Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Postoperative outcomes with minimally invasive minor hepatectomy based on ECOG performance status - analysis of multi-institutional database.","authors":"Parit T Mavani, Subir Goyal, Melissa E Hogg, Ashwin S Kamath, David A Iannitti, Kerri A Simo, W Scott Helton, Pablo E Serrano, Edwin O Onkeni, David A Geller, Patricio M Polanco, Kevin El-Hayek, Susanne G Warner, Sean P Cleary, Adnan Alseidi, Mohammad Y Zaidi, Maria C Russell, Felipe Maegawa, Kevin T Nguyen, Juan M Sarmiento, Shishir K Maithel, David A Kooby, Mihir M Shah","doi":"10.1007/s00464-025-12184-4","DOIUrl":"https://doi.org/10.1007/s00464-025-12184-4","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive liver resection (MILR) is associated with fewer postoperative complications compared to open liver resection. Eastern Cooperative Oncology Group (ECOG) performance status (PS) is a fast, reproducible patient selection tool used to guide therapy. We compared patient outcomes after MILR by ECOG PS.</p><p><strong>Methods: </strong>Non-cirrhotic patients undergoing MILR resection at one of 14 North American healthcare centers were identified from the Americas Minimally Invasive Liver Surgery (AMILES) database (2010-2024). Perioperative outcomes were compared between ECOG1 and ECOG2 patients. Multivariable analysis (MVA) was used to identify factors independently associated with postoperative complications.</p><p><strong>Results: </strong>Of 4,181 patients, 486 met our inclusion criteria. Median patient age was 62 years. Four-hundred twenty-eight patients (88.1%) were ECOG1. Overall postoperative complication rate was not lower in ECOG 1 patients compared to ECOG 2 patients on univariate (20.3 vs. 29.1%, p = 0.17), and MVA (aOR 0.60, p = 0.14). Robotic versus laparoscopic approach (aOR 0.52, p = 0.03) and use of intraoperative ablation versus no ablation (aOR 0.38, p = 0.03) were associated with decreased odds of postoperative complications. Intraoperative conversion from MILR to open was associated with increased odds of postoperative complications (aOR 2.22, p = 0.04).</p><p><strong>Conclusion: </strong>In non-cirrhotic patients with ECOG2 performance status, minimally invasive minor liver resection may be considered with an acceptable complication rate similar to ECOG1 patients.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041415","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":"SAGES guidelines for the use of intraoperative imaging of the common bile duct.","authors":"Sunjay K Kumar, Dena G Shehata, Lawrence N Cetrulo, Romeo Ignacio, Jeffrey Chiu, Brain R Davis, Marian McDonald, Matthew B Bloom, Subhashini Ayloo, Ali Kchaou, Georgios Orthopoulos, Philip H Pucher, Uretz Oliphant, Peter T Hallowell, Federico Serrot, David Overby, Eduardo Moreno-Paquentin, Bethany J Slater, Emily Miraflor","doi":"10.1007/s00464-025-12142-0","DOIUrl":"10.1007/s00464-025-12142-0","url":null,"abstract":"<p><strong>Background: </strong>There are multiple intraoperative imaging techniques used to increase safety during laparoscopic cholecystectomy, including intraoperative cholangiography (IOC), fluorescence imaging (FI) with indocyanine green (ICG), and laparoscopic ultrasound (LUS). This guideline addresses the optimal intraoperative imaging technique during laparoscopic cholecystectomy for benign biliary disease.</p><p><strong>Methods: </strong>A systematic review was conducted to address five key questions regarding the use of intraoperative imaging of the common bile duct. These results were then presented to a panel of practicing surgeons who formulated recommendations based on the best available evidence.</p><p><strong>Results: </strong>Conditional recommendations were made in favor of performing IOC in adult and pediatric patients and doing so routinely rather than selectively, IOC rather than FI with ICG, and either IOC or LUS.</p><p><strong>Conclusions: </strong>These recommendations should provide guidance regarding the use of intraoperative imaging techniques during laparoscopic cholecystectomy. This guideline also identifies important areas where the future research should focus to strengthen the evidence base.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041354","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":"Analysis of the application value and safety of emergency enteroscopy in the treatment of patients with small bowel bleeding.","authors":"Liu Zhongcheng, Tang Chao, Chen Dongting, Wang Biyao, Guo Qin","doi":"10.1007/s00464-025-12134-0","DOIUrl":"https://doi.org/10.1007/s00464-025-12134-0","url":null,"abstract":"<p><strong>Background: </strong>To explore the value and safety of emergency enteroscopy (EES) in the treatment of patients with small bowel bleeding (SBB), and to analyze the etiological characteristics of SBB patients.</p><p><strong>Methods: </strong>We collected the clinical data of 157 patients who were diagnosed as SBB and underwent emergency enteroscopy in the Sixth Affiliated Hospital of Sun Yat-sen University from May 2021 to July 2023, analyzing the results of diagnosis and treatment, as well as the occurrence of complications and follow-up.</p><p><strong>Results: </strong>A total of 157 patients (119 males and 38 females) were included in the study, aged 7-83 (44.85 ± 17.86) years, and the disease duration was 1-9 (3.20 ± 2.20) days. There were 42 patients who underwent transoral enteroscopy, 29 patients who underwent transanal enteroscopy, and 86 patients who underwent both accesses. The diagnostic rate of EES was 90.4% (142/157). The etiology of SBB was small bowel ulcer (n  = 37, 23.60%), small bowel stromal tumor (n = 11, 7.00%), post-surgical anastomotic hemorrhage (n  = 20, 12.70%), vascular malformations (n = 23, 14.60%), diverticulum of the small bowel (n = 29, 18.5%), and hemangioma of the small bowel (n = 22, 14.0%). The median follow-up time of SBB patients was (16.38 ± 7.97) months with a range of 8-35 months.</p><p><strong>Conclusions: </strong>EES is safