Frontiers in Surgery最新文献

{"title":"Conservative therapy of epidural hematoma with atorvastatin combined with glucocorticoids: cases report and literature review.","authors":"Chenrui Wu, Yu Tian, Ruichen Zhao, Runfang Chen, Chuanlin Xu, Jinsheng Huang, Rongcai Jiang","doi":"10.3389/fsurg.2025.1587988","DOIUrl":"https://doi.org/10.3389/fsurg.2025.1587988","url":null,"abstract":"<p><p>Epidural hematomas (EDH), typically requiring surgery, may be managed conservatively in select patients. We investigated atorvastatin (10 mg/day) combined with dexamethasone (2.25 mg/day) as conservative therapy in six EDH patients (GCS ≥ 13, volume < 30 ml) post-trauma. All patients recovered fully without surgery, and literatures support conservative care for stable EDH. Our findings suggest this combination therapy may promote hematoma absorption. In conclusion, atorvastatin/dexamethasone shows promise as a non-surgical EDH option, warranting further investigation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1587988"},"PeriodicalIF":1.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and practicality of a novel teaching aid for microvascular anastomosis simulation training in neurosurgery generated by 3D printing.","authors":"Guosheng Shi, Huiling Ren, Dawei Zhao, Yunwei Cui, Xiang Su, Suwei Yan, Wei Bu","doi":"10.3389/fsurg.2025.1546573","DOIUrl":"https://doi.org/10.3389/fsurg.2025.1546573","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to develop a novel teaching aid for microvascular anastomosis training in neurosurgery using 3D printing technology based on CT and MRI imaging data, and to evaluate its effectiveness and practicality.</p><p><strong>Methods: </strong>Based on CT or MRI imaging data, a 3D model integrating micro-vessels, skull, and brain tissue was fabricated and connected to a peristaltic pump and a pipeline system to create a teaching aid for microvascular anastomosis simulation training. Twenty senior medical students were recruited and divided into two groups: a control group, which trained using traditional soft rubber tubes, and an observation group, which trained using the 3D-printed teaching aid. Following the training, participants from both groups performed chicken wing artery anastomosis. The training outcomes, including the patency rate of vascular anastomosis, the time required to complete the anastomosis, and the trainees' surgical performance, were evaluated. Additionally, six experienced neurosurgeons were recruited to teach the course using both teaching aids for two hours each. They were then surveyed via a questionnaire to assess and rate the effectiveness of the teaching aids.</p><p><strong>Results: </strong>The observation group demonstrated a significantly higher patency rate of vascular anastomosis, a shorter time to complete the anastomosis, and higher scores for surgical proficiency and procedural standardization compared to the control group (all <i>P</i> < 0.001). Additionally, the neurosurgeons provided positive evaluations of the novel 3D-printed teaching aid, awarding high scores for its practicality, scientific rigor, and overall effectiveness.</p><p><strong>Conclusion: </strong>The novel 3D-printed teaching aid serves as an effective tool for microvascular anastomosis training in neurosurgery, offering significant advantages such as enhanced training effectiveness, high-fidelity simulation, cost efficiency, and customization capabilities.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1546573"},"PeriodicalIF":1.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: an unusual case of a penetrating intracranial metallic foreign body removed via surgery.","authors":"Dang Tang, Hai Song, Bibo Gao, Jiang Long, Zhongkun Ren","doi":"10.3389/fsurg.2025.1588359","DOIUrl":"https://doi.org/10.3389/fsurg.2025.1588359","url":null,"abstract":"<p><strong>Background and importance: </strong>Intracranial foreign bodies resulting from criminal assaults that cause penetrating trauma are relatively rare. Such cases are often accompanied by significant complications, including intracranial hemorrhage, cerebral contusion, major vascular injury, and cerebrospinal fluid leakage, which pose substantial challenges in clinical management. Herein, we report a successful case of surgical treatment for an intracranial metallic foreign body, aiming to provide valuable insights for similar clinical scenarios.