Surgery Today最新文献

{"title":"Clinical significance of the preoperative prognostic nutritional index in patients with resectable non-small cell lung cancer: a multicenter study.","authors":"Mamoru Takahashi, Akihiro Aoyama, Masatsugu Hamaji, Takashi Sozu, Masashi Kobayashi, Tatsuo Nakagawa, Masashi Ishikawa, Ryo Miyahara, Cheng-Long Huang, Takuji Fujinaga, Hiroaki Sakai, Hiromichi Katakura, Makoto Sonobe, Norihito Okumura, Hidenao Kayawake, Toshi Menju, Ei Miyamoto, Ryo Miyata, Harutaro Okada, Tomoya Kono, Ryota Sumitomo, Naoki Date, Takehisa Fukada, Akira Matsumoto, Yasuto Sakaguchi, Hiroshi Date","doi":"10.1007/s00595-024-02987-8","DOIUrl":"https://doi.org/10.1007/s00595-024-02987-8","url":null,"abstract":"<p><strong>Purpose: </strong>To validate the clinical impacts of the prognostic nutritional index (PNI), an immune-nutritional blood marker, in patients with resectable non-small cell lung cancer (NSCLC) using multicenter cohort data.</p><p><strong>Methods: </strong>The subjects of this retrospective multicenter study, involving 11 hospitals, were patients who underwent curative lung resection for pathological stage IA-IIIA NSCLC. We analyzed the relationship between the preoperative PNI and postoperative outcomes. Patients were divided into a high PNI group and a low PNI group (cutoff: 45). We also performed exact matching and three propensity score-based methods to validate the results.</p><p><strong>Results: </strong>Among the total 2,770 patients, 2,272 (82.0%) had a high PNI (>45) and 498 (18.0%) had a low PNI (≤45). A low preoperative PNI was a predictor of increased overall postoperative complications (relative risk 1.49; 95% confidence interval (CI) 1.31-1.69) and an independent adverse prognostic factor for overall survival (hazard ratio 1.77; 95% CI 1.45-2.17) and recurrence-free survival (1.34; 95% CI 1.14-1.59). All the methods we used (whole cohort, exact matching, and three propensity score methods) showed consistent results.</p><p><strong>Conclusions: </strong>The findings of this multicenter study suggest that immune-nutritional assessment using the PNI will provide useful prognostic information for patients with resectable NSCLC.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011534","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":"Risk factors for anastomotic leakage in rectal cancer surgery reflecting current practices.","authors":"Tatsunosuke Harada, Masakatsu Numata, Yosuke Atsumi, Toshiyuki Fukuda, Shota Izukawa, Yusuke Suwa, Jun Watanabe, Tsutomu Sato, Aya Saito","doi":"10.1007/s00595-024-02988-7","DOIUrl":"https://doi.org/10.1007/s00595-024-02988-7","url":null,"abstract":"<p><strong>Purpose: </strong>In recent years, major advancements have been made in rectal cancer surgery with the introduction of new techniques such as robotic surgery and indocyanine green fluorescence imaging (ICG-FI). This study aimed to evaluate the comprehensive risk factors for anastomotic leakage (AL) following rectal cancer surgery, incorporating recently introduced techniques and other existing factors, to reflect current practices.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of 304 patients who underwent either robotic or laparoscopic anterior resection between January 2019 and December 2023. The study analyzed patient, tumor, and surgical factors, with AL defined by clinical or radiological findings requiring intervention within 30 days after surgery.</p><p><strong>Results: </strong>A univariate analysis indicated that moderate or severe anemia and the non-use of ICG-FI were strongly associated with AL. A multivariate analysis identified moderate or more severe anemia (hemoglobin ≤10.9 g/dL for males and ≤9.9 g/dL for females) (odds ratio [OR]: 9.94, p = 0.002) and non-use of ICG-FI (OR: 10.40, p < 0.001) as independent risk factors for AL.</p><p><strong>Conclusion: </strong>Moderate or severe anemia and absence of ICG-FI were found to significantly increase the risk of AL. Preoperative anemia correction and the routine use of ICG-FI may help mitigate this risk, thus suggesting the need for further research in these areas.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967042","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":"Efficacy of robot-assisted double-flap techniques with refinements to minimize anastomosis-related complications after proximal gastrectomy.","authors":"Eiichiro Nakao, Masataka Igeta, Motoki Murakami, Shugo Kohno, Yudai Hojo, Tatsuro Nakamura, Yasunori Kurahashi, Yoshinori Ishida, Hisashi Shinohara","doi":"10.1007/s00595-024-02989-6","DOIUrl":"https://doi.org/10.1007/s00595-024-02989-6","url":null,"abstract":"<p><strong>Purpose: </strong>The double-flap technique (DFT) is an anti-reflux reconstruction procedure performed after proximal gastrectomy (PG), but its complexity and high incidence of anastomotic stenosis are problematic. We conducted this study to demonstrate the efficacy of robot-assisted DFT, with refinements, to address these issues.