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

{"title":"Office Hysteroscopy: Treating Intrauterine Pathology and Avoiding the Operating Room.","authors":"Sun Woo Kim, Ali Antoine, Lauren Cosgriff, Clarissa Diniz, Kari Plewniak, Mark Levie","doi":"10.4293/JSLS.2026.00015","DOIUrl":"10.4293/JSLS.2026.00015","url":null,"abstract":"<p><strong>Background and objectives: </strong>Office hysteroscopy is a versatile minimally invasive procedure. However, there are limited data reporting long-term follow-up of patients undergoing these procedures. The objectives of this study were to evaluate the rate of additional procedures performed in 1 and 3 years following office hysteroscopy, and to evaluate how frequently full assessment of the uterine cavity could be performed.</p><p><strong>Methods: </strong>This was a single-center retrospective cross-sectional analysis of all office hysteroscopies that were performed between July 2015 and December 2021. Chart review was performed to extract patient demographic data, medical history, office hysteroscopy procedural data, pathology results, and any subsequent gynecological surgery.</p><p><strong>Results: </strong>Only 13% of patients required further gynecologic intervention in the operating room (OR) within 1 year and 16% required further intervention in the OR within 3 years. A total of 82.7% of polyps and 90% of retained foreign bodies, were successfully removed in the office. A total of 93.4% had an adequate diagnostic office hysteroscopy with full evaluation of intrauterine cavity.</p><p><strong>Conclusion: </strong>This study supports that office hysteroscopy is an effective approach that helps patients avoid the OR with the ability to perform an excellent diagnostic procedure and to treat common pathology. While patients with more advanced pathology may end up in the OR, office hysteroscopy can aid in planning the appropriate approach and procedure to be performed for more complex cases. Most our patients did not need an OR procedure in the 3 years following office hysteroscopy.</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/PMC13224334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149558","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 Hysteroscopic and Blind Endometrial Biopsy Techniques in Postmenopausal Women.","authors":"Ozan Odabaş, Ahkam Göksel Kanmaz, Yaşam Kemal Akpak, Arda Batuhan Karaduman, Duygu Tanyeri, Emrah Töz","doi":"10.4293/JSLS.2026.00014","DOIUrl":"10.4293/JSLS.2026.00014","url":null,"abstract":"<p><strong>Objective: </strong>To compare the tissue adequacy of hysteroscopy-guided endometrial biopsy using 2 different instruments and blind Pipelle biopsy in postmenopausal women with suspected endometrial pathology.</p><p><strong>Methods: </strong>This prospective, single-center, paired comparative study included postmenopausal women evaluated for abnormal uterine bleeding or increased endometrial thickness. All participants underwent hysteroscopy-guided biopsy using spoon and grasper forceps, followed by blind Pipelle endometrial sampling during the same session. Biopsy adequacy was assessed based on predefined histopathological criteria, including cellular adequacy and tissue volume adequacy. Differences in adequacy rates among techniques were analyzed using Cochran's Q test, with pairwise comparisons performed using the exact McNemar test.</p><p><strong>Results: </strong>A total of 51 patients were included in the final analysis. Adequate tissue samples were obtained in 72.5% of hysteroscopic spoon forceps biopsies, 84.3% of hysteroscopic grasper forceps biopsies, and 94.1% of Pipelle biopsies. Overall differences in adequacy rates among the three techniques were statistically significant (<i>P</i> =<i> </i>.0106). Pairwise analysis demonstrated a significantly higher adequacy rate for Pipelle biopsy compared with spoon forceps (<i>P</i> =<i> </i>.0127), whereas no significant differences were observed between Pipelle and grasper forceps or between grasper and spoon forceps. Among inadequate samples, cellular insufficiency was the predominant cause across all techniques.</p><p><strong>Conclusion: </strong>Pipelle endometrial biopsy provides the highest rate of tissue adequacy in postmenopausal women; however, hysteroscopy-guided biopsy-particularly with grasper forceps-also yields acceptable adequacy and offers the advantage of targeted sampling. Cellular insufficiency appears to be the primary limitation to tissue adequacy in postmenopausal endometrium.</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/PMC13185791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real Robotic Surgery: A New Paradigm of Surgical Approach.","authors":"Beniamino Pascotto, Juan Santiago Azagra","doi":"10.4293/JSLS.2026.00028","DOIUrl":"10.4293/JSLS.2026.00028","url":null,"abstract":"","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic versus Laparoscopic Hiatal Hernia Repair in Elderly Patients.","authors":"Qi Liu, Xiaoyong Li, Tingting Wang, Sibo Huo, Cong Wang, Nan Liu","doi":"10.4293/JSLS.2025.00128","DOIUrl":"10.4293/JSLS.2025.00128","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive techniques have become the preferred approach for hiatal hernia repair in elderly patients, offering reduced morbidity and shorter recovery compared with open surgery. The introduction of robotic-assisted surgery provides enhanced 3-dimensional visualization and instrument dexterity, potentially improving outcomes in complex or large hernias. However, whether these advantages translate into superior clinical results compared with conventional laparoscopy in patients over 65 years remains uncertain. This review summarizes and evaluates the evidence comparing robotic and laparoscopic hiatal hernia repair in elderly individuals.