Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

{"title":"Clinical Outcomes of Duodenum-Preserving Core Pancreatic Head Resection (DP-CoPHR).","authors":"Shilin Guo, Shuhai Chen, Han Liu, Lei Wang, Jianwei Xu","doi":"10.1097/SLE.0000000000001469","DOIUrl":"10.1097/SLE.0000000000001469","url":null,"abstract":"<p><strong>Background: </strong>Compared with pancreaticoduodenectomy, duodenum-preserving pancreatic head resection (DPPHR) is superior for resecting benign or low-grade malignant tumors located in the core area (adjacent to major ducts) of the pancreatic head. However, this procedure is technically complex. We developed a modified technique, duodenum-preserving core pancreatic head resection (DP-CoPHR), designed to simplify the procedure. This study evaluates its clinical outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed 6 patients with benign or low-grade malignant tumors located in the core region of the pancreatic head who underwent laparoscopic DP-CoPHR.</p><p><strong>Results: </strong>All 6 patients (median age 26; 3 male and 3 female) successfully completed laparoscopic DP-CoPHR. Pathology revealed solid pseudopapillary neoplasm (n=4), serous cystic neoplasm (n=1), and IPMN (n=1); median tumor diameter was 4.6 cm. The median operative time was 267.5 minutes, the estimated blood loss was 100 mL, and the postoperative hospital stay was 11.5 days. Pancreatic fistula (grade B) occurred in 3 patients (50%). A biliary fistula occurred in 1 patient and was managed with ERBD. No perioperative mortalities or reoperations were recorded.</p><p><strong>Conclusion: </strong>Laparoscopic DP-CoPHR is an alternative procedure for selected patients with benign or low-grade malignant tumors in the core region of the pancreatic head. Long-term follow-up is required to confirm the patency of the common bile duct.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Perioperative Metabolic, Hemodynamic, and Respiratory Effects of Intraperitoneal Versus Preperitoneal CO 2 Insufflation.","authors":"Onur I Dinçer, Remzi C Çakir, Kemal Eyvaz","doi":"10.1097/SLE.0000000000001473","DOIUrl":"10.1097/SLE.0000000000001473","url":null,"abstract":"<p><strong>Purpose: </strong>Since laparoscopic surgery is performed with carbon dioxide (CO 2 ) insufflation, it is known to have some metabolic consequences. Due to these metabolic changes, some clinicians may prefer open surgery for inguinal hernia in patients with pulmonary comorbidities. Our study aimed to compare the metabolic and systemic perioperative effects of preperitoneal insufflation with those of intraperitoneal insufflation.</p><p><strong>Methods: </strong>This prospective controlled study included 20 patients who underwent totally extraperitoneal (TEP) inguinal hernia repair and 20 patients who underwent laparoscopic cholecystectomy. End-tidal carbon dioxide (ETCO 2 ), peak inspiratory pressure (PIP), vital parameters, and arterial blood gas analysis results [pH, bicarbonate (HCO 3- ), partial pressure of carbon dioxide (PCO 2 ), and lactate] were recorded before insufflation and at 10 and 20 minutes after insufflation. These parameters were compared between the 2 groups.</p><p><strong>Results: </strong>In comparison between groups, no statistically significant differences were found in terms of age, gender, ASA score, or BMI ( P >0.05). In both groups, within-group analyses of HCO 3 , ETCO 2 , and PCO 2 showed that 10-minute measurements were significantly higher than preinsufflation and 20-minute measurements ( P <0.05), whereas lactate levels did not show significant variation. When vital parameters were evaluated within-group analysis, diastolic blood pressure and pulse were observed to be lower in both groups at preinsufflation compared with the 10- and 20-minute measurements ( P >0.05). No statistically significant difference was observed between the groups when preinsufflation 10-minute and 20-minute analyses were evaluated for all parameters ( P <0.05).</p><p><strong>Conclusion: </strong>On the basis of the standardized intergroup analyses of pulmonary and metabolic parameters, preperitoneal and intraperitoneal CO 2 insufflation demonstrated similar perioperative respiratory and metabolic effects. Laparoscopic inguinal hernia repair, which offers rapid postoperative recovery, does not appear to impose a greater metabolic burden than laparoscopic cholecystectomy. Therefore, laparoscopy may be considered a primary surgical approach for inguinal hernia repair, similar to cholecystectomy.