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

{"title":"Clinical Outcomes of Transabdominal Preperitoneal and Totally Extraperitoneal Inguinal Hernia Repair.","authors":"Aziz Bulut, Ozcem Ofkeli, Latif Yilmaz, Alper Aytekin, Halil Ibrahim Ertem","doi":"10.4293/JSLS.2026.00057","DOIUrl":"10.4293/JSLS.2026.00057","url":null,"abstract":"<p><strong>Background and objectives: </strong>Laparoscopic inguinal hernia repair is commonly performed using the transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. Although both techniques enable preperitoneal mesh placement, their perioperative outcomes may differ. This study aimed to compare clinical outcomes and factors associated with postoperative complications after TAPP and TEP repair.</p><p><strong>Methods: </strong>This retrospective single-center study included 180 adult patients who underwent elective laparoscopic inguinal hernia repair. Demographic data, hernia-related variables, defect size, operative duration, mesh and fixation characteristics, intraoperative events, early postoperative complications, and recurrence were analyzed. Group comparisons and multivariable logistic regression analysis were performed.</p><p><strong>Results: </strong>Age, BMI, and ASA classification were similar between groups. Hernia type distribution differed significantly (p = 0.007). Operative duration was longer in the TAPP group (p < 0.001). Intraoperative complication types were comparable (p = 0.427), whereas early postoperative complications were more frequent in the TEP group (p = 0.018), with seroma being the most common event. Surgical technique was not an independent predictor of postoperative complications, while advanced age was independently associated with complication risk. Recurrence rates were low and comparable.</p><p><strong>Conclusion: </strong>TAPP and TEP demonstrated comparable intraoperative safety and recurrence outcomes but differed in operative duration and early postoperative complication profiles. These findings may help guide surgical decision-making in clinical 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/PMC13576492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977063","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":"A Comprehensive Review of Port-Site Closure Methods: A Four-Decade-Challenge to an Unsolved Issue.","authors":"Renato Costi, Alessandro Facchinetti, Manuel Baldinu, Ruben Foresti, Ugo Elmore, Filippo Montali, Alfredo Annicchiarico","doi":"10.4293/JSLS.2026.00034","DOIUrl":"10.4293/JSLS.2026.00034","url":null,"abstract":"<p><strong>Background: </strong>In the last 40 years, laparoscopic surgery has shown several benefits, including reduced pain and faster recovery, and has spread worldwide. Although international guidelines recommend closing ≥10-mm trocar sites, specific complications due to their ineffective closure, trocar-site hernia (TSH) and abdominal wall bleeding, are becoming an issue. Since various techniques/devices have been introduced for port-site closure, this review is aimed at assessing the state of the art of port-site closure in 2026.</p><p><strong>Methods: </strong>A systematic literature review of all articles reporting port-site closure techniques and devices was performed. Methods were classified according to Shaher's classification. Due to the heterogeneity of studies and collected data, statistical analysis was not feasible. Port-site closure methods are discussed with respect to risk factors, clinical evidence of port-site morbidity, and current surgical practice.</p><p><strong>Results: </strong>A total of 1,251 articles were screened and 36 were included in the review. Reported outcomes included patient body mass index (BMI), operative time, and morbidity. Operative time varied largely (from 19 seconds to 8 minutes), TSH recurrence was rare (0.2%), follow-up ranged from one week to seven years, averaging 21.2 months.</p><p><strong>Conclusion: </strong>Various devices and techniques have been introduced to address trocar-site closure. Despite more than four decades of development, no closure method has clearly demonstrated superiority over the others. Overall, the quality of the available literature remains low, and reported outcomes are not fully consistent with clinical practice. The current state of the art is therefore characterized by the absence of a gold-standard approach. Standardized comparative studies are needed.</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/PMC13440033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679001","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 versus Open Surgery\".","authors":"Divay Kumar, Aaditya Odhwani, Kuldeep Deewan, Aajay Kumar","doi":"10.4293/JSLS.2026.00072","DOIUrl":"10.4293/JSLS.2026.00072","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/PMC13576490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977111","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":"Combined Laparoscopic Radiofrequency Ablation and Laparoscopic Myomectomy: An Analysis of the ULTRA-Registry.","authors":"Emily A Sendukas, Jessica K Shields, Kimberly A Kho, Marisa Latham, Vanessa Jacoby, Michael Schembri, L Elaine Waetjen","doi":"10.4293/JSLS.2026.00048","DOIUrl":"10.4293/JSLS.2026.00048","url":null,"abstract":"<p><strong>Background and objectives: </strong>Uterine fibroids are common in women and can lead to symptoms of abnormal uterine bleeding, pelvic pain and bulk symptoms. Treatment can be medical or surgical. This study aims to describe characteristics and outcomes of women undergoing combined laparoscopic radiofrequency ablation (lap-RFA) and laparoscopic myomectomy (lap-MYO) to treat symptomatic uterine fibroids.