International journal of surgery最新文献

{"title":"Clinical application and early experience of da Vinci Xi robotic single-site laparoscopic gynecologic surgery in mainland China: early experience from a retrospective consecutive cohort of 221 cases.","authors":"Yanyan Liu, Youning Ke, Manwen Luo, Wei Zhang","doi":"10.1097/JS9.0000000000005081","DOIUrl":"10.1097/JS9.0000000000005081","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the clinical performance and learning curve of the da Vinci Xi robotic laparoendoscopic single-site surgery (R-LESS) in gynecology by analyzing a consecutive series of 221 cases from a single tertiary center in mainland China.</p><p><strong>Methods: </strong>We retrospectively analyzed the medical records of patients who underwent R-LESS using the fourth-generation da Vinci Xi system in the Department of Gynecology, Zhongnan Hospital of Wuhan University, between January 2020 and January 2022. Clinical characteristics, operative time, estimated blood loss (EBL), intraoperative and postoperative complications, postoperative 24-hour visual analog scale (VAS) pain scores, time to bowel recovery, postoperative length of stay (LOS), hospitalization costs, and learning curves were analyzed.</p><p><strong>Results: </strong>A total of 221 patients were included, including 189 benign cases and 32 malignant cases. Benign indications included uterine leiomyoma and adenomyosis (n = 70), cervical lesion (n = 20), endometrial lesions (n = 9), uterine prolapse (n = 6), hydatidiform mole (n = 2), and adnexal masses (n = 82). All malignant cases were endometrial cancer (FIGO stage IA: n = 19; IB: n = 7; II: n = 6). Surgical procedures included robotic single-site total hysterectomy (n = 67), myomectomy (n = 40), ovarian cystectomy (n = 82), and staging surgery for endometrial cancer (n = 32). All operations were successfully completed without conversion to multiport laparoscopy or laparotomy. Perioperative outcomes were as follows: (1) Total hysterectomy: operative time 115.95 ± 31.96 min, EBL 58.75 ± 22.48 mL, LOS 4.26 ± 0.93 days, 24-h VAS 1 (1-3); (2) myomectomy: operative time 113.17 ± 41.08 min, EBL 53.16 ± 22.63 mL, LOS 3.83 ± 0.99 days, 24-h VAS 1 (1-3); (3) ovarian cystectomy: operative time 85.16 ± 27.46 min, EBL 31.62 ± 19.14 mL, LOS 3.83 ± 1.15 days, 24-h VAS 1 (1-3); (4) malignant staging surgery: operative time 205.09 ± 56.05 min, EBL 111.50 ± 58.43 mL, LOS 5.75 ± 1.53 days. No intraoperative complications occurred. Postoperative complications were minimal, with one case of urinary retention after hysterectomy in the benign cohort and one infection after staging surgery in the malignant cohort. Learning curve analysis showed that proficiency was achieved after 12 cases for hysterectomy, 13 cases for adnexal mass surgery, 14 cases for myomectomy, and 17 cases for malignant staging surgery.</p><p><strong>Conclusions: </strong>This consecutive case series demonstrates that da Vinci Xi R-LESS is safe and feasible in gynecologic practice, with low blood loss, short hospital stay, and rapid postoperative recovery. Surgeons experienced in conventional laparoscopy can achieve proficiency within a relatively short learning curve.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12835-12843"},"PeriodicalIF":9.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative internal versus external biliary drainage on surgical and oncological outcomes after pancreaticoduodenectomy: a systematic review and meta-analysis.","authors":"Martin Reichert, Franziska Willis, Anca-Laura Amati, Jacqueline Braun, Julia Noll, Martin Schneider, Andreas Hecker","doi":"10.1097/JS9.0000000000005107","DOIUrl":"10.1097/JS9.0000000000005107","url":null,"abstract":"<p><strong>Background: </strong>Preoperative biliary drainage is required for complicated malignant obstructive jaundice before pancreaticoduodenectomy (PD). However, the impact of internal (IntBD) versus external biliary drainage (ExtBD) on post-pancreatectomy clinical and oncological outcomes remains controversial.