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Linea Alba Morphology and Abdominal Wall Distensibility During Pneumoperitoneum.","authors":"Shoichi Kinoshita, Hiroyuki Kuge, Kenji Nakagawa, Mitsuhiro Nakatani, Yayoi Matsumoto, Yuki Takeda, Yuhei Hashimoto, Tomohide Mukogawa","doi":"10.1097/SLE.0000000000001476","DOIUrl":"10.1097/SLE.0000000000001476","url":null,"abstract":"<p><strong>Background: </strong>The linea alba is subjected to the greatest tensile stress during anterior abdominal wall loading and plays a central role in maintaining mechanical stability. During pneumoperitoneum, abdominal wall behavior under controlled intra-abdominal pressure may reflect structural properties of its fascial components. This study examined the association between linea alba morphology and abdominal wall distensibility during pneumoperitoneum in laparoscopic surgery.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted in 343 patients undergoing laparoscopic surgery between February 2023 and December 2024. Abdominal wall distensibility during pneumoperitoneum was approximated by insufflated gas volume adjusted for body habitus under standardized anesthetic and pressure conditions. Preoperative computed tomography was used to assess interrectus distance (IRD) as a morphologic measure of the linea alba. Associations between IRD, abdominal distensibility, and body mass index (BMI) were analyzed.</p><p><strong>Results: </strong>The median IRD was 15.4 mm; 29.1% of patients had IRD ≥2 cm and 9.9% ≥3 cm, with wider IRD more frequently observed in female patients. Abdominal distensibility did not differ between patients with normal linea alba width (IRD <2 cm) and those with moderate widening (IRD 2 to 3 cm). In contrast, considerable widening of the linea alba (IRD ≥3 cm) was associated with higher abdominal distensibility, particularly among patients with lower BMI. Both IRD distribution and abdominal distensibility differed across BMI categories; patients with BMI ≥25 demonstrated significantly wider IRD but significantly lower abdominal distensibility compared with those with BMI <25, indicating that abdominal wall distensibility reflects the combined influence of IRD magnitude and body composition. In multivariable analysis, IRD ≥3 cm, BMI, and age were independent predictors of abdominal distensibility.</p><p><strong>Conclusions: </strong>Linea alba morphology was associated with greater abdominal wall distensibility during pneumoperitoneum, particularly with larger separations. While abdominal distensibility is influenced by multiple factors, linea alba morphology represents an independent structural contributor to abdominal wall mechanics. Assessment of abdominal wall behavior under standardized insufflation conditions may complement morphologic evaluation and improve understanding of interindividual variability in laparoscopic surgery.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Liver Resections: Are Postero-Superior Liver Segments Really the Last Step of the Learning Curve?","authors":"Alessandro Fogliati, Cristina M Ciulli, Francesca Carissimi, Andrea Scacchi, Mauro A Scotti, Stella K Adjei Antwi, Federica Ferraina, Fabrizio Romano, Mattia Garancini","doi":"10.1097/SLE.0000000000001460","DOIUrl":"10.1097/SLE.0000000000001460","url":null,"abstract":"<p><strong>Background: </strong>Posterior-superior (PS) laparoscopic liver resections (LLR) are generally considered the last step of the learning curve (LC). Current literature supports the approach of PS LLR after the completion of a long anterolateral (AL) LC. However, the skills needed for PS LLR are not all achievable with AL LLR. The aim of this study is to explore a new concept of LC for LLR in which AL and PS resection are approached simultaneously.</p><p><strong>Methods: </strong>This is a retrospective study analyzing LLR performed between 2017 and 2024. PS and AL LLR were approached simultaneously. Two groups of PS and AL LLR were compared, using the textbook outcomes (TO) as the primary outcome. Secondary outcomes were morbidity, conversion, and vascular accidents.