</p><p><strong>Methods: </strong>Surgical outcomes were compared between the following procedures modified over time at our institution: conventional open DFT (group O, n = 16); early robotic DFT (group RE, n = 19), which follows the conventional open PG approach; and late robotic DFT (group RL, n = 21), which incorporates refinements to the early robotic DFT technique by exploiting more of the robotic capabilities available. These robotic capabilities include pre-anchoring the stomach to the diaphragmatic crus and connecting it to the esophagus, placing interrupted sutures for anastomosis, and maximally embedding the esophagus through the entire flap.</p><p><strong>Results: </strong>Anastomotic stenosis requiring balloon dilatation developed in two (11.8%) patients from group O and three (14.3%) from group RE, but not in any patients from group RL. Reflux esophagitis, classified as Los Angeles Classification grade ≥ B, decreased from 25.0% in group O to 10.5% in group RE and was completely controlled in group RL (group RL vs group O, odds ratio 0.065, 95% confidence interval < 0.001-0.684, P = 0.007).</p><p><strong>Conclusion: </strong>Robotic surgery helps minimize anastomotic stenosis, while enhancing the benefits of anti-reflux reconstruction with DFT.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955415","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":"Prognostic impact of subcutaneous fat quality and sarcopenia on the survival outcomes in patients with colorectal cancer.","authors":"Takaaki Fujimoto, Koji Tamura, Kinuko Nagayoshi, Yusuke Mizuuchi, Yuta Okada, Satoru Osajima, Kyoko Hisano, Kohei Horioka, Koji Shindo, Naoki Ikenaga, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura","doi":"10.1007/s00595-024-02985-w","DOIUrl":"https://doi.org/10.1007/s00595-024-02985-w","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the relationship between the quantity and quality of subcutaneous fat and prognosis following colorectal cancer resection.</p><p><strong>Method: </strong>We conducted a retrospective analysis of the clinical data of 399 patients who underwent curative resection for stage 2 or 3 colorectal cancer between January 2013 and March 2019. This study examined the correlation between sarcopenia and various fat parameters, including fat area and density, and assessed their impact on the prognosis.</p><p><strong>Results: </strong>Sarcopenia was associated with a lower subcutaneous and visceral fat area, higher Hounsfield unit value in subcutaneous fat, and reduced modified intramuscular adipose tissue content in the multifidus, erector spinae, and psoas muscles. A low modified intramuscular adipose tissue content in the multifidus and erector spinae muscles was an independent prognostic factor for overall survival (hazard ratio, 2.28; p = 0.0329) and recurrence-free survival (hazard ratio: 2.32, p = 0.0233). Additionally, subcutaneous fat with a high Hounsfield unit was an independent predictor of a recurrence-free survival (hazard ratio, 2.68; p = 0.0142).</p><p><strong>Conclusion: </strong>Subcutaneous fat quality is correlated with sarcopenia and it thus serves as a prognostic factor for recurrence after stage 2 or 3 colorectal cancer resection.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955418","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":"Tele-robot-assisted minimally invasive esophagectomy using a double-surgeon cockpit on a cadaver.","authors":"Yuma Ebihara, Satoshi Hirano, Toshiaki Shichinohe, Hajime Morohashi, Eiji Oki, Kenichi Hakamada, Norihiko Ikeda, Masaki Mori","doi":"10.1007/s00595-024-02986-9","DOIUrl":"https://doi.org/10.1007/s00595-024-02986-9","url":null,"abstract":"<p><p>We conducted this study to evaluate the efficacy of robot-assisted minimally invasive esophagectomy (RAMIE) on cadavers in the prone position, utilizing telesurgical support through the double-surgeon cockpit (double SC) of the novel Japanese-made surgical robot system, hinotori^™ (Medicaroid, Kobe, Japan). The Cadaveric Anatomy and Surgical Training Laboratory (CAST Lab) at Hokkaido University and Kushiro City General Hospital (KCGH) are interconnected by a dedicated 1 Gbps internet line, spanning 300 km. An operation unit and double SC were installed at CAST Lab, whereas the double SC proctor was installed at KCGH. RAMIE was performed with telesurgical support on two adult cadavers. The onsite and proctor operation times were recorded as 88/79 min and 64/75 min, respectively. Throughout the surgical procedures, communication remained stable, with an average communication delay of 13.1 ms (range: 11.0-15.0 ms). This study demonstrated the feasibility of performing RAMIE with the patient in the prone position, supported by telesurgical support using a double SC on the hinotori^™ platform.