Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"The first reported case using real-time artificial intelligence with single-port robotics for colorectal surgery.","authors":"Richard Fortunato, Heitham Wady, Selim Gebran, James T McCormick","doi":"10.1007/s00464-026-12688-7","DOIUrl":"https://doi.org/10.1007/s00464-026-12688-7","url":null,"abstract":"<p><strong>Background: </strong>With the increased utilization of artificial intelligence (AI) tools in the operating room, we aimed to integrate real-time visual cues provided by AI (computer vision) with the Single-Port (SP) robotic platform for colorectal surgery.</p><p><strong>Methods: </strong>A patient was selected for an end-ileostomy reversal using a Single-Port Robotic platform docked at the stoma site. Novel AI technology using deep-learning software was integrated into the robotic visual output system to identify different tissues within the abdominal cavity. Visual display of the information processed by the software was projected in real-time onto monitors and organized according to pre-selected color schemes.</p><p><strong>Results: </strong>The AI technology accurately and precisely identified the individual tissue structures that had been determined intraoperatively appropriate to transect or preserve. The visual display of the AI software was color coded and easy to interpret, helping to aid safe dissection. The use of the SP robot allowed ease of access into the abdomen, providing an excellent range of motion in all quadrants, and successful mobilization of the necessary bowel to safely perform an anastomosis. This also took advantage of the prior stoma site, avoiding the need for additional incisions.</p><p><strong>Conclusion: </strong>This report demonstrates the first successful integration of artificial intelligence using computer vision and deep learning software with the Single-Port Robotic platform to perform colorectal surgery. The technical feasibilities of these combined modalities illustrate their potential for future use in an expanded role for gastrointestinal surgery.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric ischemic conditioning before esophagectomy: contemporary practices and insights from an international survey.","authors":"Alberto Aiolfi, Davide Bona, Andrea Sozzi, Yves Borbély, Luigi Bonavina","doi":"10.1007/s00464-026-12725-5","DOIUrl":"https://doi.org/10.1007/s00464-026-12725-5","url":null,"abstract":"<p><strong>Background: </strong>Gastric ischemic conditioning (GIC) before esophagectomy has been proposed to enhance the vascular submucosal network of the gastric conduit and perfusion at the anastomotic site. Its advantages remain controversial due to inconsistent literature findings, often attributed to heterogeneity in patient selection, targeted vessels, timing, and variations in GIC technique. We conducted a survey to assess contemporary surgical practices regarding GIC utilization prior to esophagectomy among expert foregut surgeons.</p><p><strong>Methods: </strong>A Google-based survey was conducted in accordance with the CHERRIES checklist, developed following an extensive literature review and directed towards expert foregut surgeons. The survey comprised 39 questions covering demographic data, professional experience, surgical modalities for esophagectomy, indications, timing, and technical aspects for GIC.</p><p><strong>Results: </strong>Overall, 115 expert foregut surgeons participated in the survey (response rate 76.7%). Overall, 56.4% indicated that they do not perform GIC whereas 43.6% reported utilizing GIC before esophagectomy. Main reasons for not performing GIC included lack of supporting literature (57.1%) and no clear benefit in reducing AL rate (42.9%). Selective GIC use was most often based on celiac trunk stenosis or calcification (67.7%), history of coronary stenting/bypass (48.4%), and thoracic aorta calcification (41.9%). Overall, 59.6% of experts using GIC preferred laparoscopy while 40.4% favored embolization. Laparoscopy was preferred for cancer staging, jejunostomy formation, and hospital availability; embolization was preferred for its simplicity, avoidance of general anesthesia, absence of adhesions, and ability to dynamically assess the vascular anatomy intraprocedural. The left gastric artery was the most frequently targeted vessel (> 90%) for both laparoscopy and embolization, either individually or in combination with the short gastric vessels or the left gastroepiploic artery. Almost 70% of GIC users indicated a preference for performing GIC ≥ 14 days before esophagectomy.</p><p><strong>Conclusions: </strong>The survey indicates that less than half of the experts support GIC prior to esophagectomy, preferring its selective application. Laparoscopy is preferred over embolization, likely due to better tumor staging and greater hospital availability. Most respondents also prefer GIC to be performed more than 14 days before esophagectomy.