Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Textbook outcome after robotic pancreatic enucleation: a two-center evaluation of an ideal perioperative pathway.","authors":"Marionna Cathomas, Zheng Li, Benedict Kinny-Köster, Bo Kong, Ingmar Rompen, Elias Gauer, Miriam Klauß, Christoph W Michalski, Martin Loos, Jin He, Thomas Hank","doi":"10.1007/s00464-026-13377-1","DOIUrl":"https://doi.org/10.1007/s00464-026-13377-1","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic pancreatic enucleation (rPE) has emerged as a parenchyma-sparing surgical approach for benign or low-grade malignant pancreatic lesions. However, standardized metrics to assess perioperative quality are lacking. This study aimed to propose an rPE-specific textbook outcome (rPE-TO) reflecting an ideal perioperative pathway and to evaluate its applicability in two independent institutional cohorts.</p><p><strong>Material and methods: </strong>Patients undergoing completed rPE at University Hospital Heidelberg, Germany, between April 2023 and March 2025 were analyzed, and the proposed rPE-TO was additionally evaluated in an independent institutional cohort from Johns Hopkins University, Maryland, USA. The rPE-TO comprised six components: no conversion to open surgery, no incomplete resection requiring reoperation, no clinically relevant postoperative pancreatic fistula (POPF), no major complications (Clavien-Dindo < IIIa, with POPF assessed separately), no readmission within 30 days, and no mortality within 90 days.</p><p><strong>Results: </strong>The Heidelberg cohort included 31 patients, of whom 20 (64.5%) achieved rPE-TO. Among the individual components, conversion to open surgery occurred in 4 patients (12.9%), incomplete resection requiring reoperation in 1 (3.2%), POPF in 6 (19.4%), major complications in 2 (6.5%), and 30-day readmission in 2 (6.5%); no 90-day mortality occurred. In the Johns Hopkins cohort (n = 48), rPE-TO was achieved in 29 patients (60.4%). Despite comparable overall rPE-TO rates, the distribution of individual failure components differed between institutions. In addition, length of hospital stay was shorter among patients achieving rPE-TO in both cohorts.</p><p><strong>Conclusion: </strong>Textbook outcome was achieved in approximately two thirds of patients undergoing rPE in both institutional cohorts. The proposed rPE-TO integrates established perioperative quality measures with procedure-specific outcomes and may provide a composite measure for assessing an ideal perioperative pathway after robotic pancreatic enucleation.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128607","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":"Feasibility and safety of cap-assisted endoscopic mucosal resection compared with endoscopic submucosal dissection for gastric adenocarcinoma of the fundic gland type.","authors":"Yuki Kano, Hiroshi Yamazaki, Takashi Sawada, Hideyuki Miyauchi, Keisuke Kohari, Hosyu Kurebayashi, Rikimaru Sawada, Yu Sato, Myuzen Kanamori, Toshifumi Iida, Susumu Banjoya, Tomoya Kimura, Koichi Furuta, Nao Takeuchi, Yoshiaki Kimoto, Kohei Ono, Yohei Minato, Eiji Sakai, Hideyuki Chiba, Satoshi Asai, Ken Ohata","doi":"10.1007/s00464-026-13457-2","DOIUrl":"https://doi.org/10.1007/s00464-026-13457-2","url":null,"abstract":"<p><strong>Background and aim: </strong>Gastric adenocarcinoma of the fundic gland type (GA-FG) is a rare gastric cancer subtype, usually located in the upper stomach and accompanied by submucosal invasion. Although endoscopic submucosal dissection (ESD) is the standard treatment, it is challenging in this location. Cap-assisted endoscopic mucosal resection (EMRC) may represent a simpler alternative; however, its efficacy and safety for GA-FG remain unclear. We therefore assessed the feasibility, safety, and histological resection depth of EMRC for GA-FG, vs. ESD.</p><p><strong>Methods: </strong>This single-center retrospective study included consecutive patients with histologically confirmed GA-FG measuring < 10 mm. They underwent ESD between August 2013 and February 2023 or EMRC between February 2023 and July 2025. Clinical outcomes, pathological findings, and delayed adverse events were compared. The distance from the muscularis mucosae to the deepest resection margin and the proportion of submucosal tissue in the resected specimens were also evaluated in the EMRC group.