JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献

{"title":"Impact of Intraperitoneal Drain Placement on Postoperative Pain After Total Laparoscopic Hysterectomy.","authors":"Özge Küçükatalay, Sercan Kantarcı, Uğurcan Dağlı, Ahkam Göksel Kanmaz, Emrah Töz, Alper İleri, Abdurrahman Hamdi İnan","doi":"10.4293/JSLS.2026.00012","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00012","url":null,"abstract":"<p><strong>Introduction: </strong>Total laparoscopic hysterectomy (TLH) is widely performed for benign gynecologic conditions; however, postoperative pain particularly shoulder pain related to residual intraperitoneal CO₂ remains a clinical concern. This study aimed to evaluate whether drain placement reduces postoperative pain and analgesic requirements after benign TLH.</p><p><strong>Methods: </strong>In this prospective observational study, 129 women undergoing TLH were included; 86 received an intraperitoneal drain and 43 did not. Drain placement was based on the surgeon's intraoperative judgment. To ensure a homogeneous low-complexity cohort, cases with complications or deviations from standard TLH were excluded. Postoperative shoulder, chest, and abdominal pain were assessed using a 10-point visual analog scale at 6, 12, and 24 hours. Analgesic use and early postoperative outcomes were also recorded.</p><p><strong>Results: </strong>Baseline demographic and perioperative characteristics were comparable between groups. Multivariable regression analysis showed that drain placement was independently associated with higher shoulder pain at 6 and 12 hours (p = 0.015 and p < 0.001) and higher chest pain at 6 hours (p = 0.039). Abdominal pain was higher at 6 hours but lower at 24 hours in the drain group (p = 0.039 and p = 0.032). Despite these time-dependent differences, overall postoperative analgesic consumption during the first 2 days was significantly higher in patients with drains (p < 0.05).</p><p><strong>Conclusion: </strong>Intraperitoneal drain placement after benign TLH was associated with increased early postoperative pain and did not reduce overall analgesic consumption. Routine drain use cannot be recommended, and selective placement should be reserved for specific clinical situations.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775375","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":"Three Strategic Pillars for Implementing Endoscopic Nipple-Sparing Mastectomy.","authors":"Guillermo Gerardo Peralta Castillo, Paulina Bajonero Canónico, Ricardo Cavazos García","doi":"10.4293/JSLS.2026.00010","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00010","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical treatment of breast cancer has evolved from radical surgery to increasingly less invasive techniques, including nipple-sparing mastectomy (NSM), and more recently toward minimally invasive breast surgery (MIB), both endoscopic and robotic, particularly in high-volume centers, demonstrating encouraging oncologic and reconstructive outcomes in selected patients.</p><p><strong>Objective: </strong>To present a structured and practical guided framework, describing the three fundamental strategic axes for the safe implementation of endoscopic mastectomy, based on the experience of a pioneering center.</p><p><strong>Methods: </strong>We propose a structured model focused on: (1) clinical and oncologic foundations; (2) technical standardization and surgical logistics; and (3) outcomes assessment, training, and reproducibility. The center's initial experience, the systematization of the implementation process, and a reflection on its applicability are presented.</p><p><strong>Results: </strong>A patient selection protocol, an equipment-and-roles checklist, standardized technical steps, and a plan for data capture and training are provided.</p><p><strong>Conclusions: </strong>Endoscopic mastectomy can be successfully implemented within a structured institutional setting, with specialized training and appropriate equipment. This article offers an actionable pathway for other centers seeking to adopt this technique.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775400","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":"Effect of Drains on Complications in Laparoscopic Repair of Unilateral Inguinal Hernia.","authors":"Kuldeep Deewan, Aaditya Odhwani, Kunal Kumar, Divay Kumar","doi":"10.4293/JSLS.2026.00021","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00021","url":null,"abstract":"","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13119382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775402","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":"Postinsufflation Optical Entry via Veress Access in the Left Upper Quadrant: Safety and Outcomes.","authors":"Niraj Balakrishnan, Harold Coley, Kaleb Eaton, Srikanth Chittareddy, Pragatheeshwar Thirunavukarasu","doi":"10.4293/JSLS.2026.00008","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00008","url":null,"abstract":"<p><strong>Background: </strong>Conventional closed-entry approaches typically employ either Veress needle insufflation followed by blind trocar insertion, or optical trocar entry without prior pneumoperitoneum. The safety, feasibility, and outcomes of optical entry after establishment of pneumoperitoneum using Veress needle, is not adequately established in published literature.</p><p><strong>Objective: </strong>We hypothesize that Veress access left upper quadrant optical entry (VALO) technique of post-Veress insufflation optical entry is safe, effective, and feasible for routine peritoneal access in laparoscopic surgery.