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

{"title":"Maximizing Robotic Efficiency in Paired Kidney Transplantation at a Resource-Limited County Hospital.","authors":"Gaetano Ciancio, Mahmoud Morsi, Giselle Guerra, Adela Mattiazzi, Phillipe Abreu, Rodrigo Vianna","doi":"10.4293/JSLS.2026.00053","DOIUrl":"10.4293/JSLS.2026.00053","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is the best option for overcoming kidney replacement therapy in end-stage kidney disease. Yet the number of available deceased donors is limited. Living donor kidney transplantation offers an effective strategy to expand the donor pool, and kidney paired donation has emerged as an important alternative option.</p><p><strong>Methods: </strong>In our cases, the primary consideration was immunological incompatibility in one living donor-recipient pair and the need to appropriately match kidney volume in another pair. We retrospectively analyzed our 2-way kidney paired donation cases in which Recipient 1 received a kidney from Donor 2, and Recipient 2 received a kidney from Donor 1. In all 4 cases, the living donor nephrectomies and transplant procedures were performed using a robotic-assisted approach.</p><p><strong>Results: </strong>Both donors experienced no perioperative or postoperative complications. Both recipients demonstrated immediately graft function, with progressive normalization of serum creatinine levels through 24 months post-transplant. We successfully performed 2 robotic-assisted living donor nephrectomies and their corresponding robotic-assisted living donor kidney transplants using a single robotic platform. All procedures were conducted at our public county hospital, where resources are carefully allocated to serve the community.</p><p><strong>Conclusions: </strong>Based on the favorable outcomes observed in our robotic transplant program, the hospital plans to expand its robotic surgery program.</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/PMC13588025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008739","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":"Transthoracic versus Transhiatal Esophagectomy for Esophageal Squamous Cell Carcinoma.","authors":"Abdullah Gunes, Omer Akay, Murat Ozdamar, Mert Guler, Murat Burc Yazicioglu, Adem Yuksel, Cagrı Tiryaki","doi":"10.4293/JSLS.2026.00054","DOIUrl":"10.4293/JSLS.2026.00054","url":null,"abstract":"<p><strong>Background: </strong>Esophageal squamous cell carcinoma (ESCC) is associated with high morbidity and mortality, and esophagectomy remains the mainstay of curative treatment. The optimal surgical technique transthoracic esophagectomy (TTE) versus transhiatal esophagectomy (THE) continues to be debated due to differences in surgical invasiveness and the extent of lymphadenectomy. This study aimed to compare clinical and oncological outcomes of TTE and THE in patients treated for ESCC.</p><p><strong>Materials and methods: </strong>This retrospective study included patients who underwent curative-intent esophagectomy for histologically confirmed ESCC between 2015 and 2023. Patients were categorized according to surgical approach (TTE vs THE), and demographic characteristics, perioperative data, pathological findings, postoperative complications, and survival outcomes were compared between the 2 groups. Complications were classified according to the Clavien-Dindo system. Disease-free survival (DFS) and overall survival (OS) were assessed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>A total of 39 patients were analyzed (21 TTE, 18 THE). Baseline demographic features and most perioperative variables were comparable. TTE was associated with a significantly longer operative time and higher lymph node yield, whereas THE showed higher rates of intraoperative transfusion and pleural effusion. Other postoperative complications were similar between groups. The TTE approach demonstrated significantly better DFS (<i>P</i> = .004). No significant difference in OS was observed between the groups (<i>P</i> = .165). No additional clinical or pathological factors were associated with survival outcomes.</p><p><strong>Conclusion: </strong>TTE resulted in a greater lymph node yield and significantly improved DFS, indicating a clear oncologic advantage over the transhiatal approach.</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/PMC13440922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679087","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":"Transvaginal Ultrasonographic Visualization of Endometriosis as a Unified Peritoneal Thickening.","authors":"Kiyohiko Yamada, Chika Nishizawa, Miyuki Akisada","doi":"10.4293/JSLS.2025.00125","DOIUrl":"10.4293/JSLS.2025.00125","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study characterized the peritoneal surface of the posterior cervix and vaginal fornix. Transvaginal ultrasonography (TVUS) was performed during laparoscopic surgery to visualize structures beyond the muscular and epithelial layers and to evaluate their association with endometriosis.</p><p><strong>Methods: </strong>Pelvic pain was assessed using a 10 cm visual analog scale. During laparoscopic surgery, saline solution was infused into the pelvic cavity, after which sagittal TVUS images were obtained from the vaginal wall to the peritoneal surface, covering the region from the midline posterior fornix to the bilateral uterosacral ligaments. Fibrotic lesions within the trapezoidal area formed by the posterior cervix, posterior fornix, and uterosacral ligaments were dissected and excised for histopathological analysis. Vaginoperitoneal thickness (VPT)-the distance from the vaginal wall to the peritoneal surface-was measured before and after lesion removal.