</p><p><strong>Results: </strong>We analyzed 94 lesions (ESD: n = 54, EMRC: n = 40). En bloc resection was achieved in all cases. The median procedure time was significantly longer for ESD vs. EMRC (25.0 vs. 6.0 min, P < 0.01), as was hospitalization length (7.0 vs. 5.0 days, P < 0.01). There were no significant differences between the groups regarding vertical margin status or adverse events. All EMRC specimens contained submucosal tissue, with a median resection depth of 817.5 μm (interquartile range 526.6-1768.4). Treatment modality was determined according to the treatment period (ESD before February 2023 and EMRC thereafter), which may have introduced temporal and selection bias.</p><p><strong>Conclusions: </strong>For GA-FG lesions measuring < 10 mm, EMRC appears to be a promising treatment option, providing adequate submucosal resection depth while reducing procedure and hospitalization time.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128562","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":"Correction: Laparoscopic central hepatectomy: Feasibility and safety.","authors":"Tiing-Foong Siow, Chiung-Hui Hsieh, U-Chon Chio, Fu-Shan Jaw, Jiann-Ming Wu, Kuo-Hsin Chen","doi":"10.1007/s00464-026-13484-z","DOIUrl":"https://doi.org/10.1007/s00464-026-13484-z","url":null,"abstract":"","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128560","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":"Bilateral external oblique intercostal block combined with intravenous patient-controlled analgesia for multimodal analgesia after laparoscopic cholecystectomy: a single-center randomized controlled trial.","authors":"Shiyou Wei, Jianmang Yu, Junyi Huang, Zhixiong Xiang, Jiong Song, Xin Lv, Xionggang Li","doi":"10.1007/s00464-026-13498-7","DOIUrl":"https://doi.org/10.1007/s00464-026-13498-7","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain after laparoscopic cholecystectomy (LC) remains common and peaks within 24 h. Opioid-based analgesia improves pain but can delay recovery, prompting opioid-sparing regional techniques within ERAS pathways.</p><p><strong>Objective: </strong>To evaluate whether adding bilateral ultrasound-guided external oblique intercostal plane block (EOIB) to standard intravenous patient-controlled analgesia (PCA) improves early analgesia and recovery after elective LC.</p><p><strong>Methods: </strong>In a prospective, single-centre, randomized controlled parallel trial, 56 patients were randomized (1:1) to receive bilateral EOIB (n=28) or no regional block (control, n=28). All patients received standardised anesthesia and PCA with butorphanol. The primary outcome was total butorphanol consumption within 24 h postoperatively. Secondary outcomes included pain scores, Quality of Recovery at 24 h, time to first flatus, nausea and vomiting, intraoperative haemodynamic events, and length of hospital stay.</p><p><strong>Results: </strong>EOIB significantly reduced 24 h butorphanol consumption [median 3.7 (IQR 3.2-4.8) mg vs. 7.2 (6.2-7.6) mg, equivalent to 18.5 vs. 36.0 mg intravenous morphine]. After adjustment, opioid consumption was 46.5% lower (95% CI 38.3-53.6; P<0.001). EOIB also increased QoR-15 at 24 h (median 140 vs. 131; P<0.001) and shortened time to first flatus (median 18 vs. 20 h; P=0.031). Cough-pain VRS scores were lower with a significant group-by-time interaction (P=0.013). Intraoperative haemodynamics did not differ, and PONV was numerically lower without statistical significance.</p><p><strong>Conclusion: </strong>Bilateral EOIB with standard PCA provides clear opioid-sparing effects after LC without increasing safety risks.</p><p><strong>Study registration: </strong>ClinicalTrials.gov, NCT07332546.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128606","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":"Association of surgical strategy guided by Wu's classification with surgical outcomes in left-sided hepatocellular carcinoma patients with frailty.","authors":"Tianyang Mao, Dingxian Feng, Qingyun Xie, Xin Zhao, Hong Wu, Fengwei Gao, Ting Zhang","doi":"10.1007/s00464-026-13415-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13415-y","url":null,"abstract":"<p><strong>Background: </strong>Frailty often indicates a poor prognosis after hepatectomy. This study aims to compare the short-term and long-term prognostic impacts of the Wu's classification group and the traditional group in treating left-sided hepatocellular carcinoma patients with frailty.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 258 patients with left-sided hepatocellular carcinoma with frailty from 2009 to 2021, who were divided into a Wu's classification group and a traditional group based on surgical approach. Propensity score matching (PSM, 1:1) was used to minimize baseline differences and reduce selection bias. Perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS) were evaluated. Kaplan-Meier survival analysis was performed to compare OS and RFS between the two groups, and Cox regression models were applied to identify independent prognostic factors.