Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

{"title":"Biomaterials in Tissue Regeneration Following Surgically Induced Bile Duct Injuries: A Systematic Review.","authors":"Héctor González Rosas, Luis de J Márquez Bohor Rugerio, Carlos J Solis-Oviedo, Fernando Pérez-Escamirosa","doi":"10.1097/SLE.0000000000001498","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001498","url":null,"abstract":"<p><strong>Objective: </strong>Bile duct injury (BDI) following cholecystectomy represents a significant surgical complication, often associated with hepatobiliary dysfunction, increased morbidity, and the need for complex reconstruction. Advances in tissue engineering and biomaterials have introduced novel strategies aimed at bile duct regeneration. This systematic review evaluates current evidence on biomaterial-based approaches for the treatment of BDI in experimental animal models.</p><p><strong>Methods: </strong>A systematic search was conducted between October 2025 and January 2026 in PubMed, Web of Science, and Ovid, following the PRISMA 2020 checklist. The selected studies explored a range of regenerative strategies applied to experimental animal models, including polymeric scaffolds, decellularized grafts, bioabsorbable stents, hydrogels, and bioactive systems incorporating growth factors or stem cells.</p><p><strong>Results: </strong>A total of 1141 records were identified from Web of Science (578), PubMed (459), and Ovid (104). After removal of 413 duplicates, 667 records were excluded during title and abstract screening. Fifty-eight articles underwent full text assessment, and 20 studies met the inclusion criteria for data extraction. These studies explored diverse biomaterial-based strategies aimed at promoting biliary regeneration and functional repair in experimental models. These approaches include decellularized and autologous grafts, polymeric scaffolds, bioactive systems, stents, and other natural materials, each with a unique set of advantages.</p><p><strong>Conclusion: </strong>Current evidence highlights the growing potential of biomaterial-based and bioactive platforms for bile duct regeneration in experimental models, underscoring the importance of continued research to optimize these strategies and facilitate their future translation to clinical approaches.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797773","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: Patient-Controlled Analgesia Using Ropivacaine (0.25%) Through Transversus Abdominis Plane Versus Epidural Route for Postoperative Pain Relief Following Midline Laparotomy.","authors":"Ruiying Huang, Li Zhou","doi":"10.1097/SLE.0000000000001495","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001495","url":null,"abstract":"","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685502","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":"Endoscopic Transmural Drainage of Walled-off Necrosis: Comparative Outcomes of EUS-guided Versus Conventional Approaches.","authors":"Bülent Ödemiş, Nazmi Gökhan Ünver, Mustafa Özdemir, Kerem Kenarli, Alper Macif, Batuhan Başpinar, Dilara Turan Gökçe","doi":"10.1097/SLE.0000000000001497","DOIUrl":"https://doi.org/10.1097/SLE.0000000000001497","url":null,"abstract":"<p><strong>Background: </strong>Walled-off necrosis (WON) is a complex sequela of acute pancreatitis that often necessitates interventional management. Endoscopic transmural drainage has emerged as the preferred first-line approach, especially with the increasing availability of endoscopic ultrasonography (EUS) guidance. This study aimed to evaluate endoscopic management of WON and identify factors associated with technical and clinical success.</p><p><strong>Methods: </strong>Patients who underwent endoscopic transmural drainage for symptomatic WON were analyzed retrospectively. Two different techniques-conventional and EUS-guided-were used as endoscopic drainage modalities. Baseline characteristics, procedural details, and outcomes were collected, and the impact of drainage modality and anatomic factors-including paracolic extension, disconnected pancreatic duct syndrome (DPDS), and colonic fistula-on clinical outcomes and adverse events was analyzed.</p><p><strong>Results: </strong>A total of 73 patients (mean age: 54.6±13.9 y; 46.6% male) underwent a total of 76 transmural drainage procedures. The median size of WON collections was 14 cm (IQR: 11-17 cm), and the most common indication was infection (62.5%). Colonic fistula and DPDS were identified in 5 (6.8%) and 38 (52.1%) patients, respectively. Technical success was assessed per procedure. Overall technical success was 97.4% (74/76), with 100% (36/36) success in the conventional group and 95.0% (38/40) in the EUS group. Clinical success was achieved in 84.9% (62/73) of patients, with similar outcomes between conventional (83.3%) and EUS-guided (86.5%) drainage (P=0.961). Reintervention was required in 67.1%, and direct endoscopic necrosectomy was performed in 31.5%. Complications occurred in 28.7% of patients, most commonly bleeding (15.1%), generally managed endoscopically.