</p><p><strong>Methods: </strong>This is a multicenter prospective cohort study including both academic centers and private practices. Women in the Uterine Leiomyoma Treatment by Radiofrequency Ablation (ULTRA) Study who were scheduled to undergo surgical management of fibroids underwent a combined lap-RFA and lap-MYO. We assessed quality of life and sexual function changes from before to 12 months after surgery using validated questionnaires.</p><p><strong>Results: </strong>Of the 480 participants in ULTRA, 49 underwent a combined lap-RFA and lap-MYO procedure between 2014 and 2022. The mean number of fibroids treated was 3.6 (standard deviation [SD] 2.0). The mean number of days to return to usual activities was 12.7 (SD 10.1). The Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire symptom severity score (0-100 points) improved by 36.4 points (SD 27.0, <i>P</i> < .001) at 12 months and the Sexual Health Outcomes in Women Questionnaire (0-100 points) assessment of pelvic problems interference with sex improved by 13 points (SD 34.4 <i>P</i> = .02) as early as 6 weeks. About 75% of women were satisfied with the surgery at 12 months.</p><p><strong>Conclusion: </strong>Combining lap-RFA and lap-MYO is associated with few peri-operative events, satisfactory recovery time, and significant improvement in quality-of-life measures with high patient satisfaction through 12 months after surgery.</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/PMC13466840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725091","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":"Evaluation of the Educational Impact of a Laparoscopic Bowel Anastomosis Simulator.","authors":"Andres Fontaine-Nicola, Edgardo Reyes, Hayley Harman, Salim Abunnaja, Alice Race, Jacob A Greenberg, Ryan Broderick, Nova Szoka","doi":"10.4293/JSLS.2026.00002","DOIUrl":"10.4293/JSLS.2026.00002","url":null,"abstract":"<p><strong>Background and objectives: </strong>The bowel anastomosis training simulator (BATS) was developed to provide realistic training in hand-sewn bowel anastomosis, previously validated for open techniques. As minimally invasive surgery (MIS) advances, effective laparoscopic training is increasingly essential. This pilot prospective cohort study aimed to evaluate the laparoscopic educational impact and validity of BATS, incorporating a structured pretask video review.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of involving 34 surgical fellows participating in a national surgical education course. All participants completed a structured laparoscopic suturing curriculum that included a pretask instructional video, a 30-minute hands-on session using the BATS simulator, two and a half hours of suturing practice on porcine models, one hour for porcine laparoscopic cholecystectomies, and one hour for 3 additional side stations. Pre and postcourse surveys assessed simulator realism, simulator educational value, as well as self-reported confidence in laparoscopic hand-sewn bowel anastomosis using a 5-point Likert scale.</p><p><strong>Results: </strong>Survey responses demonstrated high ratings for simulator realism and educational value. Baseline confidence in laparoscopic anastomosis was low (mean 2.67). Post-training, confidence significantly improved following BATS simulation (mean 4.00, <i>P</i> ≤ .01) and porcine model training (mean 3.95, <i>P </i>=<i> </i>.01).</p><p><strong>Conclusions: </strong>In this pilot study, BATS realism and educational value were confirmed. The simulator's standardized design and reproducibility make it a valuable addition to MIS training programs. Structured training with the BATS simulator significantly improved fellow confidence in laparoscopic hand-sewn anastomosis. Further studies should assess objective performance outcomes and long-term skill retention.</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/PMC13379152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579082","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":"Response to the Letter to the Editor.","authors":"Francis S Lee, Vince Huntley, Christina W Lee, Clare H Lee","doi":"10.4293/JSLS.2026.00095","DOIUrl":"https://doi.org/10.4293/JSLS.2026.00095","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/PMC13629833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111586","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":"Safety of Continuous Force Feedback in Robotic Hysterectomy and Myomectomy.","authors":"In-Young Jeong, Sanghoon Lee, Hyuntae Park, Jae-Yun Song, Seongmin Kim","doi":"10.4293/JSLS.2026.00058","DOIUrl":"10.4293/JSLS.2026.00058","url":null,"abstract":"<p><strong>Background and objectives: </strong>United States labeling of the newest robotic surgical platform contraindicates the use of force feedback instruments during hysterectomy and myomectomy because of a theoretical, clinically unexamined bleeding risk. We describe real-world outcomes and quantified intraoperative force during continuous force feedback use throughout these procedures, including closure, in a setting where this restriction does not apply.</p><p><strong>Methods: </strong>This single-surgeon observational cohort comprised 93 consecutive patients undergoing robotic hysterectomy or myomectomy between December 2024 and April 2026, classified into 3 groups: force feedback active throughout (43), the same instruments with the feature disabled (13), and conventional instruments (37). The primary outcome was a composite of vaginal cuff dehiscence, uterine wound disruption, or readmission or reintervention for bleeding within 30 days.