</p><p><strong>Methods: </strong>A retrospective single-center cohort study of all consecutive cases undergoing cholecystectomy by a single surgeon using the VALO technique as the routine initial method of peritoneal access, between July 2022 and April 2025, was conducted. Primary outcomes included success rate and access-related complications. Secondary outcomes included operative time, 30-day morbidity, mortality, and readmission rates.</p><p><strong>Results: </strong>A total of 124 patients were included, with 81 (65.4%) being female. The median age was 48.5 years. The mean body mass index (BMI) was 32.3 kg/m², and 51.6% had previous abdominal surgery. Urgent cases accounted for 67% of procedures. Peritoneal access using VALO was successful in all patients (100%). There were no access-related vascular or visceral injuries, and no conversions were needed due to entry complications. Thirty-day outcomes showed no mortality, reoperations, or incisional hernias. The readmission rate was 5.6%, and none of these were related to access complications.</p><p><strong>Conclusion: </strong>The VALO technique of Left upper quadrant postpneumoperitoneum optical entry is safe, feasible, and effective for initial peritoneal access in laparoscopic surgery, including patients with prior abdominal surgery.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839821","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":"Characteristics and Outcomes of OviTex Mesh in Laparoscopic Hiatal Hernia Repair with Fundoplication and Mesh.","authors":"Hiley Cammock, Danial A Malik, Farid Kehdy","doi":"10.4293/JSLS.2025.00108","DOIUrl":"https://doi.org/10.4293/JSLS.2025.00108","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic repair is the standard treatment for symptomatic paraesophageal and mixed hiatal hernias; however, recurrence rates remain high, particularly in large defects. Mesh reinforcement has been used to improve outcomes, but the optimal mesh type remains debated. OviTex 1S, a reinforced tissue matrix composed of ovine extracellular matrix and polypropylene, has demonstrated safety in abdominal wall reconstruction, though data for hiatal hernia repair are limited.</p><p><strong>Methods: </strong>We conducted a prospective, single-arm, single-institution study evaluating laparoscopic hiatal hernia repair with OviTex 1S mesh between January 2020 and February 2024. Adults with radiologic or endoscopic confirmation of hiatal hernia requiring mesh reinforcement were included. Primary endpoints were hernia recurrence and reflux symptom improvement. Secondary endpoints included quality of life, assessed using reflux severity scores and the Gastroesophageal Reflux Disease (GERD)-Health-Related Quality of Life (HRQL) survey. Patients were followed at 1, 3, 6, 12, and 24 months.</p><p><strong>Results: </strong>Of 443 patients undergoing paraesophageal hernia repair, 108 received OviTex 1S reinforcement. Mean age was 65.5 years, mean body mass index (BMI) 28.1 kg/m², and 82.2% were female. Three perioperative recurrences (2.8%) required reoperation. Overall recurrence occurred in 21 patients (19.4%), most beyond six months. GERD-HRQL scores improved by more than 50% at 12 months (20 ± 4.75 vs 4 ± 7; <i>P</i> = .02). Proton pump inhibitor use declined from 91.6% preoperatively to 9.4% postoperatively. No mesh-related erosions or strictures were observed.</p><p><strong>Conclusions: </strong>OviTex 1S mesh reinforcement during laparoscopic hiatal hernia repair is safe, improves reflux-related quality of life, and demonstrates low early recurrence. Long-term benefits remain limited, warranting larger multicenter studies.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674635","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":"The Sakarya Technique for Safer Laparoscopic Access.","authors":"Deniz Gul, Haci Ibrahim Cimen, Esat Unal, Anıl Erdik, Yavuz Tarik Atik, Recep Burak Degirmentepe, Bayram Dogan, Hasan Salih Saglam","doi":"10.4293/JSLS.2026.00004","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00004","url":null,"abstract":"<p><strong>Background: </strong>Abdominal access is the crucial step for laparoscopic surgery, and there is no consensus for the ideal technique for initial trocar placement. We aim to introduce our new technique used for safe initial entry to create pneumoperitoneum in transabdominal laparoscopic surgery and compare it with the Veress needle technique.</p><p><strong>Methods: </strong>We retrospectively reviewed 317 consecutive patients who underwent urological laparoscopic surgery between January 2016 and January 2025. For the initial trocar insertion, 98 patients with the Veress needle technique and 182 patients with our Sakarya technique were included in the study. All procedures were performed by a single experienced surgeon. Patients' characteristics, time from skin incision to camera entry, gas leakage, and complications were recorded.</p><p><strong>Results: </strong>The median age was 58 years (interquartile range [IQR]: 45-66), the median body mass index (BMI) was 27.68 (25.06-29.96), and 128 (40.4%) of patients were female. In our Sakarya technique, no major vascular complications were observed, but renal cyst rupture occurred in one patient, and the gas leakage rate was 5.5%. No significant difference was found in complications and gas leakage rates between the Sakarya technique and the Veress needle technique (<i>P</i> > .05). The time from skin incision to camera entry was 27 seconds (IQR: 23-32) with the Sakarya technique, significantly less than the 105 seconds (IQR: 96-124) with the Veress needle technique (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>The Sakarya technique is an easy, safe, and fast method for initial trocar insertion in laparoscopic surgery.