</p><p><strong>Results: </strong>The study compares 2 similar groups of 69 PS LLR and 146 AL LLR. PS LLR proved to be longer operations with a higher rate of conversion, but equal in major complications. No significant difference in TO achievement and no major vascular accidents in the PS group were recorded.</p><p><strong>Discussion: </strong>In conclusion, in LLR LC, the simultaneous approach of PS and AL liver resections is safe and feasible. PS LLR are challenging procedures but the achievement of optimal textbook outcome is noninferior to their AL counterpart.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Left Pancreatectomy With the Critical View of Safety and the Caudal Approach: A Standardized Technique for Training.","authors":"Pietro Addeo, Ivan Marchitelli, Pierre de Mathelin","doi":"10.1097/SLE.0000000000001471","DOIUrl":"10.1097/SLE.0000000000001471","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive left pancreatectomy improves the postoperative outcomes compared with an open approach. Vascular dissection during this procedure can be challenging, especially in cases of large tumors or misleading anatomy.</p><p><strong>Methods: </strong>In this video article, we describe a standardized technique for MLP based on 2 technical key points: the critical view of safety (CVS) and a caudal approach. A central vascular dissection to get a critical view of safety (CVS) for splenic vessels is pursued. The left gastric vein should clearly be seen separating the common hepatic vein and the splenic (CVS for splenic artery). A caudal approach with extensive retropancreatic dissection before pancreatic neck transection is used to isolate the splenic vein (CVS for splenic vein). Splenic vessels are then sectioned (or dissected in cases of preservation).</p><p><strong>Results: </strong>The technique presented was standardized in 25 consecutive patients with borderline and malignant pancreatic tumors. Conversion to open surgery occurred in one case due to tumor infiltration of the left colic flexure. No intraoperative blood transfusions were required. The median body mass index (BMI) was 22.7 kg/m 2 (17.2 to 48.5 kg/m 2 ), and 3 patients (21.4%) had BMIs > 30 kg/m 2 . Type of resection performed included left pancreatectomy with splenectomy (n = 11), left pancreatectomy with splenic vessels preservation according to the Kimura technique (n = 11), left pancreatectomy with splenic vessels resection and spleen preservation according to the Warshaw technique (n = 3). Diagnoses included neuroendocrine tumors (n = 8), pancreatic ductal adenocarcinomas (n = 4), mucinous cystadenomas (n = 6), intraductal papillary mucinous neoplasm (n = 4), and other (n = 3). No intraoperative blood transfusions were required. The median operation time was 225 minutes (90 to 330 min). The overall morbidity rate was 30%, and there was no mortality.</p><p><strong>Conclusions: </strong>A formal standardized method for MLP is presented, entailing a caudal approach to splenic vessels and a critical view of safety before vascular ligation. This approach could be an educational aid to reduce the learning curve for trainee surgeons.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Effects of Sugammadex on Postoperative Nausea and Vomiting in Laparoscopic Abdominal Surgery.","authors":"Ruiying Huang, Li Zhou","doi":"10.1097/SLE.0000000000001475","DOIUrl":"10.1097/SLE.0000000000001475","url":null,"abstract":"","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Port Robotic Transanal Minimally Invasive Surgery for Rectal Cancer: A Novel Approach With FishBowl-Early Case Series.","authors":"Alfredo Mellano, Luca Pellegrino, Sara Salomone, Simona Zaffirio, Felice Borghi","doi":"10.1097/SLE.0000000000001472","DOIUrl":"10.1097/SLE.0000000000001472","url":null,"abstract":"<p><strong>Background: </strong>Transanal minimally invasive surgery (TAMIS) emerged as a validated technique for local excision of rectal adenomas and early-stage adenocarcinomas. In organ preservation protocols, TAMIS is increasingly used for mid- and low-rectal cancers, achieving complete or major clinical response (cCR/cMR) following neoadjuvant chemoradiotherapy, complementing Watch-and-Wait strategies with low morbidity and favorable outcomes. Robotic platforms, particularly the Da Vinci SP, have improved surgical dexterity and visualization in confined pelvic spaces. Despite CE approval and encouraging feasibility data, widespread adoption of SP-TAMIS remains limited due to docking constraints. This study reports the first European series of rectal cancer cases treated with SP-TAMIS (SPrTAMIS) using a novel small FishBowl docking system and evaluates its feasibility, safety, and short-term outcomes.