Langenbeck's Archives of Surgery最新文献

{"title":"Fizz-computed tomography as a novel modality of objective esophageal hiatal assessment.","authors":"Daniel Leonard Chan, Grace Huan Yin, Manish Chug, Annemarie Hennessy, Jim Iliopoulos, Michael Leonard Talbot","doi":"10.1007/s00423-025-03647-2","DOIUrl":"10.1007/s00423-025-03647-2","url":null,"abstract":"<p><strong>Background: </strong>Traditional investigations of esophageal hiatal assessment for reflux disease and hiatal hernia (HH), such as endoscopy and barium swallow are subjective. High resolution manometry (HRM) limits hiatal hernia assessment to vertical length. We report a novel use of 3D volumetric Computed Tomography with effervescent oral contrast (Fizz-CT) as a means of preoperative HH diagnosis.</p><p><strong>Methods: </strong>A pilot series of 12 consecutive patients who underwent preoperative Fizz-CT assessment, as well as a combination of traditional investigations for HH (five primary, seven revisional HH).</p><p><strong>Results: </strong>The median age was 70years (IQR 57.5-76.8years) and median BMI 28.62 kg/m² (IQR 24.9-34.1 kg/m²). Seven patients (58%) had a recurrent HH and five patients (42%) had a primary hiatus hernia. Fizz-CT was able to diagnose the HH in all cases. The median oesophageal hiatal surface area (HSA) was 9.46cm² (IQR 4.66-13.79cm²). The median HH sac volume was 36.3cm³ (IQR 26.0-80.3cm³). All patients had a least one other investigation that has been traditionally used to diagnose HH. Seven of the 12 patients subsequently underwent laparoscopic HH repair surgery with intraoperative findings further confirming the radiological diagnosis of hiatus hernia.</p><p><strong>Conclusion: </strong>Fizz-CT imaging is a novel and accurate means of objective esophageal hiatal assessment in both primary and revisional HH patients. Vertical and radial measures of hiatal defects as well as hernia volumetry can be obtained. In post-surgical patients the relationship between the esophago-gastric junction and an infra- or supra-diaphragmatic fundoplication can also be assessed.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"83"},"PeriodicalIF":2.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fabrication and application of continuous douche for Da Vinci surgical robot arm.","authors":"Min Shi, Qian Zhang, Chunhong Gao, Jin Song, Cuixia Shen, Xiang Zhang","doi":"10.1007/s00423-025-03635-6","DOIUrl":"10.1007/s00423-025-03635-6","url":null,"abstract":"<p><strong>Background: </strong>The use of robotic surgery in hospitals is becoming increasingly widespread.</p><p><strong>Objective: </strong>This research was performed to design a continuous douche for surgical robotic arm operated instruments and evaluate its use.</p><p><strong>Methods: </strong>A continuous irrigator was designed for robotic arm operated surgical instruments. A total of 240 recovered robotic-arm instruments were selected from the Disinfection Supply Center of our hospital. These were divided into two groups according to their recycling order, with single number instruments in the control group and even number instruments in the experimental group. Each group included 120 pieces. In the experimental group, continuous douching was used for perfusion and soaking, while control group instruments were infused and soaked using a 50 mL syringe. Data on cleaning quality, accuracy of perfusion tool injection volume, incidence of liquid reverse osmosis during injection and washing, and product satisfaction were collected for both groups.</p><p><strong>Results: </strong>The qualified manipulator cleaning rate and satisfaction with perfusion tools were higher in the experimental group than in the control group, and incidence of liquid reverse osmosis was lower in the experimental group than in the control group.</p><p><strong>Conclusions: </strong>The self-made continuous perfusion device improved the instrument cleaning efficacy of the robotic surgical arm, accuracy of injection volume, and product satisfaction.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"82"},"PeriodicalIF":2.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic determinants in surgical critial patients undergoing emergency surgery for Stage III or higher colorectal cancer.","authors":"Hyun Ho Kim, Sanguk Hwang, Jinbeom Cho","doi":"10.1007/s00423-025-03653-4","DOIUrl":"10.1007/s00423-025-03653-4","url":null,"abstract":"<p><strong>Purpose: </strong>Emergency surgery in patients with colorectal cancer (CRC) is associated with elevated mortality and morbidity compared to elective operations. This study was conducted to identify the factors influencing both short and long term outcomes in emergent CRC operations, particularly in critically ill patients.