Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Pragmatic approach to implementation of universal MSI testing for new cases of colorectal cancer.","authors":"Vitaliy Y Poylin, Austin Budlong, Natasha Poylin, Mohammad Abbas","doi":"10.1007/s00464-025-11980-2","DOIUrl":"https://doi.org/10.1007/s00464-025-11980-2","url":null,"abstract":"<p><strong>Background: </strong>Microsatellite instability testing is used in cases of colorectal cancer to help identify individuals with Lynch syndrome. There is clinical, but not financial case for this testing. Net Present Value (NPV) is a financial tool designed to calculate whenever investment in the new project is financially sound. We hypothesize that investment into uniform testing on all new colorectal cancers will generate profit over time.</p><p><strong>Methods: </strong>Financial model was created based on number of patients seen and tested at tertiary medical center.</p><p><strong>Results: </strong>Uniform testing will cost $209 per patients (four test at $52.25 per test) and $5,000 is expected to be spent on pathology technician time. In that cohort, 8 out of 200 patients (equal number of males and females) is expected to be identified as having Lynch syndrome. Based on current charges, 5-year NPV is positive at $110,000 and 10-year NPV is positive at $199.663.</p><p><strong>Conclusions: </strong>Initial investment into MSI testing on all new cases of colorectal cancer results positive NPV and can help make a case for uniform testing to the hospital.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620648","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":"32nd International Congress of the European Association for Endoscopic Surgery (EAES), Maastricht, The Netherlands, 11-14 June 2024.","authors":"","doi":"10.1007/s00464-025-11801-6","DOIUrl":"https://doi.org/10.1007/s00464-025-11801-6","url":null,"abstract":"","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620647","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":"Impact of articulating laparoscopic instrument-assisted gastrectomy with D2 lymphadenectomy on perioperative and oncologic outcomes compared with conventional laparoscopy: a propensity score matching analysis.","authors":"Seohee Choi, Takahiro Kinoshita, Kazutaka Obama, Katsunobu Sakurai, Naoshi Kubo, Naruhiko Ikoma, Ali Guner, Hyoung-Il Kim","doi":"10.1007/s00464-025-11976-y","DOIUrl":"https://doi.org/10.1007/s00464-025-11976-y","url":null,"abstract":"<p><strong>Background: </strong>Articulating laparoscopic instruments (ALIs) have been developed to overcome the limited dexterity afforded by conventional laparoscopic instruments (CLIs). This study aimed to compare the postoperative and oncologic outcomes of patients who underwent laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer using CLIs versus ALIs.</p><p><strong>Methods: </strong>This retrospective study included 138 patients who underwent laparoscopic gastrectomy with D2 dissection for gastric cancer at a single institution from January 2018 to January 2024. Propensity score matching analysis was performed to minimize selection bias and compare surgical outcomes.</p><p><strong>Results: </strong>After matching, 39 patients were included in each group. The ALI group showed significantly faster postoperative recovery, with a shorter hospital stay (4.0 [3.0-5.0] days vs. 5.0 [4.0-7.0] days, p = 0.001) and quicker time to first flatus (2.0 [2.0-3.0] days vs. 3.0 [2.0-3.0] days, p = 0.004). Although the ALI group had a shorter operative time and lower estimated blood loss, these differences were not statistically significant (p = 0.202 and p = 0.634, respectively). Complication rates, including major complications, were similar between the two groups. Long-term oncologic outcomes, including overall survival and recurrence-free survival, did not differ significantly between the groups (p = 0.622 and p = 0.756, respectively).</p><p><strong>Conclusion: </strong>The use of ALIs in laparoscopic gastrectomy with D2 lymphadenectomy was associated with improved short-term perioperative outcomes without compromising long-term oncologic safety. These findings suggest that ALIs may enhance surgical efficiency and postoperative recovery in gastric cancer surgery.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609603","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":"Bariatric outcomes of high BMI patients with preoperative anti-obesity medications.","authors":"Alex D Obermark, Da Young Seo, Avery Bernazard, Jesse R Richards, Stephen Phillippe, Zhamak Khorgami, Geoffrey S Chow","doi":"10.1007/s00464-025-11851-w","DOIUrl":"https://doi.org/10.1007/s00464-025-11851-w","url":null,"abstract":"<p><strong>Introduction: </strong>Treating severe obesity (BMI > 50 kg/m²) poses unique challenges. Glucagon-like peptide-1 (GLP-1) receptor agonists have shown significant efficacy in treating obesity and can be integrated into a multimodal comprehensive treatment of obesity. This study evaluates the perioperative outcomes and efficacy of anti-obesity medications (AOMs) for prehabilitation and preoperative weight loss in a high BMI cohort.