</p><p><strong>Methods: </strong>Systematic search of MEDLINE, EMBASE, CENTRAL, Web of Science, and ClinicalTrials.gov (through January 2025) identified studies comparing IntBD and ExtBD before PD. Meta-analyses were performed using random-effects modeling to calculate risk ratios (RRs), mean differences (MDs), and respective 95% confidence intervals. The primary outcome was overall postoperative morbidity; secondary outcomes included specific surgical complications and oncological endpoints.</p><p><strong>Results: </strong>6832 patients from 31 retrospective cohort studies and 1 randomized trial were analyzed. ExtBD was associated with a lower overall complication rate after PD (RR: 1.31 [1.08-1.59]; <i>P</i> = 0.006). Post-pancreatectomy specific complications were reduced after ExtBD: pancreatic fistula (RR: 1.56 [1.29-1.90]; <i>P</i> < 0.00001), delayed gastric emptying (RR: 1.84 [1.19-2.85]; <i>P</i> = 0.006), and post-pancreatectomy hemorrhage (RR: 1.56 [1.12-2.19]; <i>P</i> = 0.01). Infectious complications, including biliary tract (RR: 2.40 [1.54-3.76]; <i>P</i> = 0.0001) and surgical site infections (RR: 1.39 [1.20-1.61]; <i>P</i> < 0.00001), were lower, length of hospitalization after PD was shorter with ExtBD (MD: 2.53 [0.20-4.86]; <i>P</i> = 0.03). Narrative analysis of long-term follow-up suggests similar distant metastases rates, but higher local recurrence (RR: 0.41 [0.32-0.55]; <i>P</i> < 0.00001) and lower 5-year overall survival (RR: 0.67 [0.50-0.90]; <i>P</i> = 0.007) of patients with periampullary cholangiocarcinoma treated with preoperative ExtBD compared with IntBD. However, long-term outcomes are biased through oncologically unbalanced cohorts.</p><p><strong>Conclusions: </strong>ExtBD was associated with lower postoperative morbidity after PD, whereas oncological outcomes remain uncertain. Given the low methodological quality and predominantly retrospective design of the included studies, these findings should be considered hypothesis-generating. Prospective trials are needed to clarify the optimal preoperative drainage strategy.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13239-13250"},"PeriodicalIF":9.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective single-arm study of gastric surgery in experimental animals assisted by Kangduo surgical robot.","authors":"Songtao Yu, Yuliuming Wang, Tianyi Ma, Tianyu Qiao, Hao Zhang, Yunxiao Liu, Chunlin Wang, Wenyang Li, Chenkai Zhang, Haonan Qi, Yuxuan Li, Zijing Guan, Bowen Chi, Ruoyu Liu, Yinghu Jin, Ziming Yuan, Guiyu Wang","doi":"10.1097/JS9.0000000000005035","DOIUrl":"10.1097/JS9.0000000000005035","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the feasibility, efficacy, and safety of gastric surgery in experimental animals assisted by the domestic Kangduo Surgical Robot 2000 (SR2000).</p><p><strong>Methods: </strong>Eight porcine models were prospectively enrolled between August and December 2023 at Harbin SAGEBOT Intelligent Medical Animal Experiment Center. Preoperative baseline characteristics, intraoperative physiological parameters, surgical procedure, and postoperative assessments and investigations were recorded to compare the feasibility, efficacy, and safety evaluation indexes of experimental animals in the perioperative period. The primary endpoint was surgical success rate. The secondary endpoints were operative workflow parameters, intraoperative blood loss, postoperative laboratory changes, perioperative adverse events, and surgeon workload assessed using the NASA-TLX instrument.</p><p><strong>Results: </strong>In eight experimental pig models, the SR2000 successfully assisted in the completion of partial gastrectomy. All surgeries were completed according to plan, with no intermediate open or intraoperative complications, and the perioperative survival rate of animals was 100%. The mean operation time of partial gastrectomy was 76.75 min (range: 50-105 min), and the positioning time was 6-17 min. Intraoperative bleeding was ≤5 ml in all the animals, and some animals showed elevated white blood cell counts and neutrophil counts (Neu) on the first day of the postoperative period. The liver and kidney function indexes (alanine aminotransferase, blood urea nitrogen, creatinine) were not significantly abnormal before and after surgery. The anastomosis healed well without complications such as infection and anastomotic fistula.