</p><p><strong>Results: </strong>A total of 258 patients were included in the analysis cohort. Among them, 104 patients were assigned to the Wu's classification group, and 154 patients to the traditional group. After PSM, 186 patients were matched, with 93 patients in each group. The Wu's classification group demonstrated significantly lower intraoperative blood loss (P < 0.001), blood transfusion rate (P = 0.018), incidence of Clavien-Dindo grade ≥ 3 complications (P = 0.014), postoperative hospital stay (P < 0.001), and hospitalization costs (P = 0.035) compared with the traditional group. No significant difference in RFS was observed between the two groups, while the Wu's classification group demonstrated significantly higher OS (P = 0.004). Hospital frailty risk score (HR = 1.672, 95% CI 1.498-1.866, P < 0.001) were independent risk factors for OS.</p><p><strong>Conclusions: </strong>Wu's classification-guided surgical strategy is associated with anatomical resection, less invasiveness, fewer postoperative complications, lower medical costs, and longer long-term survival among frail patients with left-sided HCC.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115105","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":"Access without excess: a comparison of wound infections with disposable versus hybrid trocars in minimally invasive inguinal hernia repairs.","authors":"Kimberly P Woo, Ali Alipouriani, Abby Gross, William C Bennett, Jenny H Chang, Alvaro Carvalho, Daphne Remulla, Kayleigh Risser, Nikhila Yerabandi, Li-Ching Huang, Alberto Arezzo, Vittoria Bellato, Myrthe M Eussen, Maggie Hodges, Sheetal Nijhawan, Marina Yiasemidou, Kimberly S Miles, Patricia Sylla, Shaneeta M Johnson, Lucas R Beffa, Clayton C Petro, Ajita S Prabhu, David M Krpata, Michael J Rosen, Benjamin T Miller","doi":"10.1007/s00464-026-13408-x","DOIUrl":"https://doi.org/10.1007/s00464-026-13408-x","url":null,"abstract":"<p><strong>Introduction: </strong>Operating rooms generate 70% of hospital waste. Transitioning from disposable to reusable devices could mitigate surgical waste. Partially reusable, or hybrid, trocars can be used for minimally invasive surgery (MIS), but perceptions of increased infection risk may drive preferences toward disposable trocars. However, no data substantiates this risk. Our analysis of a national hernia outcomes database investigates this presumed association.</p><p><strong>Methods: </strong>Using the abdominal core health quality collaborative (ACHQC), we identified high-volume inguinal hernia surgeons who used only disposable trocars for laparoscopic inguinal hernia repair (IHR) and hybrid trocars for robotic IHR. These two surgical approaches served as surrogates to evaluate differences between disposable and hybrid trocars. We performed a query of the ACHQC to identify patients who underwent elective MIS IHR with mesh between 2017 and 2023 by one of the previously identified surgeons.</p><p><strong>Results: </strong>A total of 34,638 patients met inclusion criteria. After propensity score matching, there were 1191 patients in each group. There was no difference in rates of surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), readmission or reoperation between the two groups. There was a statistically significant higher rate of surgical site occurrence (SSO) in the disposable trocar group (5% vs. 2%, p = 0.003). This was driven by a significantly higher rate of hematomas (12% vs 38%, p = 0.007).</p><p><strong>Conclusion: </strong>This study did not find an increased risk of SSI associated with hybrid trocars compared to disposable trocars for MIS inguinal hernia repairs. To decrease surgical waste, surgeons should consider the use of hybrid trocars for laparoscopic surgery.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115096","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":"CT-derived muscle quality predicts recurrence following ventral incisional hernia repair.","authors":"Kai-Hsing Chang, Chi-Chuan Yeh","doi":"10.1007/s00464-026-13176-8","DOIUrl":"https://doi.org/10.1007/s00464-026-13176-8","url":null,"abstract":"<p><strong>Purpose: </strong>Incisional hernia repair is challenging because of its high recurrence rate. However, the impact of sarcopenia on the outcomes of incisional hernia remains controversial. This study aimed to investigate the clinical effects of computed tomography (CT)-derived muscle quality in patients who underwent incisional hernia repair.