</p><p><strong>Method: </strong>This single center retrospective analysis focuses on patients with stage III or higher CRC who underwent emergency surgery and were admitted to the intensive care unit postoperatively.</p><p><strong>Results: </strong>Among 64 patients, 46 presented with generalized peritonitis due to free perforation. Non-survivors at 90 days had a higher incidence of preoperative shock (53.3% vs. 4.1%, P = 0.000), elevated perioperative Sequential Organ Failure Assessment scores (P = 0.000; P = 0.013), and fewer retrieved lymph nodes (LN) (P = 0.010). Multivariate analysis identified LNs retrieval as a significant predictor of 90-day mortality (AUC = 0.727). For overall survival, younger age, lower American Society of Anesthesiologists (ASA) physical status, absence of metastasis, adjuvant chemotherapy (CTx), and lower LN ratio (LNR) were associated with improved outcomes. Multivariate analysis showed ASA physical status and adjuvant CTx as significant predictors. In predicting 3-year recurrence (51% of patients), the Random Forest model achieved 65% accuracy. Age and LNR were major predictors, with 0.01 unit increase in LNR raising recurrence risk by 1.025-fold and each additional year of age by 1.035-fold.</p><p><strong>Conclusion: </strong>The number of retrieved LNs was identified as a predictor of 90 day survival, ASA physical status and adjuvant CTx were identified as prognostic factors for overall survival, and age and the LNR were found to be predictors of disease recurrence within three years.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"81"},"PeriodicalIF":2.1,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence assessment of tissue-dissection efficiency in laparoscopic colorectal surgery.","authors":"Kei Nakajima, Shin Takenaka, Daichi Kitaguchi, Atsuki Tanaka, Kyoko Ryu, Nobuyoshi Takeshita, Yusuke Kinugasa, Masaaki Ito","doi":"10.1007/s00423-025-03641-8","DOIUrl":"10.1007/s00423-025-03641-8","url":null,"abstract":"<p><strong>Purpose: </strong>Several surgical-skill assessment tools emphasize the importance of efficient tissue-dissection, whose assessment relies on human judgment and is thus subject to bias. Automated assessment may help solve this problem. This study aimed to verify the feasibility of surgical-skill assessment using a deep learning-based recognition model.</p><p><strong>Methods: </strong>This retrospective study used multicenter intraoperative videos of laparoscopic colorectal surgery (sigmoidectomy or high anterior resection) for colorectal cancer obtained from 766 cases across Japan. Three groups with different skill levels were distinguished: high-, intermediate-, and low-skill. We developed a model to recognize tissue dissection by the monopolar device using deep learning-based computer-vision technology. Tissue-dissection time per monopolar device appearance time (efficient-dissection time ratio) was extracted as a quantitative parameter describing efficient dissection. We automatically measured the efficient-dissection time ratio using the recognition model of 8 surgical instruments and tissue-dissection on/off classification model. The efficient-dissection time ratio was compared among groups; the feasibility of distinguishing them was explored using the model. The model-calculated parameters were evaluated to determine whether they could differentiate high-, intermediate-, and low-skill groups.</p><p><strong>Results: </strong>The tissue-dissection recognition model had an overall accuracy of 0.91. There was a moderate correlation (0.542; 95% confidence interval, 0.288-0.724; P < 0.001) between manually and automatically measured efficient-dissection time ratios. Efficient-dissection time ratios by this model were significantly higher in the high-skill than in intermediate-skill (P = 0.0081) and low-skill (P = 0.0249) groups.</p><p><strong>Conclusion: </strong>An automated efficient-dissection assessment model using a monopolar device was constructed with a feasible automated skill-assessment method.