</p><p><strong>Results: </strong>TVUS revealed a thickened structure on the peritoneal surface of the posterior vaginal fornix. Uniform granular hyperechogenicity was observed in 65.4% of cases, while partial hypoechoic areas were noted in 34.6%. The structure appeared as a unified lesion extending from the midline to the lateral uterosacral ligament region. Histological examination confirmed endometrial glands and/or stroma in 60.4% of excised lesions and fibrosis in 31.7%. Postoperative VPT was significantly reduced compared with preoperative measurements, with improvement in pain scores observed.</p><p><strong>Conclusions: </strong>TVUS visualized a continuous endometriotic lesion extending from the posterior cervix and fornix to the bilateral uterosacral ligaments. VPT measurement may provide a measurable parameter for describing peritoneal involvement in endometriosis.</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/PMC13588031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008691","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":"Central Vertical Spreading: A Structured Technique for Vaginal Extraction of Large Fibroids.","authors":"Satoshi Tsunetoh, Keiko Miura, Kaho Nagasawa, Nagisa Ishikawa, Natsuho Nakamura, Kiyoji Okuda, Tomohito Tanaka","doi":"10.4293/JSLS.2026.00067","DOIUrl":"10.4293/JSLS.2026.00067","url":null,"abstract":"<p><strong>Introduction: </strong>Extraction of large fibroids during total laparoscopic hysterectomy (TLH) remains technically challenging, particularly under limited vaginal visualization. Current transvaginal extraction methods are often experience dependent, and standardized procedural sequences have not been fully established.</p><p><strong>Case description/technique description: </strong>We describe a structured central vertical spreading technique for transvaginal extraction of large fibroids following laparoscopic enucleation during TLH. The specimen is placed in a retrieval bag and exteriorized vaginally. Controlled vertical incisions confined to the visible operative field are performed sequentially, followed by rotational repositioning and connection of incision lines. This stepwise sequence progressively reduces the effective extraction diameter while preserving structural continuity. Five consecutive cases after protocol standardization were evaluated to assess procedural feasibility.</p><p><strong>Discussion: </strong>The technique introduces a structured geometric principle that transforms vaginal specimen extraction from an experience-dependent maneuver into a reproducible procedural technique. In this series, all specimens were removed without powered morcellation, additional port placement, bag rupture, or extraction-related complications. This nonpowered approach may offer a structured alternative to powered morcellation in appropriately selected cases.</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/PMC13597003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025467","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":"Emergency Gynecologic Surgery Outcomes During Working and Off-Hours.","authors":"Alaattin Karabulut, Sercan Kantarcı, Uğurcan Dağlı, Didem Sezen, Elif Atıcı, Abdurrahman Hamdi İnan, Mehmet Özer, Mehmet Özeren","doi":"10.4293/JSLS.2026.00052","DOIUrl":"10.4293/JSLS.2026.00052","url":null,"abstract":"<p><strong>Objective: </strong>To compare perioperative outcomes of emergency gynecologic surgeries performed during working hours and off-hours, and to evaluate temporal trends in surgical approach, particularly laparoscopy.</p><p><strong>Methods: </strong>This retrospective cohort study included patients who underwent emergency surgery for ovarian torsion, ovarian cyst rupture, or ruptured tubal ectopic pregnancy between January 1, 2020 and October 1, 2025 at a tertiary referral center. Patients were grouped according to surgical timing as working hours or off-hours. Demographic characteristics, surgical approach, operative time, hemoglobin decrease, transfusion requirement, hospital stay, intraoperative and postoperative complications, and reoperation were compared within each diagnostic group. Annual trends in surgical approach were also analyzed, and multivariable linear regression assessed the association of off-hours surgery with operative time and length of hospital stay.</p><p><strong>Results: </strong>A total of 386 patients were included: 69 with ovarian torsion, 77 with ovarian cyst rupture, and 240 with ruptured tubal ectopic pregnancy. Most procedures were performed during off-hours. In ovarian torsion and ovarian cyst rupture, perioperative outcomes were comparable between groups. In ruptured tubal ectopic pregnancy, operative time was longer during off-hours than during working hours and remained independently associated with off-hours surgery after adjustment, while hemoglobin decrease, transfusion requirement, hospital stay, complications, and reoperation rates were similar. The proportion of laparoscopic procedures increased from 17.9% in 2020 to 90.0% in the first 9 months of 2025.</p><p><strong>Conclusion: </strong>Off-hours emergency gynecologic surgery showed largely comparable outcomes to working-hours surgery. The marked shift toward laparoscopy suggests increasing integration of minimally invasive surgery into emergency gynecologic practice.