Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

{"title":"Female Surgeons Versus Male Surgeons in Laparoscopic Appendectomy: Equal Surgical Outcomes?","authors":"Camila Bras Harriott, Manuela Monrabal Lezama, Sofia Bertona, Cristian A Angeramo, Francisco Schlottmann","doi":"10.1097/SLE.0000000000001485","DOIUrl":"10.1097/SLE.0000000000001485","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in addressing sex disparities, inequities persist in the surgical field. Although some medical specialties have achieved a more balanced sex representation, female surgeons continue to face challenges. This study aimed to determine if a surgeon's sex influences surgical performance by comparing surgical outcomes between male and female surgeons performing laparoscopic appendectomy.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of adult patients (>16 y) undergoing laparoscopic appendectomy for acute appendicitis at our institution from 2014 to 2022. Patients were categorized based on the surgeon's sex: female (FS) or male (MS). We examined demographics, intraoperative variables, and postoperative outcomes. A multivariable logistic regression analysis assessed the independent effect of the surgeon's sex on conversion to open surgery.</p><p><strong>Results: </strong>A total of 1426 patients were analyzed; 1034 (72.51%) operated by MS and 392 (27.48%) by FS. Female surgeons had longer operative times (61.1 vs. 51.6 min, P <0.0001) and a higher conversion rate to open surgery (2.80% vs. 1.06%, P =0.01). Overall morbidity (12.0% vs. 13.8%, P =0.36) and major morbidity (5.1% vs. 4.8%, P =0.83) were similar between FS and MS. Length of hospital stay and readmission rates were also comparable. Multivariable analysis identified female surgeon as an independent risk factor for conversion (OR: 3.62, 95% CI: 1.39-9.36).</p><p><strong>Conclusions: </strong>Although FS and ML showed similar postoperative outcomes, differences in operative times and conversion rates suggest a need for further investigation into factors affecting surgical performance. Efforts to address gender disparities in surgical training and leadership are essential for ensuring equal opportunities for all surgeons.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520942","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":"Trocar Assist Percutaneous Abscess Drainage: A Novel Minimally Invasive Approach Reducing Complications in Infected Necrotizing Pancreatitis-A Retrospective Cohort Study.","authors":"Zhiwu Hong, Ping Wang, Zherui Zhang, Lei Wu, Liang Wang, Yang Yang, Jianan Ren","doi":"10.1097/SLE.0000000000001480","DOIUrl":"10.1097/SLE.0000000000001480","url":null,"abstract":"<p><strong>Background: </strong>Infected necrotizing pancreatitis (INP) requires effective drainage management. We introduce a novel technique, Trocar-Assisted Percutaneous Abscess Drainage (TAPAD), for direct placement of a double-lumen irrigation-suction tube and compare it with conventional 2-stage drainage.</p><p><strong>Methods: </strong>This retrospective cohort study included INP patients treated with the 2-stage method (n=98) or TAPAD (n=88). Outcomes included subsequent surgical requirements, complications, mortality, inflammatory markers, and ICU length of stay.</p><p><strong>Results: </strong>TAPAD significantly reduced the need for subsequent surgical intervention (OR=0.36, 95% CI: 0.16-0.82; P =0.02), abdominal bleeding (OR=0.41, 95% CI: 0.20-0.85; P =0.02), and ICU length of stay (HR=2.76, 95% CI: 1.89-4.02; P <0.001). Patients in the TAPAD group exhibited lower inflammatory marker levels on days 7 and 14 postintervention.</p><p><strong>Conclusion: </strong>TAPAD represents a promising alternative to conventional 2-stage drainage, offering reduced complications and improved clinical outcomes in the management of INP.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240358","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":"Comparative Performance of GPT-5 and Gemini Models in Decision Support for Bariatric Surgery: A Simulation-Based Study.","authors":"Yahya Kemal Çalışkan, Fatih Başak","doi":"10.1097/SLE.0000000000001478","DOIUrl":"10.1097/SLE.0000000000001478","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) models are increasingly proposed for surgical decision support, yet their reliability in high-risk domains such as bariatric surgery remains uncertain. Prior bariatric AI studies have mainly evaluated patient education, isolated question-answering, or predictive modeling rather than paired safety-focused decision simulation across the perioperative pathway.