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

{"title":"Robotic versus Laparoscopic Cholecystectomy: Length of Stay and Readmission.","authors":"Janique Abrahams, Marie Kiester M Faustino, Tommy K Dinh, Saajan Bhakta","doi":"10.4293/JSLS.2026.00047","DOIUrl":"10.4293/JSLS.2026.00047","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopy has long been the standard minimally invasive approach for gallbladder removal. Proponents suggest robotic surgery may improve outcomes such as readmission rates and length of stay.</p><p><strong>Methods: </strong>A systematic review of the literature was conducted using articles from PubMed, EBSCO: Medline, and Cochrane databases. Peer-reviewed studies published between January 2015 and November 10, 2025, were included if they directly compared robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC) outcomes in adult patients.</p><p><strong>Results: </strong>Nineteen studies were included, consisting primarily of retrospective cohort studies, along with prospective cohort studies, ambispective cohort studies, and one randomized controlled trial. The age and sex distributions of patients were similar between the RC and LC groups. Most studies reported no statistically significant difference in length of stay or readmission rates between groups. One larger multicenter study demonstrated significantly lower readmission rates and a modest reduction in length of stay favoring RC; however, these findings were not consistently observed across the remaining studies.</p><p><strong>Conclusion: </strong>RC appears to offer similar short-term postoperative outcomes compared with LC with only one multicenter study reporting modest improvements favoring RC. Further high-quality studies are needed to determine whether robotic approaches provide clinically meaningful benefits.</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/PMC13492179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795003","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 Vasileios Kalles et al.","authors":"Guillermo Gerardo Peralta Castillo, Paulina Bajonero Canónico, Ricardo Cavazos Garcia","doi":"10.4293/JSLS.2026.00056","DOIUrl":"10.4293/JSLS.2026.00056","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/PMC13418063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620561","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":"Predictive Performance of ADRENAL and MAP Scores for Complications in Laparoscopic Adrenalectomy.","authors":"Serdar Basboga, Ahmet Burak Yilmaz, Kamal Karimzada, Ali Yasin Ozercan, Burak Koseoglu, Ozer Guzel, Altug Tuncel","doi":"10.4293/JSLS.2026.00076","DOIUrl":"10.4293/JSLS.2026.00076","url":null,"abstract":"<p><strong>Background: </strong>The ADRENAL and Mayo Adhesive Probability scores are preoperative composite tools designed to estimate surgical complexity in adrenal surgery. This study aimed to compare their predictive performance for postoperative complications in patients undergoing laparoscopic adrenalectomy.</p><p><strong>Methods: </strong>We retrospectively analyzed 90 patients who underwent transperitoneal laparoscopic adrenalectomy (74 total, 16 partial) between Jul 2019 and Jul 2023. Perioperative outcomes were compared across score groups. Logistic regression and ROC curve analyses were used to assess predictors and discriminative ability.</p><p><strong>Results: </strong>Postoperative complications occurred in 8 patients (8.9%), all Clavien-Dindo grade I-II. On multivariate analysis, both the ADRENAL Score (OR 2.220, 95% CI 1.303-3.781; p < 0.001) and Mayo Adhesive Probability score (OR 7.055, 95% CI 1.204-41.355; p = 0.021) were independent predictors of complications. ROC analysis demonstrated superior discriminative accuracy for the ADRENAL Score (AUC 0.877) over the Mayo Adhesive Probability score (AUC 0.735).</p><p><strong>Conclusion: </strong>Both scoring systems may be useful for predicting postoperative complications following laparoscopic adrenalectomy. The ADRENAL Score demonstrated superior predictive performance and may serve as a more reliable preoperative risk stratification tool in this setting.</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/PMC13576491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977102","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 and Feasibility of Vaginal Natural Orifice Surgery Hysterectomy for Enlarged Uteri.","authors":"Ahkam Göksel Kanmaz, Özgün Akbaş, Emrah Töz, Çağla Ezgi Uğuz Kandemir, Yaşam Kemal Akpak, Jan Baekelandt","doi":"10.4293/JSLS.2026.00077","DOIUrl":"10.4293/JSLS.2026.00077","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the impact of uterine size on surgical outcomes in vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy and compared perioperative outcomes with conventional laparoscopic hysterectomy (LH) in patients with large uteri.