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative optic nerve sheath diameter changes in vNOTES versus total laparoscopic hysterectomy: a prospective randomized study.","authors":"Fatma Acil, Andaç Dedeoğlu, Hülya Tosun Söner, Mehmet Özkılıç, Kevser Arkan, Kübra Çakar Yılmaz, Sedat Akgöl, Erhan Gökçek, Sedat Kaya","doi":"10.1007/s00464-026-12731-7","DOIUrl":"https://doi.org/10.1007/s00464-026-12731-7","url":null,"abstract":"<p><strong>Background: </strong>Pneumoperitoneum and steep Trendelenburg positioning during laparoscopic hysterectomy may increase intracranial pressure. Optic nerve sheath diameter (ONSD), measured by transorbital ultrasonography, is a validated noninvasive surrogate of intracranial pressure. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has been proposed as a less invasive alternative to total laparoscopic hysterectomy (TLH), potentially requiring lower intra-abdominal pressure and less steep Trendelenburg positioning. However, comparative data regarding their intraoperative effects on ONSD remain limited.</p><p><strong>Methods: </strong>This prospective randomized trial included 66 patients undergoing elective hysterectomy, allocated to either vNOTES (n = 33) or TLH (n = 33). ONSD was measured bilaterally at predefined intraoperative time points using transorbital ultrasonography. Longitudinal changes were analyzed using linear mixed-effects models. Postoperative nausea, vomiting, and neurological symptoms were assessed during the first 24 h postoperatively.</p><p><strong>Results: </strong>Baseline ONSD values were comparable between groups. A significant effect of time on ONSD (P < 0.001) and a significant group × time interaction (P < 0.001) were observed, indicating distinct intraoperative ONSD trajectories. Compared with vNOTES, TLH was associated with greater increases in ONSD at 30 min after pneumoperitoneum (estimated mean difference - 0.14 mm, 95% CI - 0.19 to - 0.09) and at the end of surgery after desufflation (estimated mean difference - 0.19 mm, 95% CI - 0.27 to - 0.11). Postoperative nausea and vomiting occurred more frequently in the TLH group; however, this difference did not reach statistical significance (54.5 vs. 36.4%, P = 0.138) and should be interpreted cautiously.</p><p><strong>Conclusions: </strong>Total laparoscopic hysterectomy was associated with more pronounced intraoperative increases in ONSD compared with vNOTES, likely reflecting surgical and positional factors. Although postoperative outcomes were statistically similar, the observed difference in PONV should be interpreted cautiously and did not demonstrate a statistically significant reduction.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon dilation versus endoscopic stricturotomy in the treatment of Crohn's anastomotic stricture: experimental randomized study.","authors":"Ondrej Ryska, Martin Lukas, Martin Kolar, Jaroslav Kalvach, Marketa Lengalova, Aneta Tremerova, Jan Ptacnik, Stefan Juhas, Jana Juhasova","doi":"10.1007/s00464-026-12700-0","DOIUrl":"https://doi.org/10.1007/s00464-026-12700-0","url":null,"abstract":"<p><strong>Background: </strong>Up to 80% of patients with Crohn's disease (CD) require surgery, and anastomotic strictures are a frequent postoperative complication with limited response to medical therapy. Endoscopic balloon dilation (EBD) and endoscopic stricturotomy (ESt) are widely used minimally invasive treatments, though comparative evidence remains scarce. Standardized animal models enable controlled assessment of therapeutic efficacy. This study compared EBD and ESt in a randomized experimental model replicating CD-associated anastomotic strictures.</p><p><strong>Methods: </strong>A chemically induced anastomotic stricture model was established in miniature pigs using a standardized ileo-sigmoid side-to-side anastomosis followed by serial TNBS/phenol injections. Forty-four animals with confirmed strictures were randomized to EBD, ESt, or control groups. Interventions consisted of graded balloon dilation or needle-knife stricturotomy with clip closure. Stricture diameter was measured endoscopically at baseline and every 8 weeks for 6 months. Primary outcomes were change in anastomotic diameter and long-term luminal patency. Secondary outcomes included adverse events and animal welfare indicators.</p><p><strong>Results: </strong>Both EBD and ESt increased anastomotic diameter compared with baseline. Significant improvement occurred only after ESt (final diameter 17.51 ± 4.71 mm vs. 11.27 ± 1.46 mm at baseline; p = 0.0002). EBD produced a non-significant trend toward enlargement (16.09 ± 5.35 mm; p = 0.0554). Diameter gain over 6 months was significantly greater with ESt than EBD (6.24 ± 4.40 mm vs. 3.31 ± 5.01 mm; p = 0.042). Controls showed no meaningful change. Three perforations occurred (two EBD, one ESt), all treated endoscopically without mortality. Weight gain and overall health status were comparable across groups throughout follow-up.