</p><p><strong>Materials and methods: </strong>Five patients with rectal adenocarcinoma, selected based on organ preservation criteria, underwent SPrTAMIS using the Da Vinci SP system. Preoperative assessment included endoscopy, MRI, CT, and bowel preparation. Procedures were performed under general anesthesia with CO 2 pneumorectum (12 mm Hg) and robotic instrumentation via the FishBowl docking system. Data collected included tumor characteristics, surgical duration, estimated blood loss (EBL), morbidity, mortality, length of stay (LOS), and functional outcomes (LARS and MSKCC scores).</p><p><strong>Results: </strong>All procedures were completed robotically without conversion. The mean lesion size was 8.8 mm, located 50 mm from the anal verge and 16 mm from the anorectal junction. Mean operative time was 85 minutes. No intraoperative complications or mortality occurred. GI function resumed by postoperative day (POD) 1; all patients were discharged by POD 2. One minor, asymptomatic suture dehiscence was observed. Histology confirmed complete excision with negative margins. The median follow-up was 68 days, and functional and quality-of-life outcomes were favorable.</p><p><strong>Conclusions: </strong>SPrTAMIS using Da Vinci SP and the FishBowl system is feasible and safe for rectal excision, offering ergonomic advantages and minimal anal canal trauma. Further studies are warranted to assess long-term oncologic and functional outcomes.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon-Performed Ultrasound-Guided Microwave Ablation for Benign Thyroid Nodules: A Single-Surgeon Clinical Experience.","authors":"Mehmet Ilker Turan","doi":"10.1097/SLE.0000000000001458","DOIUrl":"10.1097/SLE.0000000000001458","url":null,"abstract":"<p><strong>Background: </strong>Benign thyroid nodules are common and may cause compressive symptoms, cosmetic concerns, or hyperthyroidism. Ultrasound (US)-guided thermal ablation has emerged as a minimally invasive alternative to surgery. This study aimed to evaluate the efficacy and safety of surgeon-performed US-guided microwave ablation (MWA) for benign thyroid nodules.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data was performed on 32 patients who underwent US-guided MWA between May 2023 and May 2024. All procedures were performed by a single surgeon. Nodule volume, volume reduction ratio (VRR), thyroid function tests, and complications were evaluated at baseline and at 6- and 12-month follow-up. Technical success was defined as VRR >50% at 12 months.</p><p><strong>Results: </strong>The mean baseline nodule volume was 17.73±11.70 cm 3 , which decreased significantly to 7.40±4.92 cm 3 at 6 months and to 2.31±1.61 cm 3 at 12 months ( P <0.001). Mean VRR was 58.5% at 6 months and 87.1% at 12 months, with technical success achieved in all patients. VRR was not significantly affected by nodule composition, size, vascularity, or location. Among 3 patients with toxic adenoma, euthyroidism was achieved in 2 patients with complete discontinuation of antithyroid medications, while 1 patient improved from overt to subclinical hyperthyroidism with reduced medication dosage. No major complications were observed.</p><p><strong>Conclusions: </strong>Surgeon-performed US-guided MWA is a safe and highly effective minimally invasive treatment for benign thyroid nodules, providing substantial and durable volume reduction with excellent clinical outcomes in appropriately selected patients.