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775367","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":"Long-Term Outcomes and Safety of Robotic Bariatric Surgery.","authors":"Vivek Bindal, Dhananjay Pandey, Vijay S Pandey, Amir Iqbal, Aakash Patel, Lakshay Goel, Deepak Kumar","doi":"10.4293/JSLS.2026.00011","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00011","url":null,"abstract":"<p><strong>Background: </strong>Bariatric surgery (BS) is the most effective treatment for sustained weight loss and improvement of obesity-related comorbidities. Robotic BS (RBS) offers enhanced precision and ergonomics; however, local data remain limited.</p><p><strong>Methods: </strong>This retrospective real-world study included consecutive adults (≥18 years) who underwent single-surgeon robotic-assisted primary BS using the da Vinci® Surgical System (October 2012-December 2024), with complete perioperative and follow-up data.</p><p><strong>Results: </strong>A total of 545 patients were analyzed with a mean age of 42.98 ± 11.15 years and a mean body mass index (BMI) of 44.55 ± 6.66 kg/m²). Sleeve gastrectomy (SG) was the most common procedure (72.48%), followed by Roux-en-Y gastric bypass (RYGB, 17.61%) and one-anastomosis gastric bypass (OAGB, 9.91%). Mean docking and operative times were 6.25 ± 2.29 and 99.84 ± 29.21 minutes, respectively. Intraoperative events were infrequent (console-related 2.57%, bedside-related 4.04%, instrument-related 3.12%), with no conversions. Mean intensive care unit (ICU) and hospital stays were 0.25 ± 0.45 and 2.42 ± 0.56 days. Thirty-day complications occurred in 2.02% of patients, comprising grade I (1.10%), grade II (0.73%), and grade III (0.18%) events. Between 1 month and 1 year, 1.28% experienced minor (grade I) complications. At 1 year, mean BMI decreased to 32.68 ± 4.02 kg/m², with no mortality. Outcomes in patients with BMI ≥ 50 kg/m² were comparable, supporting the safety and feasibility of RBS in grade IV obesity.</p><p><strong>Conclusions: </strong>RBS proved safe, efficient, and effective, with low complications and consistent outcomes, supporting its use for obesity management in high-volume centers.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839773","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":"Correspondence on. Effect of Drains on Complications in Laparoscopic Repair of Unilateral Inguinal Hernia.","authors":"Birol Agca, Iksan Tasdelen, Kemal Memisoglu, Yalin Iscan","doi":"10.4293/JSLS.2026.00029","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00029","url":null,"abstract":"","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775333","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":"Real Robotic Surgery: A New Paradigm of Surgical Approach.","authors":"Beniamino Pascotto, Juan Santiago Azagra","doi":"10.4293/JSLS.2026.00028","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00028","url":null,"abstract":"","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816645","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":"Comparing Proficiency of Laparoscopic Vaginal Cuff Suturing After Training with Two Simulators.","authors":"Emily G Lin, Megan A Runge, David Aaby, Kayla N Marshall, Jessica Traylor, Susan Tsai, Angela Chaudhari, Christopher C DeStephano, Magdy P Milad","doi":"10.4293/JSLS.2025.00116","DOIUrl":"10.4293/JSLS.2025.00116","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether a gynecology-specific laparoscopic trainer better prepares premedical and medical students to perform a laparoscopic vaginal cuff surgical task than the current standard laparoscopic trainer.</p><p><strong>Methods: </strong>In a masked, block-randomized controlled trial, 49 premedical and preclinical medical students were recruited, then randomized to a laparoscopic simulator: Essentials in Minimally Invasive Gynecologic Surgery (EMIGS) or Fundamentals of Laparoscopic Surgery (FLS). A total of 26 participants were initially randomized to EMIGS and 23 participants to FLS. They trained for 2.5 hours on their assigned simulator. Video recordings of participants performing a laparoscopic vaginal cuff suturing task were collected before and after simulator training. Videos were masked and reviewed by expert minimally invasive gynecologic surgery (MIGS) surgeons and graded using a modified Global Operative Assessment of Laparoscopic Skills (GOALS) rubric. The pretraining and post-training GOALS scores were then compared between simulator groups.</p><p><strong>Results: </strong>Most demographic characteristics were similar across both groups. Ultimately, 24 participants from the EMIGS group and 21 participants from the FLS group were included in the final analysis. The mean difference between post and pre-composite GOALS scores was 6.50 for EMIGS and 4.07 for FLS, <i>P</i> = .34. The mean EMIGS post-pre difference was greater for six of the eight individual GOALS domains, although all <i>P</i>-values > .05.</p><p><strong>Conclusions: </strong>Neither EMIGS nor FLS was associated with better performance on the vaginal cuff suturing task after a single 2.5-hour training session.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046868","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}