</p><p><strong>Materials and methods: </strong>This simulation-based paired-comparison study evaluated GPT-5 and Gemini using 60 expert-validated bariatric surgery vignettes spanning preoperative, intraoperative, and postoperative decision-making. Both models were queried under standardized low-temperature conditions. Three bariatric surgeons independently scored outputs for accuracy, safety, guideline adherence, and reasoning quality. Reporting was aligned with STROBE, with AI diagnostic-evaluation elements informed by STARD-AI and analytic transparency principles informed by TRIPOD+AI.</p><p><strong>Results: </strong>GPT-5 outperformed Gemini across all domains. GPT-5 achieved higher accuracy (87.3% vs. 72.4%), stronger guideline adherence (78% vs. 46%), and fewer unsafe recommendations (2.1% vs. 8.4%). Composite scores were significantly higher for GPT-5 (6.92±0.61) than for Gemini (5.43±0.88; P <0.001). Gemini was 4 times more likely to produce an unsafe action than GPT-5 (risk ratio, 4.0; 95% CI, 2.2-7.3). The largest accuracy gap occurred in intraoperative scenarios. Expert concordance was substantial for GPT-5 (κ=0.71) and moderate for Gemini (κ=0.54).</p><p><strong>Conclusion: </strong>GPT-5 demonstrated superior accuracy, guideline alignment, and safety compared with Gemini in bariatric surgery decision simulations. Although these findings support the potential of advanced LLMs as supervised decision-support tools, unsafe outputs persisted, reinforcing the need for model version transparency, prospective validation, and clinician oversight before clinical deployment.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240379","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":"Diagnostic Efficacy and Spatial Factors of Percutaneous Transhepatic Cholangiobiopsy in Malignant Biliary Obstruction: A Comparative Analysis of Hilar Versus Distal Obstruction.","authors":"Qingfan Hao, Xue Cai","doi":"10.1097/SLE.0000000000001477","DOIUrl":"10.1097/SLE.0000000000001477","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to explore the clinical application value of percutaneous transhepatic biliary drainage (PTCD) combined with intraductal forceps biopsy in the diagnosis of malignant biliary obstruction (MBO) and to analyze the mechanisms by which obstruction site and sampling quantity influence diagnostic efficacy.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data of 47 patients with MBO who underwent PTCD combined with intraductal biopsy. The cohort was stratified into a hilar group (n=27) and a distal group (n=20). The study focused on evaluating the impact of sampling quantity and biochemical markers while comparing the characteristics of the 2 groups.</p><p><strong>Results: </strong>The technical success rate of the procedure was 100%. The overall pathologic diagnostic sensitivity was 85.1% (40/47). The biopsy positivity rate in the distal group (90.0%) was numerically slightly higher than that in the hilar group (81.5%), although the difference was not statistically significant ( P =0.682). In contrast, the median number of samples in the confirmed positive group was significantly higher than that in the negative/indeterminate group ( P =0.005). Furthermore, the postoperative complication rate was only 6.38%, with no severe adverse events reported.</p><p><strong>Conclusions: </strong>PTCD combined with intraductal forceps biopsy is a safe and effective diagnostic method. Although the difference between obstruction sites was not statistically significant, this study demonstrates that increasing sampling quantity is crucial for diagnosis. Obtaining at least 3 to 4 samples through multipoint sampling is recommended to ensure high diagnostic rates across different obstruction sites.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240409","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":"Surgical, Pathological and Exploratory Survival Outcomes Following a Superior Mesenteric Vein-First Approach to Right Colectomy and Extended Right Colectomy: A Retrospective Single-Center Series with Video Documentation from Azerbaijan.","authors":"Ilgar Ismayilov, Vusal Aliyev, Nizami Gahramanov, Konul Aghamirzayeva","doi":"10.1097/SLE.0000000000001489","DOIUrl":"10.1097/SLE.0000000000001489","url":null,"abstract":"<p><strong>Background: </strong>Published regional data on right-sided colon cancer surgery from Azerbaijan are limited. This study reports perioperative, pathologic, and exploratory survival outcomes after standard and extended right colectomy in a consecutive institutional series.