</p><p><strong>Conclusion: </strong>The feasibility, efficacy, and safety of the SR2000 were verified in animal experiments, and ergonomically optimized design have the potential for clinical dissemination.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12679-12686"},"PeriodicalIF":9.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cement leakage into adjacent vertebra during percutaneous vertebroplasty: \"Gild the Lily\" or \"Kill two birds with one stone\"?","authors":"Rui-Feng Ji, De-An Qin","doi":"10.1097/JS9.0000000000005094","DOIUrl":"10.1097/JS9.0000000000005094","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12975-12976"},"PeriodicalIF":9.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Global clinical trial landscape of microbiome modulator therapy in sepsis: gut microbiota interventions and challenges\".","authors":"Guohua You, Yiran Ren, Yuming Du","doi":"10.1097/JS9.0000000000005074","DOIUrl":"10.1097/JS9.0000000000005074","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12987-12988"},"PeriodicalIF":9.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Deciphering pathogenic mechanisms of BDCPP exposure in endometrial cancer progression via an integrated approach combining network toxicology, machine learning, and molecular docking\".","authors":"Yiming Gao, Qin Zheng, Mulin Liu","doi":"10.1097/JS9.0000000000005056","DOIUrl":"10.1097/JS9.0000000000005056","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12961-12962"},"PeriodicalIF":9.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental metal mixtures and overactive bladder: insights from population-based data.","authors":"Xingchen Xiong, Cai Lv","doi":"10.1097/JS9.0000000000005036","DOIUrl":"10.1097/JS9.0000000000005036","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12973-12974"},"PeriodicalIF":9.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national trends in 34 cancers through a novel burden-quality-of-care framework: a cross-sectional study.","authors":"Lingkang Dong, Qiang Ma, Jiaxin Yang, Yihan Cheng, Wenqi Dong, Boya Zhang, Yuli Hu, Chao Du, Wen Lu, Dongzhen Yu, Haibo Shi","doi":"10.1097/JS9.0000000000005067","DOIUrl":"10.1097/JS9.0000000000005067","url":null,"abstract":"<p><strong>Background: </strong>Current unidimensional cancer evaluation systems limit precise cancer control. This study establishes a novel burden-quality framework that integrates disease burden and quality-of-care index (QCI) to better assess cancer management effectiveness globally.</p><p><strong>Methods: </strong>The QCI was derived by principal component analysis of six standardized indicators using the Global Burden of Disease data (1990-2021). A four-quadrant framework integrated QCI with disease burden to classify 34 cancers across 204 countries/regions. The sociodemographic index (SDI) and gender disparity ratios (GDR) were used to assess inequalities.</p><p><strong>Results: </strong>Substantial heterogeneity exists in the burden and QCI across 34 cancers. Highly fatal cancers such as TBL cancers (tracheal, bronchus, and lung cancers) and pancreatic cancers are persistently trapped in a \"high burden-low quality\" dilemma. In contrast, high-burden breast cancer and low-burden thyroid cancer demonstrate superior QCI, though the latter may carry overtreatment risks. Socioeconomic factors have a profound influence on intervention equity, with SDI exhibiting a strong positive correlation with QCI (<i>r</i> = 0.90, <i>P</i> < 0.001) but a significant negative correlation with GDR (<i>r</i> = -0.71, <i>P</i> < 0.001). Notably, the trend of QCI improvement and overall reduction in cancer burden is asynchronous: high-survival cancers and high-SDI regions showed slow QCI gains, middle-SDI regions exhibited substantial increases, while low-SDI areas remained persistently disadvantaged. Demographic disparities further exacerbated these inequities - older populations bore a disproportionate disease burden yet achieved the fastest QCI improvements, whereas adolescent groups maintained high baseline quality but stagnated in progress. Additionally, gender disparities were pervasive, with females receiving better-quality care for most cancers and across most regions.