With the development of artificial intelligence technology and the growing demand for minimally invasive surgery, the intelligentization of minimally invasive surgery has become a current research hotspot. Surgical instrument segmentation is a highly promising technology that can enhance the performance of minimally invasive endoscopic imaging systems, surgical video analysis systems, and other related systems. This article summarizes the semantic and instance segmentation methods of minimally invasive surgical instruments based on deep learning, deeply analyzes the supervision methods of training algorithms, network structure improvements, and attention mechanisms, and then discusses the methods based on the Segment Anything Model. Given that deep learning methods have extremely high requirements for data, current data augmentation methods have also been explored. Finally, a summary and outlook on instrument segmentation technology are provided.
Artificial Intelligence ; Minimally Invasive Surgical Procedures/instrumentation* ; Algorithms ; Deep Learning ; Humans ; Image Processing, Computer-Assisted

The clinical application of binocular endoscope relies primarily on the visual system of physicians to create a three-dimensional effect, but it cannot provide accurate depth information. The utilization of 3D reconstruction technology in binocular endoscopy can facilitate the recovery of image depth information, and the application of deep learning-based 3D reconstruction technology can significantly improve the accuracy and real-time performance of reconstruction results, making it widely applicable in the realm of minimally invasive surgery. This paper aims to explore the key technologies and implementation methods of deep learning based 3D reconstruction for binocular endoscopic images, and seeks to outline strategies for enhancing the quality of 3D reconstruction in endoscopic images, providing guidance for sustainable development of binocular endoscopic image reconstruction technology in clinical settings. This will assist in the application of minimally invasive surgery and contribute to meeting the demands of precision medicine.
Deep Learning ; Imaging, Three-Dimensional/methods* ; Humans ; Endoscopy/methods* ; Image Processing, Computer-Assisted/methods* ; Minimally Invasive Surgical Procedures

OBJECTIVES: Oblique lateral interbody fusion (OLIF) has become a well-established treatment for lumbar spinal stenosis (LSS) due to its advantages of being minimally invasive, effective, and associated with fewer complications. However, relying solely on lateral fixation provides limited strength and uneven load distribution. Conventional posterior bilateral fixation after OLIF typically requires intraoperative repositioning, increases fluoroscopy frequency, and involves extensive dissection of posterior muscles and soft tissues, resulting in greater trauma, blood loss, and risks of dural tear, nerve root injury, and persistent postoperative low back pain. This study aims to compare the clinical efficacy of robot-assisted single-position OLIF with lateral plating and posterior unilateral fixation, OLIF with lateral fixation alone, and OLIF combined with posterior bilateral fixation for treating single-segment LSS, and to explore how to enhance fixation stability, reduce trauma, and achieve precise minimally invasive outcomes without changing patient positioning. METHODS: A retrospective analysis was conducted on the clinical data from patients treated for single-segment LSS between January 2020 and June 2023 at the First Affiliated Hospital of Kunming Medical University. Patients were divided into 3 groups: Robot group (robot-assisted single-position OLIF with lateral plate and posterior unilateral fixation, 33 cases), lateral group (OLIF with lateral fixation alone, 52 cases), and combined group (OLIF with posterior bilateral fixation, 45 cases). Surgical time, intraoperative blood loss, fluoroscopy frequency, hospital stay, pedicle screw placement accuracy, and complication rates were recorded. Pain visual analogue scale (VAS) scores and Oswestry disability index (ODI) scores were assessed preoperatively, postoperatively, and at the final follow-up. Radiological evaluations (X-ray, computed tomography, and magnetic resonance imaging) measured interbody disc height (IDH), intervertebral foraminal height (IFH), and cross-sectional area (CSA) of the dural sac. Differences between pre- and postoperative imaging indices were statistically analyzed, and complication rates, fusion rates, and cage subsidence rates were recorded. RESULTS: All patients exhibited good positioning of internal fixation devices and cages, with significant symptom relief and no cases of spinal cord injury or symptom worsening. The follow-up time was (15.2±3.6) months. The operation time of the robot group was (70.62±8.99) min, which was longer than that of the lateral group (45.90±6.09) min and shorter than that of the combined group (110.12±8.44) min. The intraoperative blood loss of the robot group was (44.27±6.87) mL, which was more than that of the lateral group (33.58±9.73) mL and less than that of the combined group (79.19±10.35) mL. The number of intraoperative fluoroscopy times of the robot group was (9.49±2.25), which was comparable to that of the lateral group (7.45±2.02) but less than that of the combined group (12.24±4.25). The hospital stay of the robot group was (9.28±2.10) days, which was longer than that of the lateral group (7.95±1.91) days and shorter than that of the combined group (12.49±5.07) days. The screw placement accuracy of the robot group was 98.48%, which was higher than that of the combined group (90.55%). Postoperative and final follow-up VAS and ODI scores were significantly lower than preoperative scores in all 3 groups (all P<0.05), and there were no significant differences in preoperative VAS and ODI scores among the groups (all P>0.05). Radiologically, IDH, IFH, and CSA at the surgical segment were significantly increased postoperatively and at final follow-up compared to preoperatively and at final follow-up compared to preoperative values (all P<0.05), with no significant differences among the groups postoperatively (all P>0.05). Internal fixation remained stable during the follow-up period, and all cages achieved fusion at final follow-up. The intervertebral fusion rate of the robot-assisted group was 93.40%, which was similar to that of the combined group (95.56%) and higher than that of the lateral approach group (90.34%). The complication rate of the robot-assisted group was 6.1%, which was comparable to that of the combined group (8.9%) and lower than that of the lateral approach group (15.4%) (P<0.05). No cases of fixation loosening or breakage were observed throughout the follow-up period. CONCLUSIONS Robot-assisted single-position OLIF with lateral plate combined with posterior unilateral fixation effectively achieves indirect decompression and excellent spinal stability without the need for intraoperative repositioning. It provides high pedicle screw accuracy, reduces intraoperative blood loss, fluoroscopy times, and complication rates, offering a fully minimally invasive new treatment option for single-segment LSS.
Humans ; Spinal Stenosis/surgery* ; Robotic Surgical Procedures/methods* ; Lumbar Vertebrae/surgery* ; Spinal Fusion/instrumentation* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Treatment Outcome ; Bone Plates ; Minimally Invasive Surgical Procedures/methods* ; Adult

