Journal of the American College of Surgeons
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The frequency and significance of the germline variants in DNA damage repair genes still need to be elucidated in patients with sporadic pancreatic ductal adenocarcinoma (PDAC). Our purpose was to determine whether germline variants in DNA damage repair genes were associated with survival of patients with sporadic PDAC. ⋯ Having a deleterious variant in a DNA damage repair gene is associated with improved survival after resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma.
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Randomized Controlled Trial
Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low- to Middle-Income Countries: A Phase II Non-Inferiority Randomized Controlled Study.
Minimal access surgery is not available to most people in rural areas of low-to middle-income countries. This leads to an increase in morbidity and economic loss to the poor and marginalized. Gasless laparoscopic (GAL) procedures are possible in rural areas because they can be performed under spinal anesthesia. In most cases, it does not require the logistics of providing gases for pneumoperitoneum and general anesthesia. The current study compares GAL with conventional laparoscopic (COL) operations for general surgical procedures. ⋯ No significant differences were found between the 2 groups. GAL can be considered as noninferior compared with COL and has the potential to be adopted in low-resource settings.
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Minimally invasive surgery techniques have evolved remarkably over the past few decades in the field of surgical oncology, including nascent techniques for pancreatic malignancies. The emergence of the robotic surgery platform has accelerated widespread implementation of minimally invasive pancreatectomy. However, whether minimally invasive approaches can maintain the quality of oncologic surgical procedures, particularly in superior mesenteric artery (SMA) dissection during pancreatoduodenectomy, remains unknown. ⋯ Specifically, vessel loops encircling the superior mesenteric vein are ligated with Endoloops, and the ends of the Endoloops are carefully retracted externally on the patient’s left side. This maneuver provides critical exposure of the SMA that allows safe, high-quality oncologic dissection. We describe our external retraction techniques in the video presentation, which can improve the safety and quality of robotic pancreatoduodenectomy.