Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Feasibility of a standardized three-dose intravenous tranexamic acid protocol in bariatric surgery: a pilot study.","authors":"Paola Llamuca-Castro, Diego Lima, Arturo Estrada, Jason Xia, Yeisson Rivero-Moreno, Raquel Nogueira, Ya Zhou, Tiwalade Adediji, Joseph Vazzana, Diego Camacho, Jenny Choi, Erin Moran-Atkin","doi":"10.1007/s00464-026-13494-x","DOIUrl":"https://doi.org/10.1007/s00464-026-13494-x","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid (TXA) has been increasingly evaluated in bariatric surgery; however, heterogeneity remains in dosing and timing, and the feasibility of implementing a standardized multidose regimen in routine practice is not well established. This pilot study evaluated implementation of a standardized three-dose intravenous TXA protocol in metabolic bariatric surgery.</p><p><strong>Methods: </strong>This prospective, sequential-period pilot study included 1077 patients undergoing sleeve gastrectomy (SG), Roux-en-Y gastric bypass, or revisional surgery during alternating 3-month TXA and non-TXA periods. The primary outcome was feasibility, assessed by recruitment, protocol adherence, and completeness of 30-day outcome ascertainment. Postoperative bleeding, operative time (OT), length of stay (LOS), and thromboembolic events were evaluated exploratorily. Bleeding was assessed using Firth penalized logistic regression under intention-to-treat (ITT) and as-treated frameworks.</p><p><strong>Results: </strong>Of 1,122 patients screened, 1077 were enrolled (96.0%; 95% CI 94.7-97.1%). Overall adherence to period-assigned treatment was 94.5% (95% CI 93.0-95.8%); all patients initiating TXA completed the three-dose regimen, and 30-day outcome ascertainment was 100.0% (95% CI 99.7-100.0%). Clinically significant bleeding occurred in 1.46% of patients assigned to TXA periods vs. 2.84% assigned to non-TXA periods (p = 0.174). In ITT analysis, TXA allocation was not significantly associated with bleeding among SG patients (OR 0.55; 95% CI 0.10-2.53; p = 0.449), whereas anastomotic procedures had higher bleeding odds than SG (OR 5.41; 95% CI 1.86-18.64; p = 0.002). No treatment-by-procedure interaction was identified (p = 0.985). OT and LOS were similar between groups, and no 30-day thromboembolic events occurred.</p><p><strong>Conclusion: </strong>Implementation of a standardized three-dose intravenous TXA protocol was feasible within routine bariatric surgical practice, with high adherence and complete outcome ascertainment. Given the low bleeding event rate observed in this pilot, adequately powered studies are needed to determine whether TXA meaningfully reduces postoperative bleeding and whether its effect differs by procedure type.</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":"149128622","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":"Does ICG-NIRF cholangiography replace the critical view of safety in laparoscopic cholecystectomy? A prospective evaluation on biliary visualization dynamics and the impact of inflammation.","authors":"Kohei Mishima, Kazuya Hirukawa, Yuta Abe, Satoru Matsuda","doi":"10.1007/s00464-026-13438-5","DOIUrl":"https://doi.org/10.1007/s00464-026-13438-5","url":null,"abstract":"<p><strong>Background: </strong>While indocyanine green near-infrared fluorescence (ICG-NIRF) cholangiography is increasingly used to facilitate real-time biliary visualization, its ability to substitute for the Critical View of Safety (CVS) as a primary anatomical endpoint remains unclear. This study aimed to characterize the intraoperative dynamics of ICG-NIRF and evaluate the impact of acute cholecystitis (AC) on its reliability.</p><p><strong>Methods: </strong>In this prospective study of 96 consecutive patients (48 AC; 48 non-AC), biliary visualization was assessed at three milestones: T1 (dissection onset), T2 (CVS declaration), and T3 (pre-clipping). Patients received ICG (1.25 mg) at induction. Dissection followed the Tokyo Guidelines 2018 (TG18) framework using standardized subserosal-inner layer technique to achieve the CVS. The primary endpoint was the simultaneous visualization of the common bile duct (CBD), common hepatic duct (CHD), and cystic duct (CyD). Factors affecting visualization were analyzed using generalized estimating equations and multivariable regression.