</p><p><strong>Conclusion: </strong>In this randomized experimental study, both EBD and ESt were technically feasible and safe. ESt resulted in significantly greater and more durable luminal enlargement than EBD. These findings support stricturotomy as a potentially more effective endoscopic option for fibrostenotic CD and may help reduce or delay surgical intervention in affected patients.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative benefits of robotic gastrectomy over laparoscopic surgery across different age and BMI groups.","authors":"Yuichiro Miki, Tsubasa Bito, Ryota Kawai, Mami Yoshii, Yasutaka Ihara, Kenji Kuroda, Kiyoshi Maeda, Ayumi Shintani","doi":"10.1007/s00464-026-12716-6","DOIUrl":"https://doi.org/10.1007/s00464-026-12716-6","url":null,"abstract":"<p><strong>Background: </strong>Although robotic gastrectomy is increasingly being employed worldwide in patients with gastric cancer, the advantages of robotic gastrectomy (RG) over laparoscopic gastrectomy (LG) remain unclear across different age and BMI groups. This study aims to compare short-term outcomes of RG and LG across different age and BMI groups.</p><p><strong>Methods: </strong>We analyzed Japanese administrative claims data for patients who underwent RG or LG for gastric cancer between February 2019 and June 2023. The study included 17,786 patients. Multivariable Cox proportional hazard regression models, incorporating interactions between the surgical approach and age, were used to assess postoperative complications, costs, and hospital stay. BMI analyses were conducted similarly.</p><p><strong>Results: </strong>RG was associated with fewer postoperative complications (grade IIIa or higher, p < 0.001) and shorter hospital stays (p < 0.001) compared to LG in most age groups. Age significantly influenced the relationship between the surgical approach and costs (p = 0.004), with RG having lower costs in older patients, while younger patients incurred lower costs with LG. BMI also affected the association between the surgical approach and complications (p = 0.048); with patients having a BMI ≥ 20 kg/m² experiencing fewer complications with RG than LG.</p><p><strong>Conclusions: </strong>RG offers greater benefits for elderly and/or non-underweight patients compared to LG.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative seven year outcomes of RYGB and SADI-S as revisional procedures for weight recurrence regain after sleeve gastrectomy: weight loss trajectory, reflux control, and metabolic safety.","authors":"Asaad F Salama, Abdelwahed Yahmadi, Hamzah El Baba, Jawher Baazaoui, Khadija Gibreal, Mohamed Bougmiza, Mohammed Al Kuwari","doi":"10.1007/s00464-026-12692-x","DOIUrl":"https://doi.org/10.1007/s00464-026-12692-x","url":null,"abstract":"<p><strong>Background: </strong>Sleeve gastrectomy (SG) is widely performed, yet 20-50% of patients experience insufficient weight loss or weight regain, leading to revisional surgery. Roux-en-Y gastric bypass (RYGB) and single-anastomosis duodeno-ileal bypass (SADI-S) are two commonly used revisional procedures, but long-term comparative data remain limited. This study evaluates 7-year outcomes of RYGB versus SADI-S as revisional surgeries for weight recurrence after SG.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on all adults undergoing revisional RYGB or SADI-S between 2014 and 2015 after inadequate weight loss or weight recurrence post-SG. Demographic, anthropometric, biochemical, and comorbidity-related variables were assessed at baseline, 1, 5, and 7 years. Statistical analyses included t-tests, chi-square tests, Kaplan-Meier curves, and multivariate regression (significance set at p < 0.05).</p><p><strong>Results: </strong>The cohort included 105 patients (RYGB = 62; SADI-S = 43). SADI-S patients had higher baseline and pre-revision BMI. Across all follow-up points, SADI-S achieved significantly greater %TWL, %EWL, and BMI reduction, demonstrating superior long-term weight-loss durability. RYGB yielded markedly better GERD resolution (95 vs. 5%, p = 0.02), while remission of diabetes, hypertension, dyslipidemia, and asthma was similar between groups. Nutritional profiles differed: SADI-S was associated with lower calcium, zinc, folate, and vitamin D levels, whereas RYGB patients had lower vitamin B12. Overall complication rates, including bleeding, marginal ulcer, internal hernia, dumping syndrome, severe malnutrition, and iron-deficiency anemia, were not statistically significant.