</p><p><strong>Clinical presentation: </strong>A 38-year-old male patient was urgently admitted to our emergency department following an intentional assault with a sickle, which resulted in an intracranial penetrating injury. Computed tomography (CT) scanning revealed the presence of a metallic foreign body that traversed the left temporal lobe and extended to the sphenoid bone and the posterior region of the right orbit. In response to this critical situation, an emergency surgical procedure was promptly initiated. The treatment strategy involved a combination of craniotomy and transnasal approaches to remove the metallic foreign body and reconstruct the skull base. Postoperatively, the patient exhibited no obvious adverse reactions, and his condition remained stable throughout the follow-up period.</p><p><strong>Conclusion: </strong>Intracranial foreign bodies often penetrate neural structures via the orbit or nasal cavity. When dealing with a long foreign body predominantly situated within the brain parenchyma, it is crucial to avoid blindly extracting it. Instead, shortening the length of the foreign body may be a more feasible approach to facilitate its safe removal and transportation. Preoperative acquisition of comprehensive imaging data is of utmost importance, as it aids in delineating the spatial relationship between the foreign body, major intracranial vessels, and cranial nerves, thereby enabling the formulation of a rational surgical plan. Whenever possible, the removal of intracranial foreign bodies should be carried out within 6-8 h post-trauma. Additionally, reliable skull base reconstruction is essential to prevent cerebrospinal fluid (CSF) leakage and mitigate the risk of infectious complications.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1588359"},"PeriodicalIF":1.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of minimally invasive approaches for gallbladder and common bile duct stones: combined endoscopic techniques vs. ERCP with laparoscopic cholecystectomy.","authors":"Haixing Fang, Wenchao Chen, Zhengrong Wu, Guoping Ding","doi":"10.3389/fsurg.2025.1543205","DOIUrl":"https://doi.org/10.3389/fsurg.2025.1543205","url":null,"abstract":"<p><strong>Objectives: </strong>The combined technology of laparoscopy, choledochoscope and gastroscope was used in the treatment of gallbladder stones combined with common bile duct stones, which consists of laparoscopic cholecystectomy (LC), laparoscopic common bile duct exploration with primary closure (LCBDE-PC) and combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage (GC-NBD). The clinical effects of the combined technology were evaluated based on hospital stay, hospital costs, postoperative complications, recurrence of stones, and overall patient satisfaction.</p><p><strong>Methods: </strong>From July 2017 to December 2020, 206 patients with gallbladder stones combined with common bile duct stones were reviewed retrospectively. According to the surgical method, the patients were divided into Triple-Scope group (LC + LCBDE-PC + GC-NBD), (<i>n</i> = 38), ERCP + LC group [endoscopic retrograde cholangiopancreatography (ERCP) followed by LC], (<i>n</i> = 96) and T tube group (LC + LCBDE + T tube drainage), (<i>n</i> = 72). The differences in stone size, hospital stay, hospital cost, postoperative gallstone recurrence rate and postoperative complications were compared among three groups.</p><p><strong>Results: </strong>No postoperative bile leak occurred in Triple-Scope group, and patients were discharged successfully, and the abdominal drain was removed around 3 days after surgery, and the nasobiliary drainage was removed around 5 days after surgery with a hospital stay of 9.5 ± 2.65 days. The length of hospital stay and hospital cost in the Triple-Scope group were lower than those in the ERCP + LC group (<i>P</i> < 0.01), but not significantly different from those in the T tube group (<i>P</i> > 0.05). The diameter of common bile duct and stone size were significantly larger in the Triple-Scope group and T-tube group than in the ERCP + LC group (<i>P</i> = 0.001; <i>P</i> = 0.004), and the recurrence rate of stones in the Triple-Scope group was not significantly different compared with those in the other two groups (<i>P</i> = 0.43).</p><p><strong>Conclusions: </strong>For patients with gallbladder stones combined with common bile duct stones, the triple-scope combination is safe and effective with fast recovery, and it is worthy of clinical promotion and application.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1543205"},"PeriodicalIF":1.