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Trial on Operability and Safety of a Simplified Robot-Assisted System (FASTER) for Colorectal Endoscopic Submucosal Dissection.","authors":"Han Bu, Xinyu Zhang, Ciliang Jin, Zhenghao Chen, Rui Hu, Yang Liu, Mengjun Chen, Feng Gao, Tanzhou Chen","doi":"10.1097/SLE.0000000000001468","DOIUrl":"10.1097/SLE.0000000000001468","url":null,"abstract":"<p><strong>Background and aims: </strong>One of the key challenges in endoscopic submucosal dissection (ESD) is achieving effective intraoperative mucosal traction. Although numerous countertraction technologies have been developed, there is still room for optimization. This randomized controlled trial was designed to assess the comparative effectiveness of a novel robotic assistance system (FASTER) versus conventional ESD techniques for managing colorectal neoplasia.</p><p><strong>Methods: </strong>A total of 24 ESD procedures were performed on 6 different anatomic sites (rectum and sigmoid colon) of 4 pigs. Twelve procedures were performed with the FASTER-assisted method and 12 with the conventional method. Key efficacy outcomes consisted of total procedure time, submucosal dissection time, submucosal dissection speed, and direct visual dissection rate. Secondary outcomes evaluated the complete resection rate and perioperative adverse events.</p><p><strong>Results: </strong>Compared with the conventional ESD group (C-ESD), the total procedure time of the FASTER-assisted ESD group (F-ESD) was significantly lower (11.5 vs. 18.0 min; P <0.001). Compared with the conventional ESD, FASTER-assisted ESD significantly increased the submucosal dissection speed (0.7 vs. 0.4 cm 2 /min; P <0.001), shortened the submucosal dissection time (4.9 vs. 10.7 min; P <0.001), and improved the rate of direct vision dissection (99.0% vs. 83.2%; P <0.001). The operation difficulty score of the F-ESD group was significantly lower than that of the C-ESD group (1.0 vs. 3.0; P <0.001). FASTER-assisted ESD significantly optimized the primary outcome measures in the treatment of sigmoid and rectal lesions.</p><p><strong>Conclusions: </strong>The FASTER system reliably provided continuous visual feedback and dynamic tissue manipulation throughout the ESD procedure. In this prospective preclinical animal investigation, it significantly shortened operation time and reduced surgical adverse events, offering an innovative solution for optimizing ESD procedures in colorectal treatment.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Surgical Approach for Peri-Portal Vein Pancreatic Body Cancer: From the Pancreatic Tail or Head Side?","authors":"Shohei Yoshiya, Yo-Ichi Yamashita, Naotaka Inomata, Sota Nakamura, Kazuhiro Tada, Yosuke Kuroda, Kentaro Iwaki, Shoji Hiroshige, Kengo Fukuzawa, Tomoharu Yoshizumi","doi":"10.1097/SLE.0000000000001461","DOIUrl":"10.1097/SLE.0000000000001461","url":null,"abstract":"<p><strong>Objective: </strong>For peri-portal vein (PV) pancreatic body (Pb) cancer, we have often encountered difficulties in selecting the appropriate surgical approach-whether from the pancreatic tail side or the head side. This study aimed to clarify which procedure is more suitable for peri-PV Pb cancer.</p><p><strong>Methods: </strong>We reviewed 30 cases of peri-PV Pb cancer. The resected status of lymph nodes, their positivity rates in each procedure, and postoperative recurrence patterns were analyzed.</p><p><strong>Results: </strong>Among the 30 patients, 26 underwent distal pancreatectomy (DP), 3 underwent pancreatoduodenectomy, and 1 underwent total pancreatectomy. In the DP group, the gastroduodenal artery (GDA) was dissected to secure resection margins in 4 cases. The pancreatic transection lines were as follows: 1 to the right of the GDA, 3 at the GDA, 8 to the left of the GDA, and 14 to the right of the PV. Pathologic findings revealed the highest rate of lymph node metastasis in the splenic lymph nodes (#11, 32.1%), followed by the common hepatic lymph nodes (#8, 30.0%) and subpancreatic lymph nodes (#18, 18.5%). Only 1 case involved metastasis outside the regional Pb nodes-posterior pancreatic head (#13)-in a patient with suspected preoperative GDA invasion. Postoperative recurrence analysis showed no critical lymph node recurrence in nodes not resected during the initial procedure.</p><p><strong>Conclusions: </strong>This study suggests that DP may be an optimal option for peri-PV pancreatic body cancer without invasion of the pancreatic head region.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}