</p><p><strong>Database: </strong>A systematic review and meta-analysis were conducted using PubMed, Embase, Scopus, Web of Science, and the Cochrane Library for studies published from 2015 to 2025. Eligible randomized or observational studies comparing robotic and laparoscopic hiatal hernia repair in patients aged ≥65 years were identified according to PRISMA 2020 guidelines. Eighteen observational studies encompassing approximately 700,000 patients were included; several studies reported mixed-age cohorts, and outcomes specific to patients aged ≥65 years were extracted when available. Pooled analysis using random-effects models demonstrated no significant difference in overall complication rates (odds ratio 0.97, 95% confidence interval 0.87-1.09) or in recurrence and mortality between techniques. Robotic repair showed shorter hospital stays by approximately half a day and lower conversion-to-open rates, particularly in complex hernias.</p><p><strong>Conclusion: </strong>Robotic hiatal hernia repair demonstrates safety and efficacy comparable to laparoscopy in elderly patients, with possible benefits in complex or reoperative cases. Current evidence supports both as effective minimally invasive approaches; however, further prospective, age-specific studies are needed to validate long-term outcomes and cost-effectiveness.</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/PMC13169468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Proficiency of Laparoscopic Vaginal Cuff Suturing After Training with Two Simulators.","authors":"Emily G Lin, Megan A Runge, David Aaby, Kayla N Marshall, Jessica Traylor, Susan Tsai, Angela Chaudhari, Christopher C DeStephano, Magdy P Milad","doi":"10.4293/JSLS.2025.00116","DOIUrl":"10.4293/JSLS.2025.00116","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether a gynecology-specific laparoscopic trainer better prepares premedical and medical students to perform a laparoscopic vaginal cuff surgical task than the current standard laparoscopic trainer.</p><p><strong>Methods: </strong>In a masked, block-randomized controlled trial, 49 premedical and preclinical medical students were recruited, then randomized to a laparoscopic simulator: Essentials in Minimally Invasive Gynecologic Surgery (EMIGS) or Fundamentals of Laparoscopic Surgery (FLS). A total of 26 participants were initially randomized to EMIGS and 23 participants to FLS. They trained for 2.5 hours on their assigned simulator. Video recordings of participants performing a laparoscopic vaginal cuff suturing task were collected before and after simulator training. Videos were masked and reviewed by expert minimally invasive gynecologic surgery (MIGS) surgeons and graded using a modified Global Operative Assessment of Laparoscopic Skills (GOALS) rubric. The pretraining and post-training GOALS scores were then compared between simulator groups.</p><p><strong>Results: </strong>Most demographic characteristics were similar across both groups. Ultimately, 24 participants from the EMIGS group and 21 participants from the FLS group were included in the final analysis. The mean difference between post and pre-composite GOALS scores was 6.50 for EMIGS and 4.07 for FLS, <i>P</i> = .34. The mean EMIGS post-pre difference was greater for six of the eight individual GOALS domains, although all <i>P</i>-values > .05.</p><p><strong>Conclusions: </strong>Neither EMIGS nor FLS was associated with better performance on the vaginal cuff suturing task after a single 2.5-hour training session.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"En-Bloc Stapler versus Clips for Hilar Vascular Control in Laparoscopic Nephrectomy.","authors":"Abdullah Golbasi, Burak Elmaagac, Ali Yasin Ozercan, Huseyin Bicer, Berk Cilek, Murat Keske, Mert Ali Karadag","doi":"10.4293/JSLS.2025.00126","DOIUrl":"10.4293/JSLS.2025.00126","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic nephrectomy is widely preferred for its advantages over open surgery, and secure hilar control is a critical procedural step. Although both clips and staplers are commonly used, studies comparing these techniques outside the setting of donor nephrectomy remain limited. This study evaluates the safety and effectiveness of en-bloc stapler ligation versus separate arterial and venous clipping.</p><p><strong>Materials and methods: </strong>This retrospective study included patients aged 18-80 who underwent laparoscopic nephrectomy between 2020 and 2025. Demographic, perioperative, and postoperative data were collected, and complications were classified using the Clavien-Dindo system. Hilar control was performed either by en-bloc stapling or separate clipping. Statistical analyses included comparative tests and logistic regression, with significance set at <i>P</i> < .05.