</p><p><strong>Conclusions: </strong>Both RYGB and SADI-S are effective and safe revisional options after SG. SADI-S offers superior long-term weight-loss and metabolic outcomes, whereas RYGB remains preferable for patients with significant or persistent GERD. Tailoring revisional procedure selection to patient characteristics and ensuring lifelong nutritional monitoring are essential for optimizing long-term outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of laparoscopic and robotic surgery for inflammatory bowel disease: a systematic review and meta-analysis.","authors":"Alessio Lucarini, Elena Belloni, Alexis Litchinko, Paolo Mercantini, Yves Panis","doi":"10.1007/s00464-026-12740-6","DOIUrl":"https://doi.org/10.1007/s00464-026-12740-6","url":null,"abstract":"<p><strong>Background: </strong>Refractory inflammatory bowel disease (IBD) often requires surgery. Ulcerative colitis (UC) usually needs proctocolectomy, while Crohn's disease (CD often involves multiple surgeries, with ileocecal resection (ICR) being the most common. Minimally invasive approaches offer faster recovery and fewer complications. Laparoscopy is established for IBD. Robotic surgery has shown its potential. This review updates evidence on robotic versus laparoscopic techniques in IBD surgery.</p><p><strong>Methods: </strong>PubMed, Scopus, CINAHL, and Cochrane databases were searched for papers comparing laparoscopic versus robotic surgery in IBD patients. Odds-ratio and weighted mean differences were calculated using models with random-effects. Risk of bias was evaluated with the Newcastle-Ottawa scale.</p><p><strong>Results: </strong>Fifteen papers reporting the outcomes of 13.225 patients were included. Papers were stratified into three categories: ICR for CD, Subtotal colectomy (SC) for UC, and proctectomy and ileal pouch-anal anastomosis (IPAA) for UC. Higher operative time was reported in the robotic cohorts (ICR 67.3 p < 0.01, SC 63.5 p < 0.001, and IPAA 39.7 p < 0.001), with a reduced conversion rate (ICR - 0.73 p = 0.02, IPAA - 0.4 p = 0.5). Outcomes were comparable for overall complications (ICR 0.1 p = 0.64, SC - 0.09 p = 0.4, and IPAA 0.01 p = 0.96) surgical (ICR - 0.58 p = 0.01, SC - 0.2 p = 0.09, IPAA - 0.3 p = 0.2) and medical complications (ICR - 0.18 p = 0.7, SC - 0.2 p = 0.2, and IPAA 0.56 p = 0.48). A slight advantage in hospital stay has been documented (ICR - 0.66 p = 0.03, SC - 0.7 p = 0.28, and IPAA - 0.29 p = 0.5).</p><p><strong>Conclusions: </strong>This meta-analysis demonstrates a slight advantage of robotic surgery over laparoscopy in IBD patients. While robotic surgery is a valid option, evidence is limited, and a cost analysis is required to justify its higher expense.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restoring circadian homeostasis is associated with immune-metabolic recovery and medium-term oncologic outcomes after rectal cancer surgery: a prospective randomized trial.","authors":"Shengjie Pan, Gang Wang","doi":"10.1007/s00464-026-12730-8","DOIUrl":"https://doi.org/10.1007/s00464-026-12730-8","url":null,"abstract":"<p><strong>Background: </strong>Major surgery disrupts circadian homeostasis, amplifying inflammatory and metabolic stress. The clinical implications of restoring temporal alignment on perioperative immune-metabolic recovery and medium-term oncologic outcomes remain incompletely defined.</p><p><strong>Methods: </strong>A two-stage prospective study was conducted at the First Affiliated Hospital of Soochow University (2019-2021). Study A (n = 300) characterized perioperative circadian disruption using a multimodal Circadian Rhythm Index (CRI). Study B (n = 240) was a randomized trial comparing standard ERAS with an integrated circadian reinforcement protocol including timed feeding, controlled light exposure, and low-dose melatonin. Co-primary endpoints were serum interleukin-6 (IL-6) AUC₀-₇d and percent change in the Prognostic Inflammatory and Nutritional Index (ΔPINI).</p><p><strong>Results: </strong>Surgery markedly reduced CRI (83.5 ± 8.9 → 59.2 ± 11.8, p < 0.001). Lower baseline CRI predicted higher IL-6 peaks and increased complication risk. Circadian reinforcement reduced IL-6 AUC₀-₇d (362 ± 145 vs 518 ± 183 pg·day/mL; p < 0.001) and attenuated inflammatory-nutritional deterioration (ΔPINI -16.9 ± 10.3% vs -30.8 ± 11.4%; p < 0.001). Hospital stay was shorter (9 [8-11] vs. 11 [9-13] days; p = 0.002), and the intervention was associated with improved 3-year disease-free survival (HR 0.56 [0.35-0.89]; p = 0.014). Mediation analysis suggested that CRI improvement accounted for 27.8% of IL-6 reduction and 22.4% of ΔPINI benefit. No serious adverse events occurred.