and efficacy of single anastomosis sleeve-ileal bypass (SASI) versus one-anastomosis gastric bypass (OAGB), and determined the optimal sample size for a prospective observational study using propensity score-matched (PSM) analysis. The short- and mid-term findings are reported herein.Methods By the mid-term analysis, 208 patients had completed at least six months of follow-up (108 SASI; 100 OAGB). Patients were matched 1:1 using propensity scores based on demographics, anthropometric measures and major comorbidities. Procedures were performed laparoscopically or robotically by experienced bariatric surgeons. Inverse probability of treatment weighting (IPTW) using average treatment effect among the treated weights was conducted as a sensitivity analysis.Results The planned sample size of 394 patients per group was not reached. After matching, no statistically significant differences in postoperative outcomes were detected between groups at 6, 12, or 18 months. Excess weight loss increased from 64.91% to 101.74% after OAGB and from 61.70% to 92.62% after SASI between short- and mid-term follow-up. At 18 months, all patients in both groups achieved medication-free blood glucose control.Conclusions SASI appeared feasible, with no significant differences from OAGB in reported short- and mid-term outcomes. The study remains underpowered; longer follow-up and the planned sample size are needed.
Background Cone-beam computed tomography (CBCT) is a critical component of liver directed therapies used to identify tumor feeding vessels. CBCT images are often limited by breathing motion artifacts. This study evaluates if post-processing CBCT images with a motion compensation algorithm improves image-quality for transarterial chemoembolization (TACE). Methods A motion compensated reconstruction algorithm was applied to CBCT images from 51 patients who underwent TACE with full-strength of half-strength contrast. All cases demonstrated respiratory motion artifact. Subjective analysis of CBCT images before and after motion compensation was performed by four blinded radiologists. Results Inter-reader agreement was substantial (Gwet's AC1 > 0.60). Across all cases, vessel sharpness (p = 0.023), confidence in identifying all feeding vessels (p = 0.036), and overall image quality (p = 0.024) were improved with the motion compensated reconstruction. The mean confidence in identifying all feeding vessels was improved in both the full-strength and half-strength contrast cases. Tumor conspicuity (p = 0.112) and the number of feeding vessels identified (p = 0.133) were not significantly different between groups. Conclusions The motion compensated reconstruction algorithm improved CBCT image quality scores across multiple criteria and improved reader confidence in the imaging findings. These findings support further prospective evaluation to determine if this translates into reduced repeat imaging, lower radiation exposure, shorter procedure time, or improved treatment selectivity.
Background Incontinence pads are the standard treatment for male stress urinary incontinence (SUI), especially after prostate surgery. Implantable devices are effective but limited by surgical waitlists and patient suitability. The PaceyCuff is a novel external urethral control device designed for extended wear while aiming to preserve blood flow, offering a less invasive option than surgery. This UK pilot study assessed preliminary clinical outcomes, tolerability, patient satisfaction, and short-term cost-offset observations.Methods Sixteen participants were enrolled. Two were excluded from the final analysis: one due to unrelated death and another due to inability to wear the PaceyCuff due to a buried penis. Baseline penile and finger peripheral oxygen saturation (SpO2), 3-h pad weight, 24-h pad count and patient-reported outcomes using the International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) and Quality of life questionnaire (QoL) were recorded. Participants were fitted with the PaceyCuff, and reassessed immediately, at 3 h and (via telephone) at two weeks and one month.Results ICIQ-UI scores fell from 17.4 to 7.2 at one month; QoL improved from 12.5 to 2.9. Urine loss decreased from 94 g to 10 g (p = .014). Pad use dropped from 4.2 to 1.7/day. Mean pain score 1.9/10, with two minor adverse events. Penile SpO2 remained stable, with no short-term clinical signs of ischaemia observed. The mean Charlson Comorbidity Index was 6.1. Weekly pad costs decreased from 42.34 pound to 17.95 pound (p = .002), potentially offsetting device costs within 13 weeks.Conclusions The PaceyCuff shows potential as a low-cost conservative and well-tolerated option for male SUI, including in patients unsuitable for surgery. Larger scale studies are required to confirm the long-term efficacy and safety associated with PaceyCuff.