</p><p><strong>Conclusion: </strong>This multidimensional burden-quality framework shifts cancer evaluation from singular evaluation to precision intervention. It emphasizes: (1) optimizing resources for high-burden-low-quality cancers, (2) avoiding overtreatment in low-burden cancers, and (3) reducing inequities linked to socioeconomic disparities and vulnerable groups (especially elderly and male patients). This research provides a foundation for precise and equitable global cancer control.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12623-12635"},"PeriodicalIF":9.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A commentary on \"Genetic insights into lipid traits and atherosclerosis risk: a Mendelian randomization and polygenic risk score analysis\".","authors":"Di Li, Zedong Cheng","doi":"10.1097/JS9.0000000000005079","DOIUrl":"10.1097/JS9.0000000000005079","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12977-12978"},"PeriodicalIF":9.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apigenin activates AKT1 to coordinate MTOR-mediated anti-apoptosis and FOXO3-driven antioxidant defense in calcium oxalate nephropathy.","authors":"Lei Li, Xiong Xu, Linfa Guo, Tongzu Liu","doi":"10.1097/JS9.0000000000005023","DOIUrl":"10.1097/JS9.0000000000005023","url":null,"abstract":"<p><strong>Background: </strong>Kidney stone disease, primarily composed of calcium oxalate (CaOx) crystals, represents a significant global health burden with high recurrence rates. Current therapeutic strategies fail to adequately address the oxidative stress and apoptosis triggered by CaOx crystals in renal tubular cells. While the natural flavonoid apigenin (API) shows promise, its precise mechanism in CaOx nephropathy remains unclear.</p><p><strong>Methods: </strong>We employed an integrated strategy combining network pharmacology and machine learning to identify potential therapeutic targets of apigenin in kidney stone disease. Experimental validation was conducted using both <i>in vivo</i> and <i>in vitro</i> models: a mouse model of CaOx nephropathy induced by glyoxylate and HK-2 cells exposed to calcium oxalate monohydrate crystals. The interaction between apigenin and AKT1 was investigated through surface plasmon resonance, molecular docking, cellular thermal shift assays, and drug affinity responsive target stability assays. Downstream signaling effects were analyzed using quantitative PCR, Western blotting, reactive oxygen species measurement, and apoptosis assessment. The functional role of AKT1 was further examined using the specific inhibitor MK-2206, siRNA-mediated knockdown, and FOXO3 overexpression experiments.</p><p><strong>Results: </strong>Apigenin treatment significantly reduced CaOx crystal deposition, improved renal function markers, and attenuated tubular damage in mice in a dose-dependent manner. Bioinformatic analysis identified AKT1 as the core target, and experimental validation confirmed that apigenin directly binds to AKT1 with high affinity, leading to enhanced phosphorylation. This activation modulated two critical downstream pathways. The mTOR pathway suppressed apoptosis through downregulation of BAX and upregulation of BCL-2; Phosphorylation of FOXO3 decreased its transcriptional activity on Keap1, resulting in reduced Keap1 expression, subsequent Nrf2 stabilization, nuclear translocation, and upregulation of the antioxidant enzyme HO-1. The essential role of AKT1 was further supported by the finding that MK-2206 and si-AKT1 treatment abolished apigenin's protective effects. Additionally, FOXO3 overexpression reversed apigenin-induced Nrf2 activation, confirming the involvement of the AKT1-FOXO3-Keap1-Nrf2 axis.</p><p><strong>Conclusion: </strong>Apigenin alleviates CaOx-induced renal injury through direct activation of AKT1, which coordinates dual protective mechanisms. Anti-apoptosis via the mTOR pathway and antioxidant defense through the FOXO3-Keap1-Nrf2 axis. This study provides comprehensive evidence of apigenin's AKT1-centered mechanism of action in CaOx nephropathy, supporting its potential as a novel therapeutic agent for kidney stone disease.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 4","pages":"10982-10999"},"PeriodicalIF":9.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}