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic therapy and cavernoma bleeding: does vascular border zone localization matter?","authors":"Alexandru Guranda, Tim Wende, Martin Vychopen, Erdem Güresir, Ulf Nestler","doi":"10.3389/fsurg.2025.1577820","DOIUrl":"https://doi.org/10.3389/fsurg.2025.1577820","url":null,"abstract":"<p><strong>Objective: </strong>Hemorrhagic events in cavernous malformations (CCMs) are linked to significant morbidity and mortality. Identifying factors contributing to bleeding is crucial for effective clinical and surgical management.</p><p><strong>Methods: </strong>This retrospective, observational, single-center study assessed potential and known risk factors for bleeding in patients with cerebral cavernous malformations. We evaluated age, gender, smoking habits, arterial hypertension, antithrombotic medication, diabetes mellitus, cavernoma shape, size changes observed in follow-up MRIs, the occurrence of epileptic seizures, and the localization of the lesion in regard of cerebral vascular territories.</p><p><strong>Results: </strong>We identified 143 patients (43.4% male, 45.5% with hemorrhagic events, and 19.6% with epileptic seizures). Antithrombotic medication was associated with a lower frequency of hemorrhage (<i>p</i> = 0.012). Arterial hypertension, diabetes mellitus, smoking habits and localization in the border zone of a vascular territory or seizures were not significantly associated with bleeding events. An increased rate of hemorrhagic events was found in cavernomas with irregular MRI shape (<i>p</i> = 0.001), or with changes in size during follow-up (<i>p</i> = 0.012). Multivariate analysis confirmed that antithrombotic therapy was associated with a reduced risk of hemorrhage (OR: 0.151, 95% CI: 0.041-0.552, <i>p</i> = 0.004), while male gender (OR: 2.114, 95% CI: 1.047-4.269, <i>p</i> = 0.037), irregular cavernoma shape (<i>p</i> = 0.001), and cavernoma growth (<i>p</i> = 0.002) were independently associated with a higher bleeding risk. Cavernoma localisation in the border zone between median and posterior arterial territories was associated with a significant lower rate of bleeding events compared to localisation in other watershed areas.</p><p><strong>Conclusion: </strong>We observed a reduced percentage of bleeding in cavernoma patients utilizing antithrombotic agents, compared to patients without antithrombotic medication. Factors such as smoking habits, irregular cavernoma shape on MRI, and changes in size during follow-up were associated with a higher frequency of bleeding events.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1577820"},"PeriodicalIF":1.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystopexy raises the post-operative complication rate during laparoscopic hysterectomy for uterine prolapse.","authors":"Carlo Ronsini, Giada Andreoli, Marco Torella, Paola Romeo, Giuseppe Sarpietro, Stefano Cianci","doi":"10.3389/fsurg.2025.1488775","DOIUrl":"https://doi.org/10.3389/fsurg.2025.1488775","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to compare the outcomes of laparoscopic colposuspension sec Shull (LCSS) and laparoscopic colposacropexy (LCSP) with and without the addition of cystopexy for the treatment of pelvic organ prolapse (POP) in terms of postoperative complications, recurrence rates, and overall effectiveness.</p><p><strong>Materials and methods: </strong>A retrospective case-control analysis was conducted on women treated for grade 3-4 POP-Q uterine prolapse at the Academic Departments of Gynaecology and Obstetrics of \"G. Martino\" of Messina, Italy, and \"L. Vanvitelli\" of Napoli, Italy, between November 2020 and February 2022. Group A consisted of patients who underwent laparoscopic hysterectomy followed by LCSS or LCSP without cystopexy. At the same time, Group B included patients who had the same procedures with the addition of cystopexy. Data on complications were collected using the Clavien-Dindo classification, and prolapse recurrence was monitored according to the POP-Q system. Statistical analysis was performed using Fisher's exact, Chi-squared, and Wilcoxon rank-sum tests.</p><p><strong>Results: </strong>A total of 148 patients were included, with 125 in Group A and 23 in Group B. Group B showed a significantly higher rate of postoperative complications (16%) compared to Group A (2.4%) (<i>p</i> = 0.016), with an Odds Ratio of 7.62 (95% CI 1.59-36.51, <i>p</i> = 0.0017). No significant difference between the groups was found in the recurrence rate of prolapse at 24 months (<i>p</i> > 0.9).</p><p><strong>Conclusion: </strong>Adding cystopexy to LCSS or LCSP increases the risk of postoperative complications without reducing prolapse recurrence rates. Further research is needed to identify patients who may benefit from cystopexy and to evaluate its impact on stress incontinence and patient satisfaction.