In recent years, minimally invasive technology has been at the forefront of advancing various disciplines due to its unique advantages. With the development of endoscopic techniques, low-temperature plasma technology, and balloon dilation methods, the application of minimally invasive surgery in pediatric otolaryngology has increased significantly in clinical practice. The primary objective of minimally invasive techniques is to preserve normal anatomical structures as much as possible, reduce tissue damage associated with surgery, lower surgical risks, accelerate postoperative recovery, and achieve surgical outcomes that are comparable to or even better than those obtained through conventional procedures. In the future, the development of minimally invasive surgery must be aimed at pursuing the maximum benefit for patients, and operations will be more scientific, functional, comfortable, and diversified. The author believes that the development of minimally invasive surgery is inseparable from multidisciplinary cooperation, including clinicians, engineers, and other professionals in different fields. Only by working together can we jointly promote the development of minimally invasive surgery technology and provide patients with more accurate, efficient, and safe treatment options.
Humans ; Minimally Invasive Surgical Procedures/methods* ; Child ; Otorhinolaryngologic Diseases/surgery* ; Endoscopy ; Otorhinolaryngologic Surgical Procedures/methods*

Objective:Analyze the clinical features in children with pharyngeal neoplasm, and explore the clinical efficacy of low-temperature plasma minimally invasive treatment in children with pharyngeal neoplasm. Methods:A total of 46 pediatric cases of pharyngeal neoplasms admitted to the Otolaryngology Department of Wuhan Children's Hospital from January 2016 to December 2023 were included. There were 23 males and 23 females, with admission ages ranging from 5 days to 9 years and 4 months, and a median age of 2 years and 2 months. The clinical manifestations, examinations, treatments, and outcomes were evaluated. Results:Among the 46 pediatric patients, 21 were admitted with throat wheezing, 7 with masses in the oropharynx or head and neck, 5 with dyspnea, 4 with snoring during sleep as the main symptom, 3 with hoarseness, 2 with sore throat, 2 with swallowing discomfort, and 2 with difficulty feeding as the first symptom. Comorbidities included 5 cases of combined laryngomalacia, 4 of snoring, 4 of congenital heart disease, 4 of severe pneumonia, 3 of myocardial damage, 1 of multiple deformities, and 1 after hematopoietic stem cell transplantation. All patients underwent CT or MRI examination, with 26 cases undergoing local ultrasound examination and 39 undergoing electronic laryngoscopy examination. A total of 19 patients were transferred to the ICU after surgery, all of whom were patients with pharyngeal cysts. All patients underwent low-temperature plasma minimally invasive surgery, and all patients were diagnosed through pathological examination, including 1 case of nasopharyngeal teratoma, 5 of pharyngeal non-Hodgkin's lymphoma, 1 of oropharyngeal rhabdomyosarcoma, 1 of laryngeal perivascular epithelioid cell tumor （PEComa）, and 38 of pharyngeal cysts （2 cases of uvula, 2 of oropharynx, 7 of epiglottic valley, 19 of tongue base, 2 of branchial cleft cyst, and 6 of throat）. Conclusion:Pharyngeal neoplasms in children are prone to upper airway obstruction, including some rare or malignant tumors. Imaging and pathological diagnosis can assist in early diagnosis. Depending on the nature of the tumor, early detection and treatment can improve the quality of life and survival rate of children. Low-temperature plasma radiofrequency ablation is safe, minimally invasive, precise, and provides a clear field of vision, making it a valuable treatment option for children with pharyngeal neoplasms.
Humans ; Male ; Female ; Child, Preschool ; Child ; Infant ; Pharyngeal Neoplasms/therapy* ; Minimally Invasive Surgical Procedures/methods* ; Cold Temperature ; Treatment Outcome