</p><p><strong>Conclusions: </strong>Perioperative circadian disruption represents a measurable and modifiable component of surgical stress. Behavioral and environmental circadian reinforcement was associated with improved immune-metabolic recovery and favorable clinical trajectories. Integration of circadian-based strategies within ERAS warrants further multicenter validation.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and feasibility of bilateral lung transplantation with video-assisted thoracic surgery.","authors":"Ji Hyeon Park, Samina Park, Seon Yong Bae, Dae Hyeon Kim, Taeyoung Yun, Bubse Na, Kwon Joong Na, Hyun Joo Lee, In Kyu Park, Chang Hyun Kang, Young Tae Kim","doi":"10.1007/s00464-026-12689-6","DOIUrl":"10.1007/s00464-026-12689-6","url":null,"abstract":"<p><strong>Background: </strong>The clamshell incision remains the most common approach for bilateral lung transplantation because it provides excellent exposure of bilateral pleural cavities and the mediastinum. However, it is associated with significant morbidity, including sternal dehiscence and instability. Video-assisted thoracic surgery (VATS) offers a less invasive alternative. This study aimed to evaluate the feasibility, safety, and early postoperative outcomes of the VATS approach.</p><p><strong>Methods: </strong>We retrospectively analyzed 136 patients who underwent bilateral lung transplantation with extracorporeal membrane oxygenation support between August 2017 and March 2025. Patients were categorized according to surgical approach: clamshell (n = 105) or VATS (n = 31). Perioperative outcomes, complications, and pulmonary function were compared between the two modalities.</p><p><strong>Results: </strong>The VATS group had a significantly shorter operative time (319 vs. 417 min., P < 0.001), less blood loss (832 vs. 2,789 mL, P < 0.001), and required fewer transfusions. Sternal wound complications and airway interventions occurred exclusively in the clamshell group. Patients in the VATS group exhibited significantly higher pulmonary function at 1 month postoperatively than did the clamshell group (forced expiratory volume in 1 s (FEV₁): 85.79 ± 18.00 vs. 67.25 ± 22.55, P < 0.001; forced vital capacity (FVC): 73.42 ± 14.14 vs. 60.00 ± 17.81, P < 0.001). These differences gradually attenuated but remained statistically significant at 12 months postoperatively (FEV₁: P = 0.05; FVC: P = 0.04).</p><p><strong>Conclusions: </strong>VATS approach for bilateral lung transplantation is feasible and safe, offering lower surgical morbidity and better pulmonary function than the conventional clamshell incision. This technique may provide distinct advantages in centers with established thoracoscopic expertise.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National adoption of robotic-assisted surgery in the United Kingdom: a decade of growth, distribution and speciality trends (2014-2024).","authors":"Neil Donald, Joseph Sebastian, Giuseppe Preziosi","doi":"10.1007/s00464-025-12513-7","DOIUrl":"https://doi.org/10.1007/s00464-025-12513-7","url":null,"abstract":"<p><strong>Background: </strong>Robotic surgery (RS) has expanded rapidly worldwide, yet few countries have systematically documented their implementation and adoption at a national level. We aimed to provide a comprehensive overview of the UK robotic surgical landscape and detect ongoing trends.</p><p><strong>Methods: </strong>A cross-sectional survey of all UK NHS trusts was conducted for data covering 2014-2024, capturing the presence, type and utilisations of robotic-assisted surgical systems (RASS). Trusts also reported annual procedure volumes by speciality. Data were analysed for adoption patterns, RASS and procedural growth.</p><p><strong>Results: </strong>97% (149/153) NHS trusts responded. 67% of trusts (100) used RASS in 2024 compared to 20% in 2014. By 2024, 212 RASS were operational, primarily the Da Vinci Xi (57%) with increasing uptake of alternative platforms across an increasing number of specialities. Robotic procedure volumes grew from 3 622 in 2014 to 36 209 in 2024. Urology, General Surgery, and Gynaecology accounted for 90% of procedures. With increasing use of RS, comparative analysis showed no decrease in overall volumes of minimally invasive surgery or within a single speciality.</p><p><strong>Conclusion: </strong>The UK has undergone significant increases in robotic capacity and experienced a tenfold increase in procedures over the past decade, with rapid diversification of platforms and specialities. We did not find that this expansion had adverse impacts on procedural volumes. These data provide a comprehensive national benchmark and highlight challenges in equality, training and health-system planning that are relevant internationally. We recommend the urgent creation of a national registry to support safe implementation and training in RS.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}