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using a prospectively maintained operative database of 89 patients who underwent superior mesenteric vein (SMV)-first right colectomy or extended right colectomy between August 2017 and April 2026. Both benign and malignant cases were included for perioperative safety analysis; oncological analyses were restricted to malignant disease.</p><p><strong>Results: </strong>Median age was 66.0 (57.0-71.0) years, and 47 (52.8%) patients were male. Malignant disease was present in 83 (93.3%). Standard right colectomy was performed in 69 (77.5%) and extended right colectomy in 20 (22.5%). Median operative time was 260.0 (210.0-315.0) minutes. Any recorded Clavien-Dindo complication occurred in 8 (9.0%), major morbidity in 4 (4.5%), reoperation in 4 (4.5%), and anastomotic leak in 3 (3.4%). Median lymph-node harvest was 33.0 (28.0-39.8); 81 (98.8%) evaluable patients had at least 12 nodes examined. Among malignant cases, stages I, II, III, and IV were reconstructed in 5, 30, 35, and 13 patients, respectively. In 83 malignant cases with analyzable survival time, estimated overall survival at 1, 3, and 5 years was 88.4%, 80.5%, and 72.7%, respectively, while exploratory disease-free survival was 87.5%, 80.9%, and 65.6%.</p><p><strong>Conclusions: </strong>In this institutional series, an SMV-first approach to right colectomy and extended right colectomy was associated with acceptable perioperative morbidity, a low anastomotic leak rate, and high lymph-node retrieval. The large proportion of stage III-IV disease underscores the need for earlier diagnosis and structured follow-up.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449407","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":"Real-World Outcomes of Barbed Versus Interrupted Sutures for Laparoscopic Choledochotomy: A 12-Month Follow-Up in Patients With Choledocholithiasis.","authors":"Peng Zhao, Ye Zhou, Changhe Zhang, Bin Xue, Xi Chen","doi":"10.1097/SLE.0000000000001481","DOIUrl":"10.1097/SLE.0000000000001481","url":null,"abstract":"<p><strong>Background: </strong>The optimal suture technique for primary closure after laparoscopic choledochotomy remains uncertain. We compared real-world outcomes of barbed continuous and conventional interrupted sutures in patients with choledocholithiasis.</p><p><strong>Methods: </strong>This single-center retrospective cohort included 200 patients with choledocholithiasis who underwent laparoscopic common bile duct exploration with primary duct closure (January 2019 to December 2023). Patients received barbed continuous sutures (n=102) or interrupted sutures (n=98) according to surgeon preference in routine practice. The primary endpoint was biliary adverse events (bile leakage or biliary stricture) within 12 months. Multivariable logistic regression and supportive Cox models were used to explore associations after adjustment for recorded clinical covariates; intraoperative duct inflammation and wall-thickness grading were not prospectively standardized and therefore were unavailable for adjusted analyses.</p><p><strong>Results: </strong>Biliary adverse events occurred in 25.0% (50/200). The 12-month event rates were 19.6% (20/102) with barbed sutures and 30.6% (30/98) with interrupted sutures. Barbed sutures were associated with fewer adverse events ( OR 0.74, 95% CI: 0.36-1.52; HR 0.61, 95% CI: 0.34-1.10). Independent predictors were age ≥70 years ( HR 2.08), CBD diameter <8 mm ( HR 2.56), maximum stone diameter ≥10 mm ( HR 2.15), and surgeon experience ≤5 years ( HR 2.51). Barbed sutures were associated with shorter suturing time, operative duration, postoperative stay, and drain duration (all P <0.001).</p><p><strong>Conclusion: </strong>Barbed continuous sutures were associated with greater operative efficiency and faster recovery, whereas biliary adverse event rates did not differ significantly after adjustment. Given the nonrandomized retrospective design and unmeasured intraoperative confounding, these findings should be interpreted as exploratory.