Objective:Over the past decades, minimally invasive cochlear implantation（CI） have achieved significant advancements, evolving from initial emphasis on incision miniaturization to comprehensive strategies for preserving intracochlear structures and functions, as well as optimizing overall minimally invasive surgical procedure. However, current academic debates persist regarding standardized definitions and consensus on technical protocols. Future research should prioritize innovations in surgical-assistive robots, refinement of hidden cochlear implant, and exploration of drug deliver electrodes. These efforts aim to advance surgical methodologies toward enhanced minimally invasive approaches, functional preservation, and personalized therapeutic interventions.
Humans ; Cochlear Implantation/trends* ; Minimally Invasive Surgical Procedures/trends* ; Cochlear Implants

Objective:To investigate the application value of intraoperative electrocochleography（ECochG） monitoring technique and insertion techniques in cochlear implant（CI） and analyze its relationship with postoperative residual hearing（RH） preservation. Methods:Thirty-one patients（35 ears） who received CI in our hospital from June 2022 to July 2024 were enrolled. The Advanced Bionics Active Insertion Monitoring（AIM） system was used for real-time ECochG monitoring during surgery. Intraoperative cochlear microphonics （CM） waveform changes were recorded and analyzed in relation to postoperative RH preservation. Results:①ECochG recordings were successfully obtained in 34 of 35 ears （97.1%）. ②According to Harris classification, there were 7 ears（20.6%） of Type A（rising）, 7 ears（20.6%） of Type C（declining）, 8 ears（23.5%） of Type CC（fluctuating）, and 12 ears（35.3%） of Type D（no response）. ③The total CM amplitude decrease was significantly moderately correlated with postoperative low-mid frequency hearing loss（r=0.67, P=0.017）. The total CM amplitude decrease was significantly moderately correlated with postoperative low frequency hearing loss（r=0.65, P=0.023）. ④For the mean amplitude variation, the Amax was 30.70 μV, the Amin was 8.64 μV, and the Aend was 18.27 μV. ⑤Sixteen cases completed postoperative follow-up, with an average low-mid frequency（125-1 000 Hz） residual hearing loss of 15.25 dB HL and a RH preservation rate of 87.5%. Conclusion:Intraoperative ECochG monitoring can effectively predict postoperative residual hearing changes, effectively guide surgical manipulation, and improve residual hearing preservation rate.
Humans ; Cochlear Implantation/methods* ; Audiometry, Evoked Response ; Cochlear Implants ; Male ; Female ; Adult ; Middle Aged ; Monitoring, Intraoperative ; Adolescent ; Young Adult ; Minimally Invasive Surgical Procedures ; Child ; Aged ; Postoperative Period

OBJECTIVE

The aim of this study was to determine the different attitudes and perception of obstetrics and gynecology residents on laparoscopic skills training.

A cross-sectional research was conducted in a tertiary hospital’s Department of Obstetrics and Gynecology using a survey questionnaire. The respondents were resident physician trainees using population sampling. An approval to use the survey questionnaire from its developer was obtained. Descriptive statistics was used for analysis of the demographic profile. Pearson product moment correlation was used to determine correlation between expectancy-value constructs, simulation use and surgical experience.

The average hours the residents spent in simulation laparoscopic exercises was 11 h in the last 12 months and at least 1 h per week with supervision (76%). The reasons for using laparoscopic simulation include skill development (94%), proximity to the simulation lab (90%), free time (85%), recommendation of attending surgeon (84%), and requirement for rotation (84%). Among the expectant value constructs, only intrinsic interest utility value (r = −0.390) showed statistical correlation suggesting a weak negative correlation with simulation use. Hours of simulation use were significantly negatively correlated with self-efficacy for learning skills required to become proficient at minimally invasive surgery (MIS) (r = −0.390) and self-efficacy for learning sufficient MIS skills to perform procedures safely (r = −0.351).