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1488775"},"PeriodicalIF":1.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Thoracic duct ligation for left-sided chylothorax after pneumonectomy with contralateral VATS procedure using indocyanine green fluorescence.","authors":"Chiara Anna Schiena, Mario Pezzella, Eleonora Faccioli, Alessandro Rebusso, Giovanni Comacchio, Stefano Silvestrin, Michele Battistel, Edoardo Rosellini, Andrea Dell'Amore, Federico Rea, Samuele Nicotra","doi":"10.3389/fsurg.2025.1558519","DOIUrl":"10.3389/fsurg.2025.1558519","url":null,"abstract":"<p><strong>Introduction: </strong>Chylothorax is a rare but potentially life-threatening condition characterized by the accumulation of lymphatic fluid in the pleural cavity. It is typically managed with conservative treatments such as fasting and/or thoracic duct embolization via lymphography. However, when these approaches fail, surgical intervention, most commonly thoracic duct ligation (TDL), is often necessary. While the advent of video-assisted thoracoscopic surgery (VATS) has enabled minimal invasive approaches for thoracic duct ligation, intraoperative identification of the thoracic duct remains technically challenging.</p><p><strong>Case report: </strong>We present the case of a 62-year-old man diagnosed with SMARCB1-deficient mediastinal sarcoma who underwent left pneumonectomy and subsequently developed a left-sided chylothorax on postoperative day 16. Initial management with conservative strategy first, including two lymphography procedures with attempted embolization, was unsuccessful. Consequently, we proceeded with thoracic duct ligation via right-sided VATS, employing indocyanine green (ICG) fluorescence to aid in the identification of the thoracic duct. Given the prior left pneumonectomy, a single-lumen endotracheal tube with a bronchial blocker was used to selectively exclude the right lower lobe during the procedure.</p><p><strong>Conclusion: </strong>This case highlights the use of ICG fluorescence in facilitating the identification and ligation of the thoracic duct in a patient with left-sided chylothorax following left pneumonectomy.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1558519"},"PeriodicalIF":1.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Application of tumor-bearing bone inactivation and bilateral fibula grafting in joint-sparing surgery for osteosarcoma patient.","authors":"Yapeng Wang, Tian'en Xu, Cong Chen, Shuo Mai, Kai Yang","doi":"10.3389/fsurg.2025.1544336","DOIUrl":"10.3389/fsurg.2025.1544336","url":null,"abstract":"<p><p>On August 28th, 2023, a 13-year-old male was diagnosed with conventional osteosarcoma of the proximal left tibia after a needle biopsy. Subsequently, the patient received two cycles of neoadjuvant chemotherapy and four cycles of postoperative chemotherapy. On December 27, 2023, the tumor resection was performed while preserving the knee joint, which involved inactivation of the tumor-bearing bone, autologous bilateral fibula grafting, and fixation of the grafted bone to the host bone using plate and screws. Follow-up after surgery included x-rays and CT scans. On February 28, 2024, two months after the surgery, new bone formation was noted at the site from which bone was harvested from the right fibula, the left knee joint had satisfactory range of motion in flexion (130°) and extension (0°). Additionally, partial healing of both the grafted bone and the host bone was observed. In the follow-up on September 23rd, 2024, nine months post-operation, the right fibula had reformed. Furthermore, the transplanted and host bones of the left tibia had healed securely. It was confirmed that there was no recurrence or metastasis of the tumor during the last follow-up by ECT. This case highlights the feasibility and effectiveness of using inactivating tumor-bearing bone and autologous bilateral fibular grafting to repair large bone defects after joint-sparing surgery for malignant tumors near the joints.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1544336"},"PeriodicalIF":1.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of unilateral biportal endoscopic lumbar intervertebral discectomy with and without annulus fibrosus suture in lumbar disc herniation: a retrospective analysis.","authors":"Wei Zhou, Mohamed Lamin Bangura, Qianlong Gong, Rong Zhang, Teng Zeng, Qi Fei, Tadiwa Chiedza Chirima, Sy-Trung Tran, Yutian Qiu, Huasong Luo","doi":"10.3389/fsurg.2025.1521892","DOIUrl":"10.3389/fsurg.2025.1521892","url":null,"abstract":"<p><strong>Background: </strong>Advancements in minimally invasive spine surgery have markedly enhanced patient outcomes in the management of lumbar intervertebral disc herniation and degenerative disorders. The Unilateral Biportal Endoscopic Interlaminar Lumbar Intervertebral Discectomy and spinal nerve decompression are prominent of these methods. This method is based on the principles established by several endoscopic spine techniques, which are lauded for their limited invasiveness, less trauma, and expedited recovery periods in contrast to conventional open operations.