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

{"title":"Robotic Cholecystectomy Remains Safe and Effective After Regular Hours: A 3-Year Update.","authors":"Emanuel Shapera, Isabella G Alessi, Fadi Elia, Yousif Elia, Loden Azure, Nikolas Kattoula, Ashton Zakar, Nawaf Hindosh","doi":"10.4293/JSLS.2026.00068","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00068","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite growing popularity in robotic-assisted surgery, access during evenings and weekends for nonelective operations may be restricted. A prior smaller comparison study in 2024 found no basis for safety concerns in managing acute cholecystitis in this setting. We sought to provide additional data to further evaluate whether restriction of robotic cholecystectomy during \"after-hours\" is justified.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 161 patients undergoing robotic cholecystectomy for acute cholecystitis according to 2018 Tokyo criteria by a single surgeon at multiple institutions between 2021 and 2026. Patients were grouped as after-hours cholecystectomy if the operation started at 5 pm or later, or anytime during the weekend (Saturday/Sunday). Preoperative, intraoperative, and outcome variables were tabulated and analyzed.</p><p><strong>Results: </strong>Sixty-five after-hours and 96 regular-hours robotic cholecystectomies were included. There were no significant differences in perioperative variables between the 2 cohorts in terms of body mass index, age, sex, cirrhotic status, ASA score, white blood cell count, nor neutrophil percentage. With the exception of alkaline phosphatase, there were no significant differences in liver function tests. There were no significant differences in operative time, estimated blood loss, length of stay, complications, nor 30-day readmissions. No bile duct injuries or mortalities occurred in either cohort.</p><p><strong>Conclusion: </strong>In this 5-year retrospective comparison, robotic cholecystectomy performed during evenings and weekends was associated with similar perioperative outcomes compared with regular-hours cases within a single experienced surgeon's practice. These findings support the feasibility of after-hours robotic cholecystectomy in this setting and provide a basis for further multisurgeon investigation.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165931","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":"Comparison of Trocar Anesthetic Injection & Transverse Abdominis Plane Block Post Laparoscopic Cholecystectomy.","authors":"Muhammad Imran Zahoor, Rizwan Ahmad Khan, Rooh Ul Ain, Fareeha K Khan, Yasir Bilal Shabbir","doi":"10.4293/JSLS.2026.00070","DOIUrl":"10.4293/JSLS.2026.00070","url":null,"abstract":"<p><strong>Background and objectives: </strong>To compare Trocar site Anesthesia Injection (TAI) and Transversus Abdominis Plane Block (TAPB) using Bupivacaine for immediate and sustained analgesia and patient satisfaction in post cholecystectomy patients to build a strategy for safe and early discharge home reducing number of admissions.</p><p><strong>Methods: </strong>Prospective, double blind randomized controlled trial on adult patients undergoing elective laparoscopic cholecystectomy in two years by convenience sampling was conducted. TAI and ultrasound guided TAPB using Bupivacaine were compared for analgesia (by VAS score 0-10) and patient satisfaction (by Likert scale 1-5) at 1, 2, 4, 6-8, 12 and 24 hours. Any patient with VAS > 4 was provided analgesia by narcotic (Tramadol) and Ketorolac. Mean, standard deviation and mean Standard error) were calculated by descriptive statistical methods. p < 0.05 was significant.</p><p><strong>Results: </strong>In total, 297 patients participated. The mean VAS was 3.02 versus 4.69 at 2 hours, 4.40 versus 6.60 at 4 hours, 3.48 versus 2.66 at 8 hours, 6.02 versus 3.66 at 12 hours and 3.41 versus 2.89 at 24 hours for TAPB and TAI group, respectively. Patients in TAI group needed Narcotic injection at 4 hours or at 8 hours while TAPB group needed at 8 hours or12 hours. The difference was significant statistically (p < 0.05). Requirement for analgesia in TAI group was significantly higher than in the TAPB groups (p < 0.05). Patients were less satisfied in TAI group than TAPB group at all hours measured (p < 0.05).</p><p><strong>Conclusion: </strong>TAPB is superior indicated by longer analgesia, less use of narcotic and increased patient satisfaction level.