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed patients who underwent bariatric surgery from April 2018 to February 2023 in the University of Oklahoma-Tulsa Comprehensive Weight Loss and Bariatric Surgery program. Patients with an initial program BMI ≥ 49.5 kg/m² were included. The primary outcome of interest was preoperative weight loss; the secondary outcome was total weight loss at 1 year postoperatively. Data on AOM type and duration were collected. Weight and BMI were measured at multiple standard intervals throughout the program. Available results of genetic obesity testing were included. Preoperative weight loss was compared between groups using the Kruskal-Wallis Test.</p><p><strong>Results: </strong>206 patients underwent bariatric surgery during the study period; 79 had a BMI ≥ 49.5 kg/m² (age: 44 ± 11.2 years, 75.9% female). 34 (43%) had obesity-related genes. The average weight and BMI of the sample at the start of the program were 165.9 kg and 58.5 kg/m². The median preoperative weight loss for lifestyle only, oral AOM, GLP-1 or GLP-1/GIP agonist, and combo medical therapy was 3.1, 8.5, 10.3, and 10.4 kg, (P = 0.01). The mean total weight loss and excess weight loss percentage were 61.97 ± 20.9 kg and 65.6 ± 20.8%.</p><p><strong>Conclusion: </strong>GLP-1 therapies induced the highest weight loss preoperatively and a greater decrease in BMI than any other strategies. Preoperative GLP-1 therapy in high-risk patients is effective in maximizing preoperative weight loss and should be considered in high BMI patients before surgery. Additional studies are needed to determine optimal duration, durability, and cost-effectiveness of AOMs before and after metabolic surgery.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609600","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":"First use of augmented reality headset in minimally invasive general surgery: seeing is believing.","authors":"Ryan C Broderick, Graham J Spurzem, J Jeffery Reeves, Hannah M Hollandsworth, Bryan J Sandler, Garth R Jacobsen, Christopher A Longhurst, Santiago Horgan","doi":"10.1007/s00464-025-11985-x","DOIUrl":"https://doi.org/10.1007/s00464-025-11985-x","url":null,"abstract":"<p><strong>Background: </strong>Augmented reality (AR) is an evolving technology with the potential to transform surgical practice. By superimposing digital information onto the surgeon's field of view, AR headsets provide an unobstructed view of the minimally invasive operative field, eliminating the need to divert attention to external monitors. We present the first series of minimally invasive general surgery (MIS) cases performed using the Apple Vision Pro headset in the USA.</p><p><strong>Methods: </strong>Attending surgeons and trainees performed consecutive MIS cases at our institution while wearing the headset from August 2024 to December 2024. Using open-source software, laparoscopic/endoscopic video sources were displayed as virtual monitors in the physical operating room space. The virtual monitors served as the primary monitors through which surgeons performed each case. Standard monitors remained present to enable other members of the operative team to view the operations. At the conclusion of each case, the operating surgeon completed the NASA Task Load Index (NASA-TLX) assessment tool to evaluate perceived workload while operating with the headset. 30-day perioperative complications were also assessed.</p><p><strong>Results: </strong>A total of 41 MIS cases were performed by 3 attending surgeons and 4 trainees. The most common procedure was laparoscopic sleeve gastrectomy (N = 9, 22.0%). Open-source software enabled simultaneous viewing of up to 3 virtual displays that could be individually positioned in the surgeon's visual field. The mean NASA-TLX score for all participants was 22.3 ± 4.7, indicating a low perceived intraoperative workload. There was no significant difference in NASA-TLX scores between attending surgeons and trainees (19.8 ± 5.3 vs 24.8 ± 3.0, p = .23). There were no intraoperative complications; 30-day morbidity and mortality were 0%.</p><p><strong>Conclusion: </strong>This study serves as a proof of concept for the use of an augmented reality headset in minimally invasive general surgery.