The residents were motivated to do well and had greater self-belief and enjoyed performing and mastering the laparoscopic skills training. The residents’ perception revealed that there was an improvement in their MIS skills with the laparoscopic simulation exercises in the short time they spent in the simulation. Despite the residents’ positive attitude and perceptions, voluntary participation was limited. The most commonly cited barriers to the access of the surgical knowledge improvement laboratory and laparoscopy simulation unit were the lack of time due to the workload, conflicting schedules, and COVID-19 pandemic restrictions. Supervision of the residents is of great importance to provide guidance and motivation to the residents in improving their technical skills and performance in the operating room.

INTRODUCTION

Splenic Abscess is an ongoing infectious process with pus accumulation specifically at the spleen, this is associated with a high mortality rate with studies showing 16.6% among those diagnosed, with risk factors mainly present are among immunocompromised state. Among the immunocompetent population, an incidence of 0.14-0.70% were documented. 13 The etiology for this may include hematogenous or contiguous spread of infection as a pathophysiology, with bacterial seeding at the site. Detection of this is through ultrasound or CT scan, with a goal of identify a complex or a simple abscess. Therapeutics lie in choosing splenectomy, placing the patient in an immunocompromised state despite being at a young age against the conservative percutaneous drainage on top of the maximized antibiotic use. A recent meta-analysis showed a mortality rate of 12% among patients with splenectomy and a complication rate of 26%, however the percutaneous drainage had a mortality of 8% and a complication rate of 10% 14 This highlights the clinical awareness and decision among patients with splenic abscess.

Presenting a case of 37-year-old female who came in with left upper quadrant pain. This patient had undergone laparoscopic cholecystectomy 6 months prior to admission with an unremarkable outcome. An onset of left upper quadrant pain was noted 3 months prior to admission and was initially conservatively managed with unrecalled antibiotics. Persistence of this prompted further work up where ultrasound revealed an abscess in the spleen and was then admitted for broad spectrum antibiotics, namely piperacillin-tazobactam and further imaging. CT scan of whole abdomen with contrast was then done which revealed splenomegaly with rim enhancing near fluid attenuating lesions in the mid to inferior pole. The complexity of the abscess prompted the decision for splenectomy, the gold standard for treatment for splenic abscess. Patient had tested negative for HIV.

Splenic abscess is a rare condition, usually presenting with fever and left upper quadrant pain, the patient however did not present with fever despite a complex abscess. Splenic abscess is associated with a high mortality rate. A wide array of differentials is considered in patients with left upper quadrant pain and laboratories are directed into investigating the structural cause for left upper quadrant pain as the spleen has many adjacent organs which may present similarly. The decision to choose splenectomy and percutaneous abscess determines survivability of infection as splenectomy places patient in an immunocompromised state, thus early recognition of splenic abscess, and feasibility of percutaneous drainage is vital to the out-hospital outcome for the patient. Among immunocompetent individuals, given the lower mortality and lower complication rates, it may be ideal to combine both medical and minimally invasive procedures and a rise in complication may then warrant splenectomy.

The clinical burden of colorectal cancer (CRC) is high. Population-based screening and early detection are essential to improve the long-term clinical outcome. Nonetheless, a significant proportion of patients still present at an advanced stage, including with acute large bowel obstruction. Image-enhanced endoscopy and artificial intelligence can improve the detection and diagnosis of colonic adenomas and early cancer. Endoscopic resection is regarded as the preferred curative treatment option for colonic adenoma and T0 and T1 CRC limited to the superficial submucosa. Emergency colonic stenting as bridge to interval curative surgery is increasingly accepted as a first-line option when technically feasible. Minimally invasive resection techniques such as laparoscopic colectomy and robot-assisted colorectal surgery have also come of age. These techniques reduce post-treatment morbidity, shorten the recovery process and can be cost-effective while maintaining long-term oncological cure. These outcome measures are relevant to our patients; therefore, minimally invasive approaches to curative resection should be embraced.
Humans ; Colorectal Neoplasms/surgery* ; Minimally Invasive Surgical Procedures/methods* ; Laparoscopy/methods* ; Colectomy/methods* ; Robotic Surgical Procedures/methods* ; Treatment Outcome ; Colonoscopy/methods*