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"80"},"PeriodicalIF":2.1,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which technical difficulty score can best predict postoperative outcomes after minimally invasive liver resections?","authors":"Louisa Bolm, Martina Nebbia, Onofrio Catalano, Gabriella Lionetto, Johanna von Bresinsky, Jannis Duhn, Shahrzad Arya, Marco Ventin, Julia Straesser, Cristina R Ferrone","doi":"10.1007/s00423-025-03612-z","DOIUrl":"10.1007/s00423-025-03612-z","url":null,"abstract":"<p><strong>Background: </strong>To assess technical difficulty scores for laparoscopic liver resections (LLR) in a large well-characterized cohort of low to high difficulty LLR.</p><p><strong>Methods: </strong>Patients undergoing LLR and open liver resection (OLS) (2007-2022) at Massachusetts General Hospital were included. Patients were classified according to the technical difficulty scores Ban difficulty score, IWATE criteria, Hasegawa score, IMM score, and Southhampton score (SHH) and calibration of these scores in predicting postoperative outcome parameters was assessed.</p><p><strong>Results: </strong>301 patients underwent LLR. Median age was 59 years and 58.5% of the patients were female. Median lesion size was 42.2 mm, median operative time was 197.7 min, and median estimated blood loss was 400.5 ml. According to the different scoring systems, 18.9% (SHH) to 52.2% (IWATE) of the LLR were high difficulty. Overall intraoperative events according to the modified Satava classification grade II (6.6%) and grade III (2.7%) were low as was postoperative 90 days major morbidity (5.3%) and mortality (1.0%). The respective scores' calibration for predicting non-textbook outcomes, intraoperative events, operative time, major postoperative morbidity, blood transfusion rates, and length of hospital stay was moderate to good for the respective scores and best for the IWATE criteria.</p><p><strong>Discussion: </strong>Even high technical difficulty LLR can be performed with low postoperative morbidity and mortality rates. The scores evaluated performed well in predicting major liver surgery outome parameters. Among the different difficulty scoring systems, the IWATE criteria performed best.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"79"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes of laparoscopic central hepatectomy: a comparison with open surgery.","authors":"Takashi Masuda, Yuichi Endo, Shun Nakamura, Wataru Miyoshino, Yuiko Nagasawa, Hiroki Orimoto, Masahiro Kawamura, Atsuro Fujinaga, Hiroomi Takayama, Yoko Kawano, Teijiro Hirashita, Masafumi Inomata","doi":"10.1007/s00423-025-03645-4","DOIUrl":"10.1007/s00423-025-03645-4","url":null,"abstract":"<p><strong>Purpose: </strong>Laparoscopic liver resection has advantages over open liver resection, including reduced blood loss and shorter hospital stays. Laparoscopic central hepatectomy (CH) is a highly challenging procedure, and such outcomes can only be achieved with a high level of expertise in laparoscopic liver surgery. Laparoscopic CH remains challenging, with safety and efficacy unclear. This study retrospectively evaluated the intra- and short-term outcomes of laparoscopic versus open CH and assessed safety and efficacy of laparoscopic surgery.</p><p><strong>Methods: </strong>CH included anterior sectionectomy (AS) and central bisectionectomy (CBS) (excluding cases with biliary reconstruction). The study comprised 38 patients receiving CH in our department from January 2010 to November 2023.</p><p><strong>Results: </strong>The laparoscopic group included 14 cases and the open group 24. AS/CBS was performed in 14/10 open group cases and 6/8 laparoscopic group cases. Short-term surgical outcomes showed no significant between-group difference in operative time, but the laparoscopic group lost significantly less blood (250 vs. 985 mL; p = 0.001) and the transfusion rate was lower (14% vs. 46%; p = 0.004). Among postoperative outcomes, incidence of bile leakage was not significantly different (33% vs. 42%; p = 0.42), but the laparoscopic group had significantly less postoperative ascites (0% vs. 17%; p = 0.047), fewer surgical site infections (SSI) (0% vs. 21%; p = 0.02), and shorter postoperative hospital stay (14 vs. 30 days; p = 0.005). The risk factor for bile leakage in CH by univariate and multivariate analysis was tumor proximity to the right anterior Glissonean pedicle (OR = 6.84; 95% CI = 1.67-32.7; p = 0.01).</p><p><strong>Conclusion: </strong>Laparoscopic CH could be performed safely. Compared to open surgery, laparoscopic CH was effective in reducing blood loss, postoperative ascites, SSIs, and shortening postoperative hospital stay. However, tumors close to the root of the right anterior Glissonean pedicle were considered a risk factor for postoperative bile leakage and require caution.