</p><p><strong>Results: </strong>A total of 171 patients were analyzed (80 EndoGIA, 91 clip). Baseline characteristics were comparable. Operative time (122 vs 135 minutes; <i>P</i> = .004) and blood loss (175 vs 198 mL; <i>P</i> = .025) were lower in the EndoGIA group. Overall complication rates were similar (30% vs 28.5%; <i>P</i> = .500), with mostly grade I-II. Major complications were rare in both groups. No arteriovenous fistulas were detected after en-bloc stapling. Multivariate analysis identified prolonged operative time and chronic obstructive pulmonary disease (COPD) as independent predictors of postoperative complications.</p><p><strong>Conclusion: </strong>Both en-bloc stapler ligation and separate clipping are safe methods for hilar control in laparoscopic nephrectomy. En-bloc stapling may reduce operative time and associated complications, offering particular advantages in complex dissections or when minimizing surgery duration is critical, thereby supporting its broader adoption in clinical practice.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12981366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468838","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":"Critical Perioperative Factors Influencing Postoperative Complications and Long-Term Survival in Patients with Gastric Cancer.","authors":"He Li, Nanbo Li, Deheng Zhu, Shuangshuang Hou, Yaoyuan Chang, Qiong Duan, Ju Wu, Jiajun Yin","doi":"10.4293/JSLS.2025.00123","DOIUrl":"10.4293/JSLS.2025.00123","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to determine key perioperative factors affecting postoperative complications and long-term survival in gastric cancer patients undergoing gastrectomy and to evaluate their predictive value for clinical outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of clinical data from patients who underwent radical gastrectomy at our institution between January 2011 and December 2019. Logistic regression, along with univariate and multivariate analyses, and Kaplan-Meier survival curves were utilized to identify significant factors impacting postoperative morbidity and long-term survival.</p><p><strong>Results: </strong>Patients were categorized into complication and noncomplication groups based on postoperative outcomes. Comparative analysis revealed significant associations between postoperative complications and the following variables: sex, hypertension, serum albumin (ALB) level, lactate dehydrogenase, prognostic nutritional index (PNI), α-fetoprotein (AFP), anastomotic method, laparoscopic versus open surgery and operative time (all <i>P</i> < .05). Multivariate logistic regression analysis indicated that laparoscopic versus open surgery, PNI, and hypertension were independent risk factors for postoperative complications. Kaplan-Meier survival analysis showed significant correlations between 3-year overall survival (OS) and age, PNI, ALB, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), tumor diameter, TNM stage, lymphovascular invasion (LVI), perineural invasion, resection extent, and reconstruction method (all <i>P</i> < .05). Receiver operating characteristic curve analysis identified optimal cutoff values for 3-year OS prediction: PNI (area under the curve [AUC] = 0.709, cutoff = 41.55) and tumor diameter (AUC = 0.661, cutoff = 4.75 cm). Univariate and multivariate Cox regression analyses identified the following independent prognostic factors: LVI, advanced TNM stage, age, PNI, hypoalbuminemia, CEA, and CA19-9.</p><p><strong>Conclusion: </strong>Laparoscopic surgery and adequate nutritional status are associated with a reduced incidence of postoperative complications. The PNI, LVI, TNM stage, ALB, CA19-9, age, and CEA were identified as independent perioperative risk factors for long-term survival in gastric cancer patients undergoing gastrectomy. The PNI is an independent factor influencing both short-term complications and long-term survival.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12915594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227201","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":"Robotic Transabdominal Preperitoneal Repair Versus Laparoscopic Totally Extraperitoneal Repair for Inguinal Hernia.","authors":"Toshikatsu Nitta, Masatsugu Ishii, Akitada Sada, Ryutaro Kubo, Atsuhiro Komiya, Takashi Ishibashi","doi":"10.4293/JSLS.2025.00119","DOIUrl":"10.4293/JSLS.2025.00119","url":null,"abstract":"<p><strong>Background and objectives: </strong>To date, no Japanese studies have compared robotic transabdominal preperitoneal repair (R-TAPP) and laparoscopic totally extraperitoneal repair (L-TEP). Herein, we present our initial experience from a single Japanese hospital, comparing both procedures and evaluating their short-term outcomes in the context of potential inclusion under Japan's national health insurance system.</p><p><strong>Methods: </strong>Patients with inguinal hernias who had not undergone previous anterior hernioplasty were retrospectively analyzed. Demographic factors (age, sex, body mass index) and perioperative data were collected. Surgical variables and postoperative outcomes were compared between patients who underwent R-TAPP using the da Vinci ξ robotic platform (Intuitive Surgical, Sunnyvale, CA) and those who underwent L-TEP. Data were assessed for all, unilateral, and bilateral cases. Five surgeons participated in this study. Surgeon-specific variables, including the number of R-TAPP and L-TEP procedures performed by each surgeons, operative times, and complication rates, were also collected to evaluate the influence of the surgeon's experience on perioperative outcomes.