</p><p><strong>Results: </strong>CVS was achieved in 93.8% of cases, whereas simultaneous three-duct NIRF visualization was achieved in only 16.7% at T1, showing significant temporal improvement by T3 (46.9%; OR 4.61, p < 0.001). Multivariable analysis identified AC as the sole independent predictor of both CBD (OR 4.48, p = 0.016) and CHD (OR 3.80, p = 0.003) non-visualization at T3, with identification failure rates increasing stepwise with TG18 severity (p = 0.001).</p><p><strong>Conclusion: </strong>ICG-NIRF signals follow a dissection-dependent trajectory that is consistently attenuated by inflammation. Because the CVS provides anatomical certainty far beyond that of fluorescence alone, ICG-NIRF complements but does not replace the standardized dissection framework. In cases of severe AC, surgeons must prioritize meticulous surgical maneuvers over potentially unreliable fluorescence signals.</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":"149128541","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":"Role of extended venous thromboembolism prophylaxis in patients with colorectal neoplasia who underwent minimally invasive colorectal surgery within an enhanced recovery after surgery protocol.","authors":"Nouf AlMarzooqi, Laurence Robert, Liane S Feldman, Sender Liberman, Lawrence Lee","doi":"10.1007/s00464-026-13445-6","DOIUrl":"https://doi.org/10.1007/s00464-026-13445-6","url":null,"abstract":"<p><strong>Background: </strong>Patients with colorectal cancer are at increased risk of venous thromboembolism (VTE) due to malignancy-associated hypercoagulability and the physiologic stress of surgery. Current guidelines recommend extended-duration thromboprophylaxis for up to 28 days following major abdominal or pelvic cancer surgery. However, its effectiveness in patients managed by Enhanced Recovery After Surgery (ERAS) pathways is uncertain. This study evaluated the effectiveness of extended thromboprophylaxis after minimally invasive colorectal resection managed within a mature ERAS program in reducing clinically significant VTE.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including all adult patients undergoing elective minimally invasive colorectal resection for neoplasia at a high-volume Canadian academic centre between 01/2016 and 12/2024. Patients undergoing open surgery, emergency procedures, or receiving therapeutic anticoagulation were excluded. All patients received standard in-hospital thromboprophylaxis. Extended thromboprophylaxis with dalteparin 5000 U for 28 days post-discharge was provided at the physician's discretion before 03/2018 and was subsequently included in the ERAS protocol. The primary outcome was symptomatic post-discharge VTE within 30 days of surgery. Secondary outcomes included bleeding complications, length of stay, emergency department visits, and readmissions.</p><p><strong>Results: </strong>A total of 1043 included in the primary analysis after excluding inpatient VTE events (n=351 patients did not receive extended prophylaxis, n=692 received extended prophylaxis). The incidence of post-discharge VTE was 0.5% (6/1043). There was a higher incidence of VTEs in the -eDVTp group compared to the +eDVTp group [5/351(1.4%) vs. 1/692 (0.1%), p=0.010]. Post-discharge VTE was significantly higher in patients who did not receive extended prophylaxis compared with those who did (1.4% vs. 0.1%, p = 0.010). There were no significant differences in overall or clinically significant bleeding between groups.</p><p><strong>Conclusions: </strong>In patients undergoing minimally invasive colorectal resection within a mature ERAS pathway, the incidence of symptomatic post-discharge VTE is very low. Although extended thromboprophylaxis was associated with a statistically significant reduction in VTE events, the absolute risk reduction was small.</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":"149128587","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":"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}