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"78"},"PeriodicalIF":2.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 outcomes of gasless transoral endoscopic thyroidectomy and lateral neck dissection for papillary thyroid cancer.","authors":"Jing Fang, Shengying Wang, Yiwei Wang, Weifang Tang, Zhengzhi Zhu, Shikai Hong, Jianjun Liu","doi":"10.1007/s00423-025-03639-2","DOIUrl":"10.1007/s00423-025-03639-2","url":null,"abstract":"<p><strong>Purpose: </strong>Entirely endoscopic surgery via an oral approach is a novel surgical procedure that results in favorable cosmetic outcomes for papillary thyroid cancer (PTC) patients. However, technical constraints have limited the utilization of a single approach for neck lymph node dissection. The aim of this study was to report the safety and outcomes of a novel gasless transoral endoscopic thyroidectomy and lateral neck dissection (LND) procedure for papillary thyroid cancer patients with lateral lymph node metastases.</p><p><strong>Methods: </strong>This study reported a newly designed suspension system and trocars for a novel surgical procedure of gasless transoral endoscopic thyroidectomy and LND. Patients who underwent gasless transoral endoscopic thyroidectomy and LND at the Department of Thyroid Surgery, the First Affiliated Hospital of the University of Science and Technology of China, between January 2022 and December 2023 were included. This study documented the demographic information, operative details, postoperative outcomes, and rates of postoperative complications among the patients included in the analysis.</p><p><strong>Results: </strong>A total of 43 PTC patients, including 6 male patients and 37 female patients with an average age of 30.53 years, were included in the study. The average number of examined lymph nodes was 33.81, including an average of 5.21 examined lymph nodes at level II. The mean operative time was 293.05 min, with an average postoperative hospital stay of 5.21 days. One patient had a history of chyle leakage, three had transient recurrent laryngeal nerve injury, and four experienced transient hypoparathyroidism after surgery.</p><p><strong>Conclusion: </strong>Our innovative design of gasless transoral endoscopic thyroidectomy and LND surgery prevents incisional scars and shows promising safety and outcomes in papillary thyroid cancer patients with lateral lymph node metastases. This entirely endoscopic approach represents a viable alternative surgical option for selected cases.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"77"},"PeriodicalIF":2.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Allograft Dysfunction after liver transplantation- definition, incidence and relevance in a single-centre analysis.","authors":"Bengt A Wiemann, Oliver Beetz, Clara A Weigle, Philipp Tessmer, Simon Störzer, Dennis Kleine-Döpke, Florian W R Vondran, Nicolas Richter, Moritz Schmelzle, Felix Oldhafer","doi":"10.1007/s00423-025-03633-8","DOIUrl":"10.1007/s00423-025-03633-8","url":null,"abstract":"<p><strong>Purpose: </strong>Early Allograft Dysfunction (EAD) is a serious complication following liver transplantation. With more marginal donors and critical recipients, identifying EAD risk factors and their impact on long-term outcomes is crucial.</p><p><strong>Methods: </strong>We reviewed all liver transplants performed between 2007 and 2017 at our institution, excluding pediatric recipients, combined thoracic transplants, and retransplants in the same hospital stay. EAD was defined as either: (i) AST/ALT > 2000 IU/l in first 7 postoperative days (POD), (ii) Bilirubin ≥ 10 mg/dl on POD 7, (iii) INR ≥ 1.6 on POD 7.</p><p><strong>Results: </strong>Of the 621 cases analyzed, the EAD rate was 53.6%. Multivariate analysis identified only donor-dependent variables as independent risk factors for the onset of EAD: donor age (p = 0.012), donor serum sodium (p = 0.021), cold ischemic time (p = 0.007) and graft weight (p < 0.001). EAD significantly impaired graft survival (69.2% vs. 86.2% after 1 year; p = 0.005) but did not impact long-term patient survival (76.3% vs. 87.6% after 1 year; p = 0.162). Of the EAD components, elevated INR proved to be the only reliable predictor of patient mortality. Additionally, an AST/ALT concentration of > 4000 IU/l significantly improved the predictive value of the EAD definition for patient survival (p = 0.002).