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137253","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":"Laparoscopic Cholecystectomy versus Percutaneous Drainage for Acute Cholecystitis in Elderly.","authors":"Yanxun Li, Lili Liu, Jinjin Sun","doi":"10.4293/JSLS.2026.00080","DOIUrl":"10.4293/JSLS.2026.00080","url":null,"abstract":"<p><strong>Background: </strong>There is ongoing debate regarding the best management strategy for acute calculous cholecystitis (ACC) in the oldest old population. The present study sought to evaluate clinical outcomes following laparoscopic cholecystectomy (LC) versus percutaneous transhepatic gallbladder drainage (PTGD) in elderly individuals diagnosed with ACC.</p><p><strong>Methods: </strong>This retrospective study included 135 elderly ACC patients (mean age >80 years) treated from January 2023 to December 2024. Of these, 68 underwent LC and 67 received PTGD. Between-group comparisons covered baseline profiles, a primary composite outcome (all-cause death or major complications at 1 year), secondary endpoints, and healthcare resource use.</p><p><strong>Results: </strong>The two groups were largely comparable at baseline, except that gallbladder wall thickness (median 4.0 vs 3.0 mm, <i>P</i> = .003) and symptom-to-admission interval (3.0 vs 2.0 days, <i>P</i> = .048) were slightly higher in the LC cohort. The primary composite endpoint was met by 30.9% of LC patients versus 55.2% of PTGD patients (<i>P</i> = .004). Major complications alone also favored LC (29.4% vs 52.2%, <i>P</i> = .007). One-year mortality showed no significant between-group difference (1.5% vs 3.0%, <i>P</i> = .618). Compared with PTGD, LC yielded markedly fewer overall infectious events (7.4% vs 40.3%, <i>P</i> < .001), lower reintervention requirement (7.4% vs 32.8%, <i>P</i> < .001), and less recurrent biliary disease (7.4% vs 47.8%, <i>P</i> < .001). Median hospital stay was shorter after LC (5.0 vs 10.0 days, <i>P</i> = .013).</p><p><strong>Conclusion: </strong>For elderly ACC patients, LC offers significant advantages over PTGD in terms of major complications, reinterventions, recurrent biliary disease, and hospitalization duration. Thus, LC ought to be the favored approach for elderly individuals who are surgical candidates.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137288","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":"AI-Assisted Volumetric Comparison of Parenchyma-Sparing Effect in Robotic Segmentectomy vs Lobectomy.","authors":"Muhammet Sayan, Ilknur Aytekin Celik, Mahir Fattahov, Bengisu Artiran, Fevzi Oguzhan Temirkaynak, Ali Celik","doi":"10.4293/JSLS.2026.00086","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00086","url":null,"abstract":"<p><strong>Background and objective: </strong>In recent years, pulmonary segmentectomy has become a preferred treatment option for early-stage lung cancer. The primary factor encouraging clinicians to choose segmentectomy is the assumption of greater parenchymal preservation. In this study, we investigated the parenchyma-sparing effect of robotic pulmonary segmentectomy compared with robotic lobectomy using artificial intelligence (AI)-assisted 3-dimensional (3D) volumetric analysis.</p><p><strong>Methods: </strong>Preoperative and postoperative thoracic computed tomography scans of patients diagnosed with lung cancer between January 2022 and December 2025 who underwent robotic lobectomy or segmentectomy were analyzed using Synapse 3D software. Resected, remaining, expected, and measured lung volumes were calculated. Differences between predicted and measured values were analyzed using the independent-samples <i>t</i> test or the Mann-Whitney <i>U</i> test, depending on the data distribution.</p><p><strong>Results: </strong>A total of 39 patients were included in the study. Lobectomy was performed in 21 patients, and segmentectomy in 18. The median resected lung volume was 360.5 mL (interquartile range [IQR]: 198-550) in the segmentectomy group and 896 mL (IQR: 599-1194) in the lobectomy group (<i>P</i> < .001). The difference in expected remaining lung volume percentages between the lobectomy and segmentectomy groups was statistically significant (<i>P</i> < .001), whereas the difference in measured postoperative remaining lung volumes was not statistically significant (<i>P</i> = .1).</p><p><strong>Conclusion: </strong>This pilot study demonstrated that robotic segmentectomy may not provide the expected parenchymal preservation advantage compared with lobectomy. Further prospective multicenter studies with larger cohorts are required.