</p><p><strong>Conclusions: </strong>Endoscopic transmural drainage is an effective and safe intervention for the management of WON, with high technical and clinical success. EUS-guided drainage offers significant advantages by allowing intervention in patients without luminal bulging and in those with smaller collections, thereby expanding treatment eligibility to a broader patient population.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685507","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":"Integrating ERCP Within UK Higher Surgical Training: A Structured, Curriculum-Embedded Model.","authors":"Javed Latif, John Isherwood, Imran Bhatti, Ashley Dennison","doi":"10.1097/SLE.0000000000001459","DOIUrl":"10.1097/SLE.0000000000001459","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is integral to hepatopancreatobiliary (HPB) surgical practice, yet structured access to ERCP training within UK higher surgical training (HST) remains limited. Barriers include rota commitments, competing operative priorities, and restricted access to endoscopy lists. This study describes a structured, curriculum-integrated ERCP training model and examines the systemic factors influencing surgical trainee exposure.</p><p><strong>Methods: </strong>A structured ERCP training model embedded within UK HST is described and evaluated using a longitudinal case-study exemplar using prospectively logged data. Procedural volume, key performance indicators (KPIs), and levels of supervision were analyzed using data from the Joint Advisory Group (JAG) Endoscopy Training System (JETS) e-portfolio. Variation in annual case exposure was examined in relation to rota commitments, endoscopy list availability, and center-specific training infrastructure.</p><p><strong>Results: </strong>Over a 33-month period, 365 ERCP procedures were completed, consistent with and exceeding the JAG-reported median of ∼300 supervised procedures required for certification. Procedural exposure varied across training rotations, reflecting differences in service configuration and access to ERCP lists. KPIs improved progressively in keeping with recognized ERCP learning curves, with native papilla cannulation rates exceeding 90% early within the structured training pathway, following an initial learning phase and sustained achievement of therapeutic benchmarks for stone clearance and biliary stenting.</p><p><strong>Conclusion: </strong>This study demonstrates that ERCP competence can be achieved within UK higher surgical training when exposure is intentionally integrated into HPB rotations and supported by structured planning, longitudinal mentorship, and access to high-volume endoscopy services. The training model highlights transferable strategies to overcome systemic barriers to surgical ERCP training and may inform future curriculum development to support sustainable ERCP service provision.</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":"147594837","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":"Analysis of Risk Factors and Construction of Risk Prediction Model for Patients With First Recurrence After Initial Curative Resection for Hepatocellular Carcinoma.","authors":"Nan Ye, Yunxiao Lv, Bin Wang, Sicong Zhao, Jing Zhao","doi":"10.1097/SLE.0000000000001466","DOIUrl":"10.1097/SLE.0000000000001466","url":null,"abstract":"<p><strong>Objective: </strong>To investigate treatment strategies and relevant clinical indicators for patients with first recurrence after initial curative resection for hepatocellular carcinoma (HCC), and to construct a nomogram model for predicting the risk of survival and disease progression, as well as to validate its predictive performance.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 200 patients who experienced their first recurrence after initial curative resection for HCC in our hospital between January 2018 and July 2025. Patients were randomly divided into a training cohort and a validation cohort at a ratio of 7:3. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors affecting survival and disease status. On the basis of these factors, nomogram prediction models were established respectively for overall survival (OS) and progression-free survival (PFS). The prognostic capabilities were assessed by calibration curves and receiver operating characteristic (ROC) curves. The prediction models derived from the training cohort were validated in the validation cohort to assess their accuracy and feasibility.