</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/PMC13440921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679039","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":"Comment on: \"Three Strategic Pillars for Implementing Endoscopic Nipple-Sparing Mastectomy\".","authors":"Vasileios Kalles, Ioannis Papapanagiotou, Apostolos Mitrousias, Antonio Toesca","doi":"10.4293/JSLS.2026.00044","DOIUrl":"10.4293/JSLS.2026.00044","url":null,"abstract":"","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/PMC13417864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620462","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":"Anal Intraepithelial Neoplasia Detection on Routine Colonoscopy: Review of 3550 Patients.","authors":"Maryam Aleissa, Saleh A Busbait, Koby Herman, Jai P Singh, Guriqbal Bhullar, Molly Flanagan Synowicz, Ernesto R Drelichman, Vijay K Mittal, Jasneet S Bhullar","doi":"10.4293/JSLS.2026.00063","DOIUrl":"10.4293/JSLS.2026.00063","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV) is prevalent in the general population with lifetime risk of about 80% whom didn't receive HPV vaccine. AIN publications have been focusing on high risk patients for developing AIN. It is usually asymptomatic especially during the early phases; 60-70% of anal squamous cell carcinomas (ASCC) are seen in an advance stage.</p><p><strong>Materials and methods: </strong>We performed a retrospective review of 3550 colonoscopies done at a single institution in Henry Ford Providence Hospital. All patients underwent routine colonoscopy which had the anorectum and transition zone were inspected for AIN lesion with narrow band imaging (NBI) during retroflexion. Any suspected abnormalities were biopsied then reviewed by gastrointestinal pathologist. Any patient with confirmed AIN was referred for high resolution anoscopy with definitive treatment.</p><p><strong>Results: </strong>Our study covered 3550 patient of whom 41 patients (1.2%) resulted in suspicious lesion for AIN (19 males, 22 females; median age 52.25 years). The pathology result was 24 lesion (58%) had AIN 1, 16 patients (39%) had AIN 2-3 and one patient (2.4%) had invasive squamous cell carcinoma. Of these patients 48.8% were negative for HIV and immunocompetent. There was no complication related to the biopsy during colonoscopy.</p><p><strong>Conclusions: </strong>Even though AIN lesions are infrequently detected during routine colonoscopy, it is still feasible and valuable even in immunocompetent patients. Retroflexion plus NBI during colonoscopy can be used as an opportunity for AIN detection. Treating AIN lesion and detection them may lead to ASSC prevention. Routine colonoscopy presents a valuable opportunity for opportunistic detection of AIN lesions.</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/PMC13576667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977104","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":"\"Surgical Treatment Experience of Intestinal Endometriosis\".","authors":"Kunal Kumar, Preina Kessrani, Rakhi Bai, Kashish Suraj","doi":"10.4293/JSLS.2026.00081","DOIUrl":"10.4293/JSLS.2026.00081","url":null,"abstract":"","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/PMC13588022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008631","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":"Visceral Fat Area Influences Lymph Node Retrieval in Robotic Right Colectomy.","authors":"Masatsugu Ishii, Toshikatsu Nitta, Akitada Sada, Ryutarou Kubo, Hitoshi Inoue, Taisei Hoshiyama, Takashi Ishibashi","doi":"10.4293/JSLS.2026.00050","DOIUrl":"10.4293/JSLS.2026.00050","url":null,"abstract":"<p><strong>Background and objectives: </strong>Visceral obesity may affect surgical difficulty in colorectal procedures. While body mass index (BMI) is commonly used to assess obesity, it does not accurately reflect intra-abdominal fat distribution. This study evaluated the impact of visceral fat area (VFA) on perioperative outcomes in robotic-assisted right colectomy.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive patients undergoing robotic-assisted right colectomy with lymphadenectomy between January 2023 and May 2025. VFA was measured on preoperative computed tomography at the L4 level. Patients were categorized into low-VFA (<100 cm²) and high-VFA (≥100 cm²) groups. Surgical outcomes and lymph node yield were compared.</p><p><strong>Results: </strong>Sixty-one patients were included, and 29 (47.5%) were classified as high VFA. Lymph node yield was significantly lower in the high-VFA group (<i>P</i> < .001). Operative time, blood loss, and postoperative complications did not differ significantly between groups. Major complications occurred in 6.5% of patients.</p><p><strong>Conclusion: </strong>Visceral adiposity is associated with reduced lymph node retrieval in robotic-assisted right colectomy, without increasing perioperative morbidity. VFA may serve as a practical indicator of operative complexity.</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/PMC13588023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008716","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 Appendectomy Is Superior in Patients with Higher Fat Thickness' with Great Interest\".","authors":"Kuldeep Deewan, Aaditya Odhwani, Haresh Kumar, Anmol Kumari","doi":"10.4293/JSLS.2026.00045","DOIUrl":"10.4293/JSLS.2026.00045","url":null,"abstract":"","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/PMC13394828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579104","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}