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609602","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":"Pediatric hepatic hydatid cysts: recurrence risk factors following laparoscopic surgery-a 16-year cohort analysis.","authors":"Marwa Messaoud, Amani N Alansari, Radhouene Ben Salah, Sami Sfar, Basma Haggui, Amine Ksia, Mongi Mekki, Lassaad Sahnoun","doi":"10.1007/s00464-025-11965-1","DOIUrl":"https://doi.org/10.1007/s00464-025-11965-1","url":null,"abstract":"<p><strong>Background: </strong>Recurrence of hepatic hydatid cysts after laparoscopic surgery poses a significant challenge in pediatric patients. The administration of albendazole therapy pre- and post-operatively is proposed to reduce recurrence rates, yet its impact requires further investigation. This study aims to identify predictive factors associated with recurrence of hepatic hydatid cysts in children following laparoscopic surgery, focusing on cyst characteristics and perioperative albendazole therapy.</p><p><strong>Methods: </strong>A retrospective cross-sectional analytical study was conducted using medical records of pediatric patients under 16 years of age who underwent laparoscopic surgery for hepatic hydatid cysts between 2006 and 2021. Collected data included patient demographics, cyst characteristics (size, location, and number), preoperative and postoperative albendazole therapy, surgical duration, and intraoperative complications. Logistic regression analysis was used to identify factors associated with cyst recurrence during the follow-up period, with statistical significance set at p < 0.05.</p><p><strong>Results: </strong>A total of 152 pediatric patients were included, with a mean age of 7.9 ± 3.3 years. The recurrence rate was 12% (n = 18). In multivariate analysis, longer surgical duration (HR = 1.02; 95% CI 1.00-1.03; p = 0.013) and cysts located outside liver segment II (HR = 0.11; 95% CI 0.01-0.9; p = 0.039) were independently associated with recurrence. Albendazole therapy, administered pre- or post-operatively, was more frequent in the non-recurrence group but did not reach statistical significance. No cases of peritoneal hydatidosis were recorded during follow-up.</p><p><strong>Conclusion: </strong>Key predictors of post-laparoscopy recurrence included extended surgical duration and cyst location. Although perioperative albendazole therapy was more frequent in the non-recurrence group, it did not reach statistical significance in reducing recurrence rates. These findings highlight the importance of tailored surgical approaches and careful postoperative monitoring to improve patient outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609604","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":"Automatic recognition of surgical phase of robot-assisted radical prostatectomy based on artificial intelligence deep-learning model and its application in surgical skill evaluation: a joint study of 18 medical education centers.","authors":"Xue Zhao, Shin Takenaka, Shuntaro Iuchi, Daichi Kitaguchi, Masashi Wakabayashi, Kodai Sato, Shintaro Arakaki, Kimimasa Sasaki, Norihito Kosugi, Nobushige Takeshita, Nobuyoshi Takeshita, Shinichi Sakamoto, Tomohiko Ichikawa, Masaaki Ito","doi":"10.1007/s00464-025-11967-z","DOIUrl":"https://doi.org/10.1007/s00464-025-11967-z","url":null,"abstract":"<p><strong>Background: </strong>Surgical proficiency influences surgical quality and patient outcomes in robot-assisted radical prostatectomy (RARP). Manual video evaluations are labor-intensive and lack standardized objective metrics. Herein, we aimed to develop an artificial intelligence (AI) deep-learning model that can identify the surgical phases in RARP videos and create a parameter-based scoring system to distinguish experts from novice surgeons based on the results of the AI model.</p><p><strong>Methods: </strong>A dataset of 410 RARP videos from 18 Japanese medical institutions was analyzed. The videos were annotated into 11 phases and divided into training and testing sets. Surgeons were categorized as experts or novices based on their RARP experience. We developed a deep-learning-based surgical phase classification model and compared the phase duration, number of transitions between phases, and AI confidence scores (AICS) between the groups based on the model's output. Key parameters were standardized and identified using stepwise multivariate logistic regression. A surgical skill scoring system was constructed based on the receiver operating characteristic curve cut-off values.</p><p><strong>Results: </strong>Of the 213 videos, 99 were used for training, 20 for validation, and 94 for testing (61 experts and 33 novices). The model achieved an accuracy of 0.89 in identifying surgical phases. The experts had significantly shorter durations in phases 2-8 and higher AICS than the novices. Stepwise analysis identified phases 2 (Retzius space expansion), 7 (dorsal venous complex incision, apex treatment, hemostasis), and 8 (urethrovesical anastomosis) and the AICS as key predictors of expertise. The scoring system developed from these variables effectively distinguished experts from novices with an accuracy of 86.2%.