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168698","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":"Cable Organizer for Laparoscopic and Endoscopic Procedures.","authors":"Yang Mi, Yujie Hao, Jiwen Shang, Wei Guan","doi":"10.4293/JSLS.2026.00091","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00091","url":null,"abstract":"<p><strong>Background: </strong>During laparoscopic and endoscopic procedures, multiple devices are used simultaneously, requiring preconnection and arrangement of their cables. Traditionally, cables are bundled with gauze and fixed with drape clips, which hinders intraoperative adjustment of cable number and orientation. Thus, an innovative device for more flexible and convenient equipment line management is needed. Commercial cable-management products lack adjustability during surgery; a rotatable, angle-lockable organizer could fulfill this need.</p><p><strong>Methods: </strong>We designed a novel surgical cable organizer and produced a prototype via 3-dimensional (3D) printing. It comprises 2 discs: the upper one has 6 pairs of arc-shaped buckles, and the lower one contains adhesive for attachment to surgical drapes. Their opposing serrated surfaces enable rotation or angle locking. We compared the time for surgeons from different specialties to connect and adjust laparoscopic and endoscopic cables using the new device and the traditional gauze method.</p><p><strong>Results: </strong>In simulated operations, the cable organizer significantly shortened the time for cable connection (1.46 ± 0.46 vs 4.56 ± 0.72 seconds; <i>P</i> ≤ .001), direction adjustment (1.25 ± 0.21 vs 4.11 ± 0.39 seconds; <i>P</i> ≤ .001) and increasing cable (1.27 ± 0.23 vs 3.51 ± 0.63 seconds; <i>P</i> ≤ .001) versus conventional methods, a benefit attributable to its rotatable, angle-locking dual-disc structure. However, the design needs further optimization and validation of sterilization, biocompatibility and mechanical durability, with wider clinical validation, before clinical use.</p><p><strong>Conclusion: </strong>This innovative cable organizer greatly reduces device management time during laparoscopic and endoscopic surgeries, which may enhance operating room efficiency.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182477","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":"Triple-Action Seroma Prevention Protocol in Subcutaneous Onlay Endoscopic Repair.","authors":"Moshe Dudai, Marah Ganiem, Rut Meruham","doi":"10.4293/JSLS.2026.00094","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00094","url":null,"abstract":"<p><strong>Background and objectives: </strong>Postoperative seroma is a common surgical site occurrence following procedures that create large subcutaneous dead spaces. This case series describes a triple-action seroma prevention protocol used during subcutaneous onlay endoscopic repair and reports early postoperative outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed 36 consecutive adults who underwent modified subcutaneous onlay laparoscopic abdominal wall reconstruction for rectus diastasis and midline hernias, with or without postoperative incisional hernia, between March 2024 and December 2025. The protocol combined progressive-tension quilting sutures, irrigation with 20 mL of 12% hypertonic saline retained for 10 minutes, and fibrin sealant application. Closed-suction drains and an abdominal binder were used routinely.</p><p><strong>Results: </strong>Seroma was recorded in 2 of 36 patients (5.6%). Among 15 patients with postoperative incisional hernia and rectus diastasis, seroma occurred in 1 patient (6.7%). Both affected patients were men with obesity and dense subcutaneous fibrosis. Drain output decreased to approximately 20 mL within 10 hours, and drains were removed on postoperative day 1 in all but 1 patient. No infection, mesh infection, skin necrosis, flap ischemia, hypernatremia, or fibrin sealant-related anaphylaxis was recorded. One additional small fluid collection detected at 6 weeks was managed conservatively.</p><p><strong>Conclusion: </strong>In this descriptive series of subcutaneous onlay endoscopic repair, the triple-action seroma Prevention protocol was associated with a low observed seroma rate and early drain removal. These findings are preliminary and require confirmation in larger prospective controlled studies.