</p><p><strong>Conclusions: </strong>EAD risk factors are primarily donor-based and significantly impair graft but not patient survival. The high EAD rates and increased use of marginal grafts suggest the need to adjust conventional EAD definitions to optimize graft allocation in the future.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"76"},"PeriodicalIF":2.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 heller myotomy for esophageal achalasia: an updated systematic review and meta-analysis.","authors":"Alberto Aiolfi, Riccardo Damiani, Michele Manara, Francesco Cammarata, Gianluca Bonitta, Antonio Biondi, Davide Bona, Luigi Bonavina","doi":"10.1007/s00423-025-03648-1","DOIUrl":"10.1007/s00423-025-03648-1","url":null,"abstract":"<p><strong>Background: </strong>The surgical treatment for esophageal achalasia has evolved over the years, with laparoscopic Heller myotomy (LHM) and partial fundoplication becoming widely used worldwide. More recently, an increased interest in the robotic Heller myotomy (RHM) has arisen.</p><p><strong>Purpose: </strong>Compare short-term and functional outcomes of RHM vs. LHM.</p><p><strong>Methods: </strong>Systematic review and meta-analysis. PubMed, MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried. Primary outcome was esophageal perforation (EP). Risk ratio (RR), standardized mean difference (SMD), and 95% confidence intervals (95% CI) were effect size and relative inference measures. PROSPERO Registration Number: CRD42024512644.</p><p><strong>Results: </strong>Fourteen observational studies (12962 patients) were included. Of those, 2503 (19.3%) underwent RHM. The patient age ranged from 34 to 66 years and 51.7% were males. EP occurred in 259 patients (1.99%). The cumulative incidence of EP was 1.67% for RHM and 2.07% for LHM. Compared to LHM, RHM was associated with a reduced risk of EP (RR: 0.31; 95% CI 0.16-0.59). No differences were found in term of dysphagia requiring reoperation or additional endoscopic procedures (RR: 0.47; 95% CI 0.20-1.09) and postoperative Eckardt score (SMD: -0.42; 95% CI -0.94, 0.11). Blood loss, conversion to open, operative time, and hospital length of stay were comparable.</p><p><strong>Conclusions: </strong>RHM may be associated with a reduced risk of EP compared to LHM. However, because of selection bias, diverse surgeon expertise, variations in surgical technique, and prior endoscopic procedures these findings should not be viewed as conclusive while the superiority of one approach over the other remains to be established.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"75"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for blood transfusion in patients undergoing hysterectomy for stage I endometrial cancer.","authors":"Abdelrahman Yousif, Hatem S Mohamed, Anna Woodham, Mohanad Elchouemi, IIana Chefetz","doi":"10.1007/s00423-025-03629-4","DOIUrl":"10.1007/s00423-025-03629-4","url":null,"abstract":"<p><strong>Purpose: </strong>To highlight the risk factors contributing to blood transfusion among patients undergoing surgical intervention for Stage I Endometrial Cancer (EC).</p><p><strong>Method: </strong>Using the American College of Surgeons National Surgical Quality Improvement Program database, a nationally validated database dedicated to improving surgical care, females over the age of 18 who underwent surgery for EC stage I between the years 2016-2022 were queried. The cohort was then characterized based on those who received blood transfusion 72 h postoperatively.</p><p><strong>Results: </strong>27,183 patients with endometrial cancer who received surgical management were identified. 668 (2.5%) of those patients received blood transfusions. A multivariate logistic model found that a medical factor low preoperative Hct % (aOR 22.4, 95% CI[17.7, 28.3]; p < 0.001) and surgical factors such as 180 min or more of operative time (aOR 3.38, 95% CI[2.77, 4.14]; p < 0.001), larger uteri of 250-500 g (aOR 1.93, 95% CI[1.48, 2.49]; p < 0.001) and ≥ 500 g (aOR 2.35, 95% CI[1.77, 3.12]; p < 0.001), and abdominal approach compared to laparoscopic (aOR 6.36,95% CI[4.95, 8.18]; p < 0.001) were significantly associated with receiving blood transfusion.</p><p><strong>Conclusion: </strong>Many significant risk factors were found to be associated with blood transfusions in patients with Stage I endometrial cancer. These findings allow surgeons to proactively prepare adequate measures for patients who may require blood transfusions when they undergo surgery for endometrial cancer.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"72"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}