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932689","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":"Increased acute-phase reaction after the transoral endoscopic thyroidectomy vestibular approach (TOEVA) compared with minimally invasive video-assisted thyroidectomy (MIVAT) for unilateral thyroidectomy.","authors":"Daqi Zhang, Lanlan Wan, Francesco Frattini, Gianlorenzo Dionigi","doi":"10.1007/s00595-024-02982-z","DOIUrl":"https://doi.org/10.1007/s00595-024-02982-z","url":null,"abstract":"<p><strong>Purposes: </strong>We analyzed the acute-phase response in unilateral thyroidectomy by comparing the transoral endoscopic thyroidectomy vestibular approach (TOEVA) with the minimally invasive video-assisted thyroidectomy (MIVAT).</p><p><strong>Methods: </strong>Patients were randomly assigned to undergo either TOEVA or MIVAT, after we obtained their written informed consent to participate in this study. Blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-1β (IL-1β), IL-6 and tumor necrosis factor (TNF-) were measured before surgery and then 4, 24, and 48 h after surgery. The VAS pain score, analgesic utilization, and time to resume normal activities were recorded.</p><p><strong>Results: </strong>There were 29 patients who underwent TOETVA and 30 who underwent MIVAT. The groups were well balanced in terms of age, gender, American Society of Anesthesiologists (ASA) score, and preoperative values. There were no postoperative complications in this series. The operation time was longer in the TOETVA group (p < 0.001). Patients recommenced routine activities earlier after MIVAT (p < 0.05). The TOETVA group showed a greater drop in lymphocyte count 4 h (p < 0.01) and 24 h (p = 0.04) postoperatively, a higher ESR value 48 h postoperatively (p = 0.02), a longer increase in IL-6 (p = 0.05), 24 (p = 0.003) and 48 h postoperatively (p < 0.001), and a higher CRP 24 (p = 0.05) and 48 h postoperatively (p = 0.01) than the MIVAT group. There was no difference in postoperative IL-1β, TNF, total white blood cell count, polymorphonuclear cell count, and VAS or analgesic requirement between the groups, except on the day of surgery.</p><p><strong>Conclusions: </strong>An increased inflammatory response in the acute phase was observed after TOETVA compared with MIVAT, suggesting that TOETVA is associated with increased tissue trauma. This may account for the earlier recovery after the MIVAT procedure.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928056","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 outcomes and long-term survival of laparoscopic distal gastrectomy at high-volume centers in Korea and China: a two-centered retrospective analysis.","authors":"Sen Wang, Ji-Hyeon Park, Qingya Li, Yikai Shen, Jee-Sun Kim, Do-Joong Park, Seong-Ho Kong, Haisheng Fang, Hye-Seung Lee, Linjun Wang, Diancai Zhang, Hao Xu, Hyuk-Joon Lee, Zekuan Xu, Han-Kwang Yang","doi":"10.1007/s00595-024-02931-w","DOIUrl":"10.1007/s00595-024-02931-w","url":null,"abstract":"<p><strong>Purpose: </strong>Laparoscopic distal gastrectomy is now widely used in East Asia and worldwide with different preferences and outcomes. This study aimed to compare the short- and long-term outcomes and preferences between two high-volume gastric cancer centers in Korea and China.</p><p><strong>Methods: </strong>Patients who underwent laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer from Seoul National University Hospital (SNUH) and the First Affiliated Hospital of Nanjing Medical University (NMUH) from 2017 to 2020 were enrolled in this study.</p><p><strong>Results: </strong>A total of 1166 SNUH cases and 847 NMUH cases enrolled in this study. The overall complication rate of SNUH (14.49%) did not differ from that of NMUH after LADG or TLDG (12.28%). The anastomosis-related complications rate (2.74%) did not show a significant difference with that of NMUH (2.01%) either. The median postoperative hospital stay for SNUH (7,(7,10)) was shorter than that for NMUH (8,(7,9)). The 5-year overall survival (OS) rate of SNUH was not significantly different from that of NMUH.</p><p><strong>Conclusion: </strong>There was no significant difference in the overall complication rate, anastomosis-related complication rate, resected lymph nodes, and 5- year overall survival rate between SNUH and NMUH except for the postoperative stay. Both the LADG and TLDG achieved satisfactory short- and long-term outcomes when performed by surgeons with adequate experience.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"52-61"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recipient blood group does not affect hepatocellular carcinoma recurrence after living donor liver transplantation in Korea.","authors":"Sung-Min Kim, Shin Hwang, Gi-Won Song, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Dong-Hwan Jung, Gil-Chun Park, Young-In Yoon, Woo-Hyoung Kang, Sang-Hoon Kim, Sung-Gyu Lee","doi":"10.1007/s00595-024-02879-x","DOIUrl":"10.1007/s00595-024-02879-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study assessed whether or not the ABO blood type affects the incidence of HCC recurrence after living donor liver transplantation (LDLT).</p><p><strong>Methods: </strong>This retrospective observational study included 856 patients with hepatocellular carcinoma (HCC) who underwent LDLT between January 2006 and December 2016 at the Asan Medical Center.