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278950","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":"Intraoperative Difficulty, Rather Than Preoperative Factors, Determines Failure to Achieve the Critical View of Safety During Laparoscopic Cholecystectomy: A Large Cohort Study.","authors":"Kanan Ismayilzada, Babek Tabandeh","doi":"10.1097/SLE.0000000000001487","DOIUrl":"10.1097/SLE.0000000000001487","url":null,"abstract":"<p><strong>Background: </strong>Failure to achieve the critical view of safety (CVS) during laparoscopic cholecystectomy is an uncommon but clinically significant intraoperative scenario that necessitates alternative strategies to prevent bile duct injury. Although preoperative models are widely used to predict difficult cholecystectomy, their ability to identify cases in which safe dissection becomes unachievable remains unclear.</p><p><strong>Methods: </strong>This retrospective cohort study included 1001 consecutive patients undergoing laparoscopic cholecystectomy. CVS failure was defined as the inability to safely complete standard dissection, requiring transition to a bailout strategy. Clinical, laboratory, imaging, and intraoperative variables, including the Nassar difficulty score, were analyzed. Independent predictors were assessed using Firth penalized logistic regression.</p><p><strong>Results: </strong>CVS failure occurred in 19 patients (1.9%), reflecting the rarity but clinical significance of this intraoperative endpoint. Patients with CVS failure had significantly higher Nassar scores and more frequently underwent emergency surgery. In multivariable analysis, intraoperative difficulty, as measured by the Nassar score, was the strongest independent predictor of CVS failure (OR=18.44, 95% CI: 7.79-62.67; P <0.001), whereas preoperative variables were not independently associated with CVS failure.</p><p><strong>Conclusion: </strong>Failure to achieve CVS is primarily driven by intraoperative difficulty rather than preoperative factors. These findings highlight CVS failure as a distinct intraoperative threshold and support the importance of structured intraoperative assessment to guide the timely adoption of bailout strategies and enhance surgical safety.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438060","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 Predictive Model Integrating Coagulation Profiles for Preoperative Risk Stratification of Difficult Single-Incision Laparoscopic Cholecystectomy: A Retrospective Cohort Study Based on Explainable Machine Learning.","authors":"Shijie Hu, Yan Xia, Jinxin Sheng, Song Zhu, Wei Bao, Lijuan Yang, Junwei Fan","doi":"10.1097/SLE.0000000000001514","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001514","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative prediction of surgical difficulty in single-incision laparoscopic cholecystectomy (SILC) remains challenging, as models for multiport surgery are not directly applicable.</p><p><strong>Methods: </strong>This retrospective single-center study included 520 patients, who were randomly divided into a training cohort (n=364) and an internal validation cohort (n=156). Six predictors were identified, guiding 8 machine learning models. Performance was assessed using the area under the curve (AUC), calibration, decision curve analysis, and classification metrics. The optimal model was interpreted through SHapley Additive exPlanations and deployed online.</p><p><strong>Results: </strong>The optimal neural network achieved excellent validation performance (AUC: 0.867, accuracy: 0.833, specificity: 0.941, NPV: 0.855), with good calibration (Brier 0.118) and net benefit across clinical thresholds. Ablation analysis showed AUC decreased by 0.043 when coagulation parameters were excluded; correlation analyses suggested they provide complementary predictive value. Exploratory sensitivity analysis using a hard-event endpoint maintained good discrimination (AUC: 0.877), supporting robustness of the composite outcome. The model is publicly available as an online calculator at https://newprediction.shinyapps.io/predict/.</p><p><strong>Conclusion: </strong>We developed an interpretable machine learning model incorporating coagulation parameters to identify patients at increased risk of difficult SILC. The model demonstrated favorable predictive performance and may support preoperative risk stratification, patient selection, and individualized surgical planning.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115169","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":"Combined Use of Three Endoscopes With Primary Suture of Common Bile Duct and Antegrade Nasobiliary Drainage for Common Bile Duct Stones.","authors":"Xugang Li, Yili Zhang, Tingyan Liu, Kai Chen","doi":"10.1097/SLE.0000000000001479","DOIUrl":"10.1097/SLE.0000000000001479","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical application value of the combined use of 3 endoscopes (laparoscope, choledochoscope, gastroscope) with antegrade nasobiliary drainage in the treatment of common bile duct stones.