</p><p><strong>Methods: </strong>177 patients treated with Unilateral Biportal Endoscopic Transforaminal Lumbar Intervertebral Discectomy for lumbar disc herniation were selected and assigned into Sutured (39 patients) and Un-sutured groups (138 patients). Different variables, including clinical outcomes and estimated cost, were evaluated using IBM SPSS 27.0.1 with a <i>p</i>-value < 0.05 considered statistically significant.</p><p><strong>Results: </strong>The study identified disparities in clinical outcomes, such as reoperation problems, surgery durations, and projected costs between the two groups. Reoperation rates were lower in the sutured group. Un-sutured patients had a shorter surgery time. Both groups had comparable Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) scores. Both groups have similar Body Mass Indexes (BMIs) throughout hospitalization. The two groups had equal discharge satisfaction scores. There is not much variation in surgical bleeding across groups. Follow-up times were identical for both groups (26.46 ± 2.01 for the sutured group and 26.83 ± 2.68 for the un-sutured group). The two groups showed a slight difference in estimated costs, with the sutured group averaging RMB 29,234.78 ± 5,265.83, compared to RMB 22,311.10 ± 3,527.00 for the un-sutured group.</p><p><strong>Conclusion: </strong>Annulus fibrosus suturing during minimally invasive lumbar disc surgery may increase time and expense and reduce the risk of recurrent herniation and reoperation. Sutured and non-sutured techniques have equal clinical results and low intraoperative blood loss, making them feasible alternatives depending on the situation and patient demands.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1521892"},"PeriodicalIF":1.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From open to robotic surgery in pediatric ureteral reimplantation: overcoming the learning curve for improved outcomes.","authors":"G Mattioli, F Fanti, M Carlucci, S Parodi, V Fiorenza","doi":"10.3389/fsurg.2025.1573233","DOIUrl":"10.3389/fsurg.2025.1573233","url":null,"abstract":"<p><strong>Introduction: </strong>With growing role of minimally invasive surgery, laparoscopic ureteral reimplantation (LUR) and robotic ureteral reimplantation (RALUR) have gained popularity in pediatric vesicoureteral reflux (VUR) treatment. However, literature on complex ureterovesical junction (UVJ) pathologies remains limited. This study reports RALUR outcomes over time and compares them with those of LUR and open ureteral reimplantation (OUR) for UVJ pathologies at a tertiary center.</p><p><strong>Materials and methods: </strong>Data from 80 RALUR (18 non dismembered ND-RALUR and 62 dismembered D-RALUR) performed in 2018-2023 were prospectively collected and compared with data from 21 LUR (16 non dismembered ND-LUR and 5 dismembered D-LUR) in 2018-2020 and 61 OUR in 2014-2021. Surgical indications included VUR, obstructive megaureter (OM), and refluxing obstructive megaureter (ROM), even in duplex system, bladder diverticula, ureterocele and prior UVJ surgeries.</p><p><strong>Results: </strong>Median age and weight were 2.1 years, 12 kg (OUR), 1.7 years, 13.5 kg (LUR), and 3.3 years, 15.0 kg (RALUR). No intraoperative complications occurred. Abdominal drainage and bladder catheterization were more frequent and lasted longer in OUR than in RALUR (<i>p</i> < 0.001). RALUR was associated with shorter hospitalization and reduced analgesic use (<i>p</i> < 0.001). Success rates were 79% (OUR), 50% (LUR), and 65% (RALUR), improving to 97%, 95%, and 98% after reinterventions. RALUR success increased from 55% (2020-2021) to 81% (2022-2023) (<i>p</i> = 0.02).</p><p><strong>Discussion: </strong>RALUR achieved comparable success to OUR and LUR while offering improved ergonomics, useful for complex cases, shorter hospital stays, and easier future endoscopic approaches. The increasing success rate reflects the robotic learning curve and growing surgical expertise.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1573233"},"PeriodicalIF":1.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}