</p><p><strong>Results: </strong>Baseline characteristics were comparable across groups. Mean intraoperative force in the active group was 2.1 newtons for hysterectomy and 2.2 newtons for myomectomy. The composite event occurred in 1 of 43 active-group patients (a readmission for bleeding) and in no patient in the other groups; no cuff dehiscence or uterine wound disruption occurred in any group. After adjustment for procedure, higher mean force was associated with shorter operative time.</p><p><strong>Conclusion: </strong>Continuous force feedback through the closure phases of robotic hysterectomy and myomectomy was not associated with cuff dehiscence or uterine wound disruption, and mean operative force clustered near 2 newtons. These hypothesis-generating findings warrant larger studies before safety equivalence can be inferred.</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/PMC13404926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604463","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":"Medical Article Assessment Using Artificial Intelligence.","authors":"Douglas E Ott","doi":"10.4293/JSLS.2026.00066","DOIUrl":"10.4293/JSLS.2026.00066","url":null,"abstract":"<p><strong>Background and objectives: </strong>The worthiness of a medical article is not known until it is read and critically evaluated. A process using artificial intelligence (AI) was developed and assessed to do that for a specific article.</p><p><strong>Methods: </strong>A medical article was uploaded to an AI large language model program with instructions to answer specific bounded questions about that article only, its methodological components, assessment of findings, and appropriateness and validity of conclusions. Fifty articles were evaluated and compared using AI and human assessment.</p><p><strong>Results: </strong>Agreement was found 89% of the time. Disagreements were concerned with word use, context, and by experiences and human memory. No AI fabrications occurred.</p><p><strong>Conclusion: </strong>This method eliminated, or at least heightened awareness of the problems, biases, limitations, and confounders of an article to be read. Isolation and validity of the components that collectively produce the conclusions from what is found and said in an article is more clearly delineated by a step-by-step process, eliminates human legacy conflicts, and quickly determines the legitimacy of conclusions.</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/PMC13588153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008698","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":"Pyloric Stenosis as a Manifestation of MELAS Is Unlikely.","authors":"Josef Finsterer","doi":"10.4293/JSLS.2026.00083","DOIUrl":"10.4293/JSLS.2026.00083","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/PMC13588280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008744","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":"Crossing Vessels in Retroperitoneal Laparoscopic Pyeloplasty: Anatomy and Outcomes.","authors":"Ahmed Rabie, Mohamed Elsaqa, Andrew Fishman, Wayne Debeatham, Mitchell Fraiman, Michael Grasso","doi":"10.4293/JSLS.2026.00062","DOIUrl":"10.4293/JSLS.2026.00062","url":null,"abstract":"<p><strong>Purpose: </strong>Crossing vessels are commonly encountered during pyeloplasty for ureteropelvic junction obstruction (UPJO) and may influence surgical strategy. We aimed to describe the anatomical distribution of crossing vessels and their management options during retroperitoneal laparoscopic pyeloplasty (RLP) and report the long-term outcomes.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed consecutive adult patients who underwent RLP for UPJO between 2006 and 2025 by a single surgeon. Preoperative computed tomography (CT) or magnetic resonance (MR) urography was routinely performed to assess vascular anatomy. Surgical technique emphasized identification of crossing vessels, routine UPJ reconstruction, mobilization and/or transposition of arteries, selective ligation of nonessential veins, and creation of a dependent tension-free anastomosis.</p><p><strong>Results: </strong>The study included 165 patients with mean age of 58.2 years. Crossing vessels were identified in 114 patients (69.1%), most commonly gonadal vein variants (45.6%) and accessory renal arteries (31.6%). Mean operative time was 175 minutes, with no conversions to open surgery. Only 19 (16.67%) patients required ureteral transposition. Postoperative Clavien-Dindo grade III complications occurred in 5 (3%) patients, with no grade IV or V events. With median follow-up of 64 months, overall success rate was 96.1%. None of the variables were statistically linked to failed pyeloplasty (<i>P</i> > .5 for all variables).</p><p><strong>Conclusions: </strong>RLP with systematic identification of crossing vessels is associated with excellent long-term functional outcomes and low morbidity. Management of crossing vessels should be individualized according to the type and relation of the crossing vessel to the UPJ. Ureteral transposition should not be a routine part of RLP.</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/PMC13466839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724896","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}