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on 80 patients diagnosed with cholecystolithiasis and choledocholithiasis admitted to Dongshan Hospital from January 2024 to August 2025. According to the bile drainage method, patients were divided into the endoscopic nasobiliary drainage tube group (ENBD group, n = 40), who underwent concurrent 3-endoscope combination with antegrade nasobiliary tube placement, and the T-tube group (n = 40), who underwent 2-endoscope (laparoscope, choledochoscope) combination with T-tube placement. Intraoperative, postoperative, and complication conditions were compared between the two groups.</p><p><strong>Results: </strong>All patients in both groups underwent surgery and had drainage tubes successfully placed, with no fatalities reported. There were no statistically significant differences between the two groups in intraoperative blood loss or postoperative complications (bile leakage, pancreatitis) ( P > 0.05). The operation time in the ENBD group was longer than that in the T-tube group ( P < 0.05). However, the duration of tube retention in the ENBD group was significantly shorter than that in the T-tube group, with a statistically significant difference (Z = -7.698, P < 0.05). The postoperative hospital stay in the ENBD group was significantly shorter than that in the T-tube group, with statistically significant differences ( P < 0.05).</p><p><strong>Conclusion: </strong>The concurrent combined use of 3 endoscopes with antegrade nasobiliary drainage is a safe and effective surgical option for the treatment of selected cases of common bile duct stones.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240363","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":"The Ring of Protection Sign: A Novel Ultrasound Marker to Standardize Hydrodissection Safety in Thermal Ablation of Benign Thyroid Nodules.","authors":"Sanjay K Yadav, Saurabh Maurya, Siddhartha Chakravarthy, Dhananjaya Sharma","doi":"10.1097/SLE.0000000000001482","DOIUrl":"10.1097/SLE.0000000000001482","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided thermal ablation has become an established alternative to surgery for benign thyroid nodules. Hydrodissection is routinely used to protect adjacent critical structures; however, assessment of its adequacy remains subjective, with no standardized imaging marker to confirm procedural readiness before energy delivery. This prompted us to describe and evaluate a novel ultrasound imaging marker, the ring of protection (RoP) sign, designed to confirm complete circumferential hydrodissection and enhance procedural safety during microwave ablation (MWA) of benign thyroid nodules.</p><p><strong>Methods: </strong>The ring of protection sign is defined as a continuous circumferential anechoic fluid rim completely surrounding the target thyroid nodule, visible in 2 orthogonal ultrasound planes, persisting during gentle probe compression, and eliminating direct contact between the nodule and adjacent critical structures. We detail the technical methodology, sonographic criteria, and clinical application of the ring of protection sign during ultrasound-guided MWA. Outcomes of patients treated using ring of protection-guided hydrodissection (RoP group) were compared with those undergoing standard hydrodissection (HD group).</p><p><strong>Results: </strong>Sixty-three patients were included (HD: n=28; RoP: n=35), with comparable baseline demographic and nodule characteristics. Mean procedure time was significantly shorter in the RoP group (20±10 vs. 26±13 min; P =0.049). No major complications occurred in either group. Minor complications, volume reduction ratios (at 6 and 12 mo), postprocedural pain, and cosmetic outcomes were similar between groups.</p><p><strong>Conclusion: </strong>The ring of protection sign is a simple, reproducible, and clinically meaningful ultrasound marker that provides objective confirmation of adequate hydrodissection before thyroid thermal ablation. Its adoption may help standardize procedural readiness assessment, improve training consistency, and further enhance the safety profile of thyroid ablation techniques.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340569","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}