</p><p><strong>Results: </strong>This study included 324 patients (37.9%) with blood type A, 215 (25.1%) with blood type B, 210 (24.5%) with blood type O, and 107 (12.5%) with blood type AB. ABO-incompatible LT was performed in 136 (15.9%) patients. The independent risk factors for the disease-free survival (DFS) were maximal tumor diameter, microvascular invasion, and Milan criteria. The only independent risk factor for the overall survival (OS) was microvascular invasion. The ABO blood group did not affect the DFS (P = 0.978) or OS (P = 0.261). The DFS according to the ABO blood group did not differ significantly between the ABO-compatible (p = 0.701) and ABO-incompatible LDLT recipients (p = 0.147). The DFS according to the ABO blood group did not differ significantly between patients within the Milan criteria (p = 0.934) and beyond the Milan criteria (p = 0.525). The DFS did not differ significantly between recipients with and without type A blood (p = 0.941).</p><p><strong>Conclusions: </strong>This study demonstrated that the ABO blood group system had no prognostic impact on the oncological outcomes of patients undergoing LT for HCC.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"99-109"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311761","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":"Mac-2 binding protein glycosylation isomer as a novel predictor of early recurrence after resection for hepatocellular carcinoma.","authors":"Kyohei Yugawa, Takashi Maeda, Keiji Tsuji, Mototsugu Shimokawa, Akihiro Sakai, Shohei Yamaguchi, Kozo Konishi, Kenkichi Hashimoto","doi":"10.1007/s00595-024-02885-z","DOIUrl":"10.1007/s00595-024-02885-z","url":null,"abstract":"<p><strong>Purpose: </strong>Hepatocellular carcinoma (HCC) frequently recurs after radical resection, resulting in a poor prognosis. This study assessed the prognostic value of Mac-2 binding protein glycosylation isomer (M2BPGi) for early recurrence (ER) in patients with HCC.</p><p><strong>Methods: </strong>Patients who underwent radical resection for HCC between 2015 and 2021. HCC recurrence within one year after curative resection was defined as ER.</p><p><strong>Results: </strong>The 150 patients were divided into two groups: non-ER (116, 77.3%) and ER (34, 22.7%). The ER group had a lower overall survival rate (p < 0.0001) and significantly higher levels of M2BPGi (1.06 vs. 2.74 COI, p < 0.0001) than the non-ER group. High M2BPGi levels (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.31-2.41, p < 0.0001) and a large tumor size (OR 1.31, 95% CI, 1.05-1.63; p = 0.0184) were identified as independent predictors of ER. M2BPGi was the best predictor of ER according to a receiver operating characteristic (ROC) analysis (area under the ROC curve 0.82, p < 0.0001).</p><p><strong>Conclusions: </strong>M2BPGi can predict ER after surgery and is useful for risk stratification in patients with HCC.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"62-69"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470873","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":"Factors prolonging the operative time for transumbilical laparoscopic-assisted appendectomy in pediatric patients: a retrospective single-center study.","authors":"Yohei Sanmoto, Yudai Goto, Kazuki Shirane, Akio Kawami, Kouji Masumoto","doi":"10.1007/s00595-024-02896-w","DOIUrl":"10.1007/s00595-024-02896-w","url":null,"abstract":"<p><strong>Purpose: </strong>Transumbilical laparoscopic-assisted appendectomy (TULAA) is one of the first endoscopic surgeries performed by trainee pediatric surgeons. While the operative time is generally shorter than for conventional laparoscopic appendectomy, the indications for this procedure are unclear and many unknown factors can prolong the operative time. We conducted this study to identify the factors that may prolong the operative time for TULAA.</p><p><strong>Methods: </strong>This retrospective, single-center study was conducted between 2015 and 2023. We performed multivariate analysis to identify the factors associated with prolonged operative time by analyzing TULAA procedures performed by trainees.</p><p><strong>Results: </strong>The study included 243 patients. The median operative time was 84 min (interquartile range, 69-114 min). Multivariate analysis revealed that an increased body mass index, elevated C-reactive protein level, a history of conservative treatment for acute appendicitis, and appendix perforation, for the patient; < 6 years' experience since graduation for the operating surgeon; and lack of board certification as a supervisor from the Japanese Society of Pediatric Surgeons for the attending surgeon were independent risk factors for prolonging the operative time.</p><p><strong>Conclusion: </strong>Having an attending surgeon with board certification as a supervisor by the Japanese Society of Pediatric Surgeons contributes to reducing the operative time required for TULAA.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"110-115"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499052","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}