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study included 812 patients who underwent hysterectomy between January 2024 and January 2026. Patients were categorized into 3 groups: vNOTES with small uteri (n = 102), vNOTES with large uteri (n = 87), and LH with large uteri (n = 623). Primary outcomes were operative time, estimated blood loss, conversion rates, and complications. Secondary outcomes included postoperative complications, hospitalization period, postoperative hemoglobin change, uterine weight and pain scores assessed using the visual analogue scale (VAS) at 12 and 24 hours postoperatively.</p><p><strong>Results: </strong>There were no statistically significant differences among 3 groups regarding operative time, hemoglobin drop or estimated blood loss (<i>P</i> > .05). Uterine weights were significantly higher in the large uterus groups (vNOTES: 385 ± 89.6 g; LH: 420 ± 107.2 g) compared to the small uterus group (135 ± 45 g, <i>P</i> < .001). Conversion to laparotomy was significantly higher in the LH group (5.3%) than the vNOTES groups (0% and 1.15%, <i>P</i> = .015). VAS at 12 hours were significantly lower in the vNOTES small uterus group (<i>P</i> = .006), whereas 24-hour scores and complication rates were comparable across all groups.</p><p><strong>Conclusion: </strong>vNOTES hysterectomy is a safe and feasible approach for patients with enlarged uteri, demonstrating noninferiority to conventional laparoscopy. vNOTES may offer lower risk of conversion to laparotomy compared to laparoscopy in cases of uterine enlargement.</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/PMC13614834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062185","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":"Totally Extramucosal Hand-Sewn Robotic Gastrojejunostomy for Roux-en-Y Gastric Bypass.","authors":"Miljana Vladimirov, Firas Makdesi, Ayman Georgios, Zsolt Madarasz, Jens Hoeppner, Alejandro Gandsas","doi":"10.4293/JSLS.2026.00025","DOIUrl":"10.4293/JSLS.2026.00025","url":null,"abstract":"<p><strong>Background: </strong>Roux-en-Y gastric bypass is an established metabolic-bariatric procedure performed using minimally invasive approaches, including laparoscopy and robotic assistance. Robotic platforms provide technical advantages that facilitate hand-sewn gastrojejunostomy, allowing surgeons to implement a consistent and reproducible technique.</p><p><strong>Methods: </strong>The surgical technique of a single-layer, continuous, extramucosal hand-sewn gastrojejunostomy performed during fully robotic Roux-en-Y gastric bypass is described. Consecutive primary and revisional procedures were performed by a single bariatric surgeon using the da Vinci X, Xi, or 5 robotic platforms. Perioperative outcomes were analyzed. An accompanying video is accessible to demonstrate our operative technique.</p><p><strong>Results: </strong>Between April 1, 2024, and January 31, 2026, 73 consecutive Roux-en-Y gastric bypass procedures were performed by a single surgeon, including 34 primary and 39 revisional cases. Using the described suturing technique, no anastomotic leaks or gastrojejunostomy-related bleeding were observed. One anastomotic stricture occurred within the 30-day postoperative period and was successfully managed with endoscopic dilation.</p><p><strong>Summary: </strong>The described single-layer, continuous, extramucosal robotic hand-sewn gastrojejunostomy in Roux-en-Y gastric bypass was feasible and safe in a consecutive series of primary and revisional procedures.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13196838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148016265","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":"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":"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":2.0,"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":"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":2.0,"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":"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":"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":2.0,"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":"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":"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":2.0,"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":"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":"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":2.0,"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}