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182479","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":"Credit Where Credit's Due: Gynecology Paves the Way for MIS (Minimally Invasive Surgery).","authors":"Camran Nezhat, Barbara Page, Zahra Najmi, Saira Kothari, Neel Ambarge, Isabella Choi, Arman Sirjani, Shreeya Rao Lalam, Ceana Nezhat, Farr Nezhat","doi":"10.4293/JSLS.2026.00108","DOIUrl":"10.4293/JSLS.2026.00108","url":null,"abstract":"<p><p>The introduction of modern-day minimally invasive surgery (MIS) marked a turning point in the history of medicine, driving one of the sharpest declines in surgical mortality and morbidity ever recorded-standing alongside antisepsis and antibiotics as one of the most consequential life-saving advances in medical history. By averting an estimated 10 to 20 million surgical deaths and sparing over 1 billion patients the severe, long-term disabilities once inherent to large-incision approaches, MIS transformed surgical practice across all disciplines within a single generation. As a first-person historical account and companion piece to our systematic outcomes review, this Clinical Opinion reconstructs the lived experience of that paradigm shift: from the haunting realities of 1970s open laparotomy to Camran Nezhat's pioneering transition from eyepiece laparoscopy to monitor-guided operative endoscopy. The author reflects on the personal motivations, technological improvisations, and multidisciplinary collaborations that expanded videoendoscopy beyond diagnostics into complex operative interventions, as well as the fierce institutional resistance that nearly extinguished the movement. Beyond its technical achievements-including dramatic reductions in perioperative blood loss, multiunit transfusions, infections, and hospital stays-MIS catalyzed a fundamental reimagining of surgery itself. It inverted two centuries of surgical doctrine, replacing the belief that \"the bigger the incision, the better the surgeon\" with a new ethos centered on shared visualization, organ preservation, and pathology-directed precision. Ultimately, this narrative highlights the cost of innovation, the role of patients as the true drivers of progress, and the ongoing obligation to ensure equitable global access to minimally invasive and robotic-assisted care.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194801","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":"Preoperative Ultrasound Assessment of Abdominal Wall Thickness and Vascular Proximity at the Umbilical Region.","authors":"Ceana Nezhat, Connie W Cheng, Gerald A Feuer, Nisha Lakhi","doi":"10.4293/JSLS.2026.00071","DOIUrl":"10.4293/JSLS.2026.00071","url":null,"abstract":"<p><strong>Objective: </strong>To quantify abdominal wall thickness and distances to the superior mesenteric artery (SMA) and major retroperitoneal vessels using standardized transabdominal ultrasound with color Doppler.</p><p><strong>Study design: </strong>Prospective observational study conducted at a single high-volume minimally invasive gynecologic surgery center. Consecutive patients scheduled for laparoscopic surgery underwent preoperative ultrasound mapping of abdominal wall thickness and skin-to-vessel distances to the aorta, IVC, and SMA. Primary outcomes were abdominal wall thickness and skin-to-vessel distances. Secondary outcomes included comparison of measurements before and after anesthesia and across BMI categories (<20, 20-24.9, 25-29.9, ≥30 kg/m²).</p><p><strong>Results: </strong>A total of 193 patients were enrolled. Mean skin-to-vessel distances were: aorta 5.73 cm (SD 2.11), IVC 5.72 cm (SD 2.15), and SMA 4.34 cm (SD 1.50). Abdominal wall thickness and skin-to-vessel distances increased significantly across BMI categories (all p < 0.001). Among patients with paired measurements (n = 81), no significant differences were observed before versus after anesthesia.</p><p><strong>Conclusions: </strong>Preoperative transabdominal ultrasound with color Doppler is a feasible, noninvasive tool for measuring abdominal wall thickness and vascular proximity across BMI categories, with stability before and after anesthesia supporting its reliability as an office-based assessment. These normative data provide a foundation for future studies evaluating whether individualized preoperative ultrasound can improve laparoscopic entry safety.