</p><p><strong>Results: </strong>Multivariate analysis revealed that independent factors influencing OS included alpha-fetoprotein (AFP) level, maximum tumor area, lymph node metastasis, histologic grade of the tumor at initial resection, and microvascular invasion (MVI). Independent factors affecting PFS included age, AFP level, and histologic grade of the tumor at initial resection. On the basis of these factors, individualized risk prediction models were constructed respectively for OS and PFS in patients with first postoperative recurrence. In the training cohort, the area under the curve (AUC) values for OS at 1-year, 2-year, and 3-year were 0.872, 0.919, and 0.831, respectively; for PFS, the corresponding AUC values were 0.740, 0.746, and 0.748. Calibration curves and ROC curves demonstrated good consistency between model predictions and actual observations. Different treatment strategies did not significantly affect the OS or PFS.</p><p><strong>Conclusion: </strong>AFP level, maximum tumor area, lymph node metastasis, histologic grade of the tumor at initial resection, and MVI are independent risk factors for OS in patients with first recurrence after initial curative resection for HCC. Age, AFP level, and histologic grade of the tumor at initial resection are independent risk factors for PFS. The risk prediction models developed in this study effectively predict 1-year, 2-year, and 3-year risks of OS and PFS, demonstrating strong predictive performance and providing valuable insights for clinical medical professionals in patients with first recurrence after initial curative resection for HCC.</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":"148017458","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 Hiatal Hernia Repair in Over 65-Year-Old Population: Feasibility, Technique, and Early Results.","authors":"Mattia Di Benedetto, Jérome R Lechien, Lorenzo Casali, Andrea Locatelli, Giovanni Dapri","doi":"10.1097/SLE.0000000000001465","DOIUrl":"10.1097/SLE.0000000000001465","url":null,"abstract":"<p><strong>Background: </strong>The incidence of hiatal hernia (HH) and associated comorbidities increases with age, which contributes to a higher perioperative risk in elderly patients. As life expectancy rises, general surgery must increasingly confront the challenge of treating this benign yet symptomatic condition in the elderly, where the primary goal is functional improvement and enhanced quality of life. We aimed to evaluate the safety and efficacy of laparoscopy for HH repair in this high-risk patient cohort.</p><p><strong>Methods: </strong>In a prospective database, we enrolled all consecutive elderly (65-year-old or older) patients who underwent laparoscopic HH repair (hernia reduction, cruroplasty, and fundoplication). Data analyzed included demographic and anthropometric, intra-operative and post-operative results and complications, mortality, length of stay (LOS), and clinical results during follow-up.</p><p><strong>Results: </strong>We enrolled a total of 28 patients, of whom 8 were males (28.6%), and 20 were females (71.4%). All patients came to consultation because of strong symptoms and were studied with esophagogastroduodenoscopy, x-ray oral swallow/oral contrast CT-scan, 24-hour pH-Impedance testing, and high-resolution esophageal manometry. Median age at the time of surgery was 73 (IQR 68-77) years, mean body mass index (BMI) was 24.5±2.3 Kg/m 2 , and median Charlson Comorbidity Index was 3.5 (IQR 3-4.75), corresponding to an estimated mean 10-year survival of 57.7%. Intraoperatively, a total of 3 complications (10.7%) were observed (2 cases of pneumothorax requiring placement of a chest drain, and 1 case of gastric perforation managed with laparoscopic suture); mean operative time was 162±79 minutes, and mean intraoperative blood loss was 42.5 mL (range: 0 to 200). A total of 14 Toupet fundoplications (50%) and 14 Nissen fundoplications (50%) were performed. A mesh was positioned in 1 patient (3.6%). No conversions to open surgery occurred.</p><p><strong>Postoperatively: </strong>three patients (10.7%) were transferred to the intensive care unit for monitoring; 4 complications occurred (14.3%): 3 radiologic pneumothoraxes (Clavien-Dindo score 1) and 1 cruroplasty disruption following extubation (Clavien-Dindo score 3). The mean LOS was 4.3±1.4 days. Peri-operative mortality was 0%, and there was one 90-day readmission (3.6%). During a mean follow-up period of 20±15 months, no HH recurrences or wrap stenosis were observed.</p><p><strong>Conclusions: </strong>Despite the ongoing debate regarding upper gastrointestinal minimally invasive surgery in elderly patients with multiple comorbidities, this study shows that a laparoscopic approach for symptomatic HH in an elderly population is feasible and safe, with no severe complications and no mortality, with favorable outcomes during follow-up. Advanced age alone should not be a limiting factor for the surgical decision-making, especially in experienced centers.</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":"148043749","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":"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}