</p><p><strong>Results: </strong>Resident participation significantly differed between the 2 techniques across total, unilateral, and bilateral groups. In the unilateral subgroup, the mean operative time was shorter for R-TAPP (95.4 minutes) than for L-TEP (122.3 minutes). The R-TAPP group had higher costs, but complication rates were comparable. One Clavien-Dindo grade III postoperative bleeding event occurred in the L-TEP group, while only minor complications, including paralytic ileus and inferior epigastric artery injury, were observed after R-TAPP. The surgeon-specific analysis demonstrated variability in operative times among the 5 surgeons; however, 4 of the 5 surgeons showed consistently shorter operative times with R-TAPP than with L-TEP, suggesting a procedural trend favoring R-TAPP despite differences in experience.</p><p><strong>Conclusion: </strong>Both R-TAPP and L-TEP were performed safely, with no notable differences in perioperative outcomes. However, R-TAPP may provide improved operative efficiency, particularly in primary unilateral inguinal hernias. Although surgeon experience influenced operative performance, the consistent trend toward shorter operative times across surgeons suggests that R-TAPP may offer intrinsic procedural advantages. Further prospective studies with balanced surgeon distribution and long-term follow-up are warranted.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052749","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":"Four Techniques for Closing Laparoscopic Ports in Obese Patients.","authors":"Milton Alberto Muñoz-Leija, Jesús Gabriel Rosales-Vázquez, Gabriel Rosales-Pérez, Guillermo Álvarez-Valdés","doi":"10.4293/JSLS.2025.00121","DOIUrl":"10.4293/JSLS.2025.00121","url":null,"abstract":"<p><strong>Objective: </strong>The study objective was to compare the complication rates of four different techniques for closure: (1) no closure, (2) conventional closure with Vicryl, (3) Carter-Thomason, (4) M-Close in patients with obesity.</p><p><strong>Methods: </strong>The study design is a retrospective comparison of four surgical cohorts. All results refer to 12-mm supraumbilical incisions after laparoscopic surgery in patients with obesity. All patients had at least 12 months of follow-up.</p><p><strong>Results: </strong>Second surgery for a hernia was performed in 7 (12%) of 57 no-closure patients, 4 (8%) of 53 conventional closure patients, 1 (3%) of 31 Carter-Thomason patients, and 0 of 118 M-Close patients (overall difference: <i>P</i> < .001). The 95% confidence interval for these percentage rates of second surgery for hernia was: 5.3-21.1% for no closure, 1.9-15.1% for conventional closure, 0-9.7% for Carter-Thomason, and 0-0% for M-Close. Noteworthy differences for other complications were also found.</p><p><strong>Conclusions: </strong>This study suggests that M-Close reduces the rate of second surgery for hernia. The results also reinforce guideline recommendations that all incisions 10 mm or larger should be closed. This report provides a basis for planning randomized comparative trials.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513250","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 Reproducible Method of Measuring the Esophageal Hiatus and Potential Use in Hiatal Hernia Repairs.","authors":"Hiley Cammock, Sarah Couch, Danial A Malik, Jeremy T Gaskins, Farid Kehdy","doi":"10.4293/JSLS.2025.00110","DOIUrl":"10.4293/JSLS.2025.00110","url":null,"abstract":"<p><strong>Objective: </strong>Esophageal hiatus closure during hiatal hernia repair is essential. Improper closure can lead to recurrence and high patient morbidity. Our aim is to introduce an easy and reproducible method of calculating the surface area (hiatal surface area [HSA]) of the esophageal hiatus. Standardization of this value will enable surgeons to have an evidence-based approach for hiatal hernia closure during laparoscopic repair.</p><p><strong>Methods and procedures: </strong>We developed a measurement of HSA of the esophageal hiatus corresponding to a right-angle triangle: Area = (1/2) base × height. The height was defined as the left crus of the diaphragm. The base was defined as perpendicular to the crus and tangential to the medial edge of the esophagus. The mean esophageal hiatus surface area was calculated from deceased patients without a hiatal hernia undergoing full autopsies and compared to patients undergoing laparoscopic repair.</p><p><strong>Results: </strong>A total of 237 (37 cadaveric) hiatuses were measured. The median HSA defect in the cadaveric group was 1.97 cm² with an interquartile range (IQR) of 1.13 to 3.0 cm² was significantly larger compared to 5.0 cm² with an IQR of 3.5 to 7.5 cm² in the operative group (<i>P</i> < .001). Multivariate linear regression demonstrated an overall significant positive correlation between esophageal hiatus surface area defect and the variables of age and weight but not with gender.</p><p><strong>Conclusion: </strong>This study demonstrated a new reproducible method of measurement for esophageal hiatus. The significant difference between the two groups suggests that our formula can be utilized to develop a standardized value for the surface area of the esophageal hiatus.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"30 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486480","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}