</p><p><strong>Methods: </strong>Clinical data and images of patients who underwent ventral incisional hernia repair between 2016 and 2018 at a university-based tertiary referral center were retrospectively collected. Muscle quality was assessed via CT using the hounsfield unit average calculation (HUAC), total psoas index (TPI), and indexed psoas muscle area (PMAi). The primary outcome was the association between hernia recurrence and CT-derived muscle quality, while the secondary outcome compared the different muscle quality assessment methods in detecting incisional hernia recurrence.</p><p><strong>Results: </strong>A total of 105 patients were included, with a recurrence rate of 30.5% (32/105). Adjusting for diabetes mellitus, surgery method, mesh position, hernia width, and all three methods for determined muscle quality, Multivariate analysis identified HUAC L3 without contrast (cutoff ≤ 20.1) as an independent predictor of recurrence (p = 0.035). Kaplan-Meier analysis revealed significantly different recurrence-free survival based on the HUAC cutoff (p = 0.017), whereas TPI and PMAi showed no significant association with incisional hernia recurrence (p > 0.05).</p><p><strong>Conclusion: </strong>CT-derived muscle quality (HUAC ≤ 20.1 on non-contrast CT at the L3 level) was potentially associated with incisional hernia recurrence. HUAC was superior to TPI and PMAi as a surrogate for muscle quality.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115113","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":"Laparoscopy as the initial approach for hemodynamically stable abdominal stab wounds requiring exploration: a South African single-center experience.","authors":"Modise Zacharia Koto, Oleh Yevhenovych Matsevych, Lehlogonolo David Mashego, Tebogo Koto, Lerumo Evans Motla, Sifiso Flax Derrick Mthembu, Lorato Natasha Koto, Imraan Ismail Sardiwalla, Neha Kumar, Matlou Ernest Mabitsela","doi":"10.1007/s00464-026-13428-7","DOIUrl":"https://doi.org/10.1007/s00464-026-13428-7","url":null,"abstract":"<p><strong>Background: </strong>The role of laparoscopy in penetrating abdominal trauma remains debated, and its adoption varies widely, largely due to concerns regarding missed injuries and the need for advanced laparoscopic expertise. We report our single-center experience using laparoscopy for hemodynamically stable patients with abdominal-region stab wounds with an indication for operative exploration (peritonitis, evisceration, or CT findings).</p><p><strong>Methods: </strong>We performed a retrospective analysis of data from a single-center trauma unit over a 23-month period. Patients with abdominal-region stab wounds meeting operative criteria and managed with laparoscopic exploration were included.</p><p><strong>Results: </strong>Of 170 patients with abdominal stab wounds, 10 (5.9%) were hemodynamically unstable and underwent immediate laparotomy. Of the remaining 160 stable patients, 19 (11.9%) were successfully managed non-operatively. Laparoscopic exploration was performed in 141 patients; 4/141 (2.8%) required conversion to laparotomy. The final laparoscopic cohort comprised 137 patients. The mean ISS was 10.1 (range 9-18). Diagnostic laparoscopy was performed in 14 patients (10.2%), and therapeutic laparoscopy in 123 (89.8%). Mean length of stay was one day (range 1-2) for diagnostic and 4.6 days (range 1-20) for therapeutic laparoscopy. There were no missed injuries. Complications (Clavien-Dindo III-V) occurred in 8.8% of patients, and 30-day mortality was 0.7%.</p><p><strong>Conclusion: </strong>Laparoscopy is feasible for hemodynamically stable patients with abdominal-region stab wounds who require surgical exploration, with favorable outcomes in this series. Laparoscopy should be considered the initial operative approach in centers with appropriate expertise and resources. The range of therapeutic interventions and the threshold for conversion to laparotomy should be individualized based on the surgeon's experience, institutional capabilities, and equipment availability.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115149","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":"Ruling the robot: a phase-based analysis of resident autonomy across core robotic general surgery procedures.","authors":"Arjun N Patel, Georgia Lydon, Thomas Allen, Stephen Fann, Bruce Crookes, Mary K Bryant, William P Lancaster, Rana Pullatt, Heather L Evans, Douglas J Cassidy","doi":"10.1007/s00464-026-13439-4","DOIUrl":"https://doi.org/10.1007/s00464-026-13439-4","url":null,"abstract":"<p><strong>Background: </strong>Robotic surgery has become foundational in general surgery training, yet limited data exist on resident participation in core robotic procedures. This study assessed resident involvement in robotic cholecystectomies and inguinal hernia repairs (IHR) across operative phases and postgraduate year to characterize how participation evolves throughout training.