</p><p><strong>Conclusions: </strong>The developed AI model revealed that the duration of several surgical phases and AICS are key parameters in assessing surgical skill proficiency in RARP. The new scoring system established based on these indicators reliably differentiates expert from novice surgeons.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609666","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":"Anastomotic leakage following robot-assisted minimally invasive esophagectomy (RAMIE): which anastomosis should be preferred?","authors":"Marco Milone, Cezanne D Kooij, Michele Manigrasso, Lucas Goense, Marc J van Det, Ewout A Kouwenhoven, Suzanne S Gisbertz, Beat P Müller, Philipp Lingohr, Takeo Fujita, Hans F Fuchs, Christiane J Bruns, Dolores T Krauss, Jan W Haveman, Boudewijn van Etten, Daniel Perez, Jan-Hendrik Egberts, Paul Turner, Guillaume Piessen, Frank Benedix, Peter P Grimminger, Luca Bellaio, Vladimir J Lozanovski, Giovanni Ferrari, Anne Mourregot, Philippe Rouanet, Jens-Peter Hölzen, Mazen A Juratli, Andreas Pascher, Arul Immanuel, James D Luketich, Nicholas Baker, Gijs I van Boxel, Tomas Harustiak, Hecheng Li, Michal Hubka, Zhigang Li, Paolo Strignano, Richard van Hillegersberg, Jelle P Ruurda","doi":"10.1007/s00464-025-11977-x","DOIUrl":"https://doi.org/10.1007/s00464-025-11977-x","url":null,"abstract":"<p><strong>Background: </strong>The optimal technique for intrathoracic esophagogastric anastomosis in esophagectomy remains undetermined. This study evaluates different anastomotic techniques in robot-assisted minimally invasive esophagectomy (RAMIE) and their impact on anastomotic leakage rates.</p><p><strong>Materials and methods: </strong>This observational, retrospective, comparative cohort study analyzed data obtained from the Upper GI International Robotic Association (UGIRA) Esophageal Registry. All consecutive patients with a histologically proven esophageal malignancy who underwent RAMIE with intrathoracic esophagogastrostomy were included. The anastomotic technique was performed based on the clinical judgement and expertise of each individual surgeon. For comparison, the four most common techniques were included: circular end-to-side, linear side-to-side, handsewn end-to-side, and handsewn end-to-end. The primary endpoint of this study was the occurrence of anastomotic leakage, defined by the Esophagectomy Complications Consensus Group as a full-thickness gastrointestinal defect involving the esophagus, anastomosis, staple line, or conduit, regardless of its presentation or method of identification.</p><p><strong>Results: </strong>Between 2016 and September 2023, 1518 patients were included. Univariable analysis demonstrated that the linear stapled side-to-side anastomosis was associated with the lowest anastomotic leakage rate (14.0%), while the handsewn end-to-end anastomosis had the highest (32.8%) (p < 0.001). The anastomotic leakage rates for circular end-to-side and handsewn end-to-side anastomoses were 19.4% and 26.9%, respectively. Multivariable analysis confirmed that anastomotic technique was independently associated with anastomotic leakage. Specifically, handsewn anastomoses were associated with a higher risk of anastomotic leakage for both end-to-side (OR 1.675, 95% CI 1.195-2.348, p = 0.003) and end-to-end (OR 2.181, 95% CI 1.403-3.390, p < 0.001) techniques compared to circular end-to-side anastomoses.</p><p><strong>Conclusions: </strong>In RAMIE, linear side-to-side and circular end-to-side stapled anastomoses are associated with lower anastomotic leakage rates compared to handsewn techniques. While acknowledging the multifactorial complexity of anastomotic leakage, these findings favor the use of mechanical stapling in clinical practice.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609664","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":"Comparing robotic to open retromuscular ventral hernia repair: a multi-center propensity-matched analysis.","authors":"Daphne Remulla, Aldo Fafaj, Xinyan Zheng, Kimberly P Woo, William C Bennett, Alvaro Carvalho, Brianna L Slatnick, Diego L Lima, Kimberly S Miles, Benjamin T Miller, David M Krpata, Clayton C Petro, Ajita S Prabhu, Michael J Rosen, Lucas R Beffa","doi":"10.1007/s00464-025-11922-y","DOIUrl":"https://doi.org/10.1007/s00464-025-11922-y","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic retromuscular ventral hernia repair (r-RVHR) may benefit patients by converting an open surgery (o-RVHR) to a minimally invasive approach. Current comparative trials are limited by small patient cohorts and exploratory outcomes. This study compares short- and long-term outcomes of robotic versus open retromuscular ventral hernia repairs using a nationwide registry.