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137291","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":"Comparison of Laparoscopic and Open Surgery for Appendiceal Mucocele in Terms of Safety and Feasibility.","authors":"Mustafa Yılmaz, Mahsum Barçin, Zafer Can Kesikminare, Cansu Zerey, Fadime Eda Gökalp, Hilmi Bozkurt, Özlem Zeliha Sert","doi":"10.4293/JSLS.2026.00051","DOIUrl":"10.4293/JSLS.2026.00051","url":null,"abstract":"<p><strong>Objectives: </strong>Appendiceal mucocele (AM) is a rare clinicopathological entity, and the optimal surgical approach remains controversial because of concerns regarding intraoperative rupture and mucin spillage. This study aimed to compare laparoscopic surgery (LS) and open surgery (OS) in patients with AM in terms of perioperative safety, postoperative recovery, and pathological outcomes.</p><p><strong>Methods: </strong>This retrospective single-center study included 53 patients who underwent surgery for AM between January 2010 and January 2026. Patients were divided into LS and OS groups. Demographic and clinical characteristics, operative findings, postoperative outcomes, and histopathological results were compared between the groups.</p><p><strong>Results: </strong>Of the 53 patients, 20 underwent LS and 33 underwent OS. Baseline clinical characteristics were generally comparable between the groups, although female sex was more frequent in the LS group. Operative time, surgical procedure distribution, intraoperative perforation findings, intraoperative mucocele rupture, Clavien-Dindo scores, morbidity, readmission, and reoperation rates were not significantly different between the groups. LS was associated with earlier return of bowel function, earlier tolerance of a soft diet, and shorter postoperative hospital stay. Low-grade appendiceal mucinous neoplasm was the most common histopathological diagnosis, and pathological diagnosis distribution and surgical margin positivity were comparable between the groups.</p><p><strong>Conclusion: </strong>LS may be considered a safe and feasible alternative to OS in selected patients with AM, providing comparable perioperative and pathological outcomes with more favorable short-term postoperative recovery. Careful patient selection, meticulous surgical technique, and readiness for conversion remain essential.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604430","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":"Bilateral Salpingectomy for Sterilization: A Prospective Comparison of Laparoscopy and vNOTES.","authors":"Ozan Odabaş, Arda Batuhan Karaduman, Volkan Kolbaşı, Özgün Akbaş, Emrah Töz, Yaşam Kemal Akpak, Ahkam Göksel Kanmaz","doi":"10.4293/JSLS.2026.00073","DOIUrl":"10.4293/JSLS.2026.00073","url":null,"abstract":"<p><strong>Objective: </strong>Prospective data comparing vaginal natural orifice transluminal endoscopic surgery (vNOTES) with laparoscopy, and general with spinal anesthesia, in bilateral salpingectomy performed for elective sterilization remain limited. This study compared these surgical approaches and anesthesia modalities with respect to early postoperative pain and perioperative outcomes.</p><p><strong>Methods: </strong>In this single-center prospective comparative cohort study, 375 women aged 30 to 45 years who underwent bilateral salpingectomy for elective sterilization between January 1, 2025, and January 1, 2026, were evaluated. Patients were grouped by surgical approach as laparoscopy (n = 180) or vNOTES (n = 195), and by anesthesia type as general (n = 187) or spinal anesthesia (n = 188). The primary endpoint was the 12-hour postoperative visual analog scale (VAS) pain score. Secondary endpoints included 24-hour VAS score, shoulder pain, decrease in hemoglobin, additional analgesic requirements, nausea and vomiting, complications, conversion to laparotomy, and 6-month Female Sexual Function Index (FSFI) scores.</p><p><strong>Results: </strong>The 12-hour VAS score was lower with vNOTES than laparoscopy (2.82 ± 0.66 vs 3.62±1.08; <i>P</i> < .001). vNOTES was also associated with lower 24-hour pain, less shoulder pain, and reduced additional analgesic use. Body mass index (BMI) was similar between surgical groups. Spinal anesthesia was associated with a lower 12-hour VAS scores compared to general anesthesia (2.83 ± 0.67 vs 3.58 ± 1.08; <i>P</i> < .001), although shoulder pain was higher with spinal anesthesia (<i>P</i> < .001). No conversion to laparotomy occurred.</p><p><strong>Conclusion: </strong>For elective sterilization, vNOTES bilateral salpingectomy was associated with lower early pain and reduced analgesic requirement compared with laparoscopy. Spinal anesthesia may reduce early pain but may influence shoulder pain patterns.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008639","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}