</p><p><strong>Methods: </strong>A retrospective review of robotic cholecystectomies and unilateral IHR performed over a single academic year at one tertiary academic institution was conducted using My Intuitive App case logs. Cholecystectomies were divided into three phases (dissection, clipping, removal) and IHR into two phases (dissection, reconstruction). Resident participation was quantified for each phase and the overall case. Differences by postgraduate year were assessed using one-way ANOVA, junior (PGY2/3) versus senior (PGY4/5) comparisons using two-sample t-tests, and inter-phase participation using repeated measures ANOVA.</p><p><strong>Results: </strong>151 robotic cholecystectomies and 101 robotic unilateral IHR performed by seven surgeons met inclusion criteria. Resident participation in cholecystectomy measured 50.7% (dissection), 90.5% (clipping), 89.4% (removal), and 72.1% (overall) compared to attending surgeons. For IHR, participation measured 44.8% (dissection), 72.5% (reconstruction), and 57.4% (overall). Across postgraduate years, significant differences in participation were identified in the cholecystectomy dissection (p < 0.001), clipping (p = 0.001), and overall case (p < 0.001), but not the removal phase (p = 0.077). For IHR, significant differences were identified across all phases (p < 0.001). Senior residents participated significantly more than junior residents across all phases for both procedures. In both case types, resident participation in the dissection phase significantly lagged behind all other phases regardless of postgraduate year.</p><p><strong>Conclusion: </strong>Resident participation in robotic cholecystectomy and IHR varies significantly by operative phase and training level. Dissection consistently represents the phase of lowest resident involvement, while senior residents demonstrate greater autonomy across all phases. These findings underscore the importance of phase-level operative data in understanding resident progression and informing competency-based surgical training.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115203","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 efficacy and safety of hybrid versus conventional endoscopic submucosal dissection for non-ampullary duodenal submucosal tumors.","authors":"Shao-Bin Luo, Li Wang, Ji-Yuan Zhang, Yi-Fan Qu, Quan-Lin Li, Ping-Hong Zhou, Zu-Qiang Liu","doi":"10.1007/s00464-026-13245-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13245-y","url":null,"abstract":"<p><strong>Background and aims: </strong>Hybrid endoscopic submucosal dissection (H-ESD) is established to be curable and safe for colorectal submucosal tumors (SMTs). We aimed to evaluate the feasibility and safety of H-ESD and conventional ESD (C-ESD) for non-ampullary duodenal SMTs (NAD-SMTs).</p><p><strong>Methods: </strong>From September 2017 to December 2024, patients with NAD-SMTs treated with H-ESD or C-ESD at the Endoscopy Center of Zhongshan Hospital were retrospectively analyzed. After propensity score matching (PSM), baseline characteristics, clinical outcomes, and follow-up were retrospectively analyzed.</p><p><strong>Results: </strong>With similar baseline characteristics between the two groups after PSM, the H-ESD group had a shorter procedural duration (41 vs. 67 min, P < 0.001) compared to the C-ESD group. The en bloc resection rates were 93.8 and 92.2%, and the R0 resection rates were 90.6 and 89.1%, respectively. Although there was no statistically significant difference, the H-ESD group had a lower overall adverse event (AE) rate. The H-ESD group had 1 case of abdominal effusion and 1 case of febrile episode, whereas the C-ESD group had 2 cases of intraprocedural bleeding, 1 case of intraoperative muscle layer injury, 1 case of pneumoperitoneum, 1 case of delayed bleeding, and 1 case of abdominal effusion. During the median follow-up period, no recurrence occurred in the H-ESD group, while one local recurrence was detected in the C-ESD group.</p><p><strong>Conclusions: </strong>Both H-ESD and C-ESD were safe and effective for NAD-SMTs; however, H-ESD resulted in a reduced procedure time without increasing the occurrence of AEs compared with C-ESD. Therefore, H-ESD may be recommended as a treatment for NAD-SMTs.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115066","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}