</p><p><strong>Methods: </strong>This propensity-matched analysis compared patients who underwent robotic or open ventral hernia repair with retromuscular mesh placement using Abdominal Core Health Quality Collaborative registry data (2014-2021). Groups were matched according to body mass index, Ventral Hernia Working Group classification, wound class, diabetes, smoking status, hernia width, and recurrent hernia repair. Primary outcome included hernia recurrence risk up to five years postoperatively evaluated two ways: 1) clinical/radiographic assessment only and 2) a pragmatic definition incorporating patient-reported bulging. Secondary outcomes included length of stay, wound morbidity, and patient-reported outcomes.</p><p><strong>Results: </strong>1228 r-RVHR patients were matched to 1228 o-RVHR patients. Robotic RVHR was associated with longer operative times (p < 0.001), reduced length of stay (1 vs 3 days; p < 0.001), 30-day surgical site infection rates (1.7% vs 3.4%; p = 0.013), and surgical site occurrences (SSO) requiring procedural intervention (1.9% vs 3.6%; p = 0.011), but higher overall SSO (16.4% vs 11.0%; p < 0.001). Robotic RVHR showed similar two-year pragmatic recurrence rates but higher recurrence risk after three years (HR 1.46, 95% CI 1.15-1.85, p = 0.002) with no difference in clinical recurrence risk. Transversus abdominis release and surgeon experience were independently associated with reduced recurrence risk regardless of surgical approach. At five years, r-RVHR patients reported worse quality of life scores (78 vs 90; p = 0.044). Both groups experienced significant follow-up attrition over time.</p><p><strong>Conclusion: </strong>Robotic RVHR is associated with improved early post-operative outcomes yet may be associated with higher long-term pragmatic recurrence rates compared to open RVHR. These findings require investigation through prospective randomized trials with robust long-term follow-up.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609601","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":"A comparison of high efficiency and traditional benign anorectal operating room days: a cohort study.","authors":"Alessandro Leonardo Ricci, Sunil Patel, Kelly Brennan, Vanessa Wiseman, Tyler McKechnie, Ameer Farooq","doi":"10.1007/s00464-025-11956-2","DOIUrl":"https://doi.org/10.1007/s00464-025-11956-2","url":null,"abstract":"<p><strong>Background: </strong>High efficiency (HE) operating rooms (OR) describe the intentional grouping of surgical cases according to case complexity, anesthetic, and nursing requirement. This approach has the potential to increase case volumes while protecting patient outcomes.</p><p><strong>Objective: </strong>Comparison of a HE to a Traditional model on surgical efficiency metrics, patient outcomes, and total costs in benign anorectal surgery.</p><p><strong>Methods: </strong>This single-center retrospective cohort study was conducted at a Canadian tertiary care academic center. Cases booked for the colorectal ambulatory surgical list during the pre-intervention (Traditional) phase spanning 2021-2022 were compared to the post-intervention (HE) phase implemented in 2023. The primary outcome of this study was surgical efficiency, defined as the number of cases completed per surgical list. Secondary outcomes included patient outcomes and hospital costs.</p><p><strong>Results: </strong>257 patients were included in this study (Traditional 125 cases in 24 OR lists, HE 132 cases in 19 OR lists). Mean age (Traditional 52.2 vs. HE 49.1, p = 0.130) and male sex (57.6% vs. 56.8%, p = 0.899) were similar between groups. In the HE phase, more benign anorectal cases were completed per day (5.2 cases vs. 6.9cases, p < 0.001). The HE model saved 13 min (72.0 min vs 59.7 min, p < 0.001) per case. This included a decrease in surgical time (26.8 min vs. 21.3 min, p = 0.069), anesthetic time (20.2 min vs. 16.3 min, p < 0.001), and turnover time (22.6 min vs.18.5 min, p < 0.001). Perioperative outcomes, such as total PACU time (87.3 min vs 103.2 min, p = 0.080) and time to discharge (72.8 min vs 82.5 min, p = 0.262), were similar between phases. A HE model resulted in cost savings of approximately $368.13 per case ($1575 vs. $1207, p = 0.0013).</p><p><strong>Conclusion: </strong>Implementation of a HE model resulted in more cases being completed, similar patient outcomes, and decreased costs of care. Adoption of this model should be considered for non-complex surgical procedures, especially in resource-limited settings.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609663","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}