Zidan Mohamed H, El-Masry Hassan, Amgad Ahmed, Altabbaa Hashem, Abdou Marwan Emad, Amer Samar A, Zayed Nour, Ismail Haidy Osama, Alokl Mohammed, Abokhozima Ahmed
Alexandria University, Alexandria, Egypt.
The Research Papyrus Lab, Alexandria, Egypt.
Obes Surg. 2025 Mar;35(3):1086-1108. doi: 10.1007/s11695-025-07694-y. Epub 2025 Feb 4.
Since the early 1980s, efforts to standardize ergonomic practices in laparoscopic surgeries have aimed to improve procedural efficiency and reduce complications, but clinical validation remains limited. In metabolic and bariatric surgeries (MBS), innovations in trocar site placements, driven by the popularity of laparoscopic sleeve gastrectomy (LSG), have advanced surgical techniques. However, practices often vary based on individual surgeon preferences rather than standardized evidence-based criteria. This study introduces the Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) checklist, aiming to standardize port placements and improve reporting consistency. A systematic review and meta-analysis of LSG studies were conducted following PRISMA guidelines. Data were extracted from 34 studies involving 7173 cases. Key variables included port configurations, manipulation angles, and outcomes such as operative time and excess weight loss percentage (EWL%). Innovative methods were used to estimate manipulation and azimuth angles from available intraoperative images. Statistical analyses and meta-regression were performed to identify associations between port configurations and surgical outcomes. Findings revealed substantial variability in port placements, with no significant effect of manipulation angles or port numbers on operative time or EWL% at 6, 12, and 24 months (p-values > 0.05). High residual heterogeneity suggests that factors beyond manipulation angles and port counts contribute to outcome variability. The PSPOSO checklist provides a framework for standardizing port placement and ergonomic parameters in MBS, enhancing reproducibility and safety. Future studies should validate the checklist across diverse clinical settings to refine surgical approaches and improve patient outcomes. PROSPERO: CRD42024598674.
自20世纪80年代初以来，在腹腔镜手术中规范人体工程学操作的努力旨在提高手术效率并减少并发症，但临床验证仍然有限。在代谢和减重手术（MBS）中，受腹腔镜袖状胃切除术（LSG）普及的推动，套管针穿刺部位放置方面的创新推动了手术技术的发展。然而，实践操作往往因外科医生的个人偏好而异，而非基于标准化的循证标准。本研究引入了用于肥胖和代谢手术的穿刺部位放置及结果（PSPOSO）检查表，旨在规范穿刺部位放置并提高报告的一致性。按照PRISMA指南对LSG研究进行了系统评价和荟萃分析。从34项涉及7173例病例的研究中提取了数据。关键变量包括穿刺部位配置、操作角度以及诸如手术时间和超重减轻百分比（EWL%）等结果。采用创新方法从可用的术中图像估计操作角度和方位角。进行了统计分析和荟萃回归，以确定穿刺部位配置与手术结果之间的关联。研究结果显示穿刺部位放置存在很大差异，在6个月、12个月和24个月时，操作角度或穿刺部位数量对手术时间或EWL%没有显著影响（p值>0.05）。高残留异质性表明，除操作角度和穿刺部位数量之外的因素导致了结果的变异性。PSPOSO检查表为规范MBS中的穿刺部位放置和人体工程学参数提供了一个框架，提高了可重复性和安全性。未来的研究应在不同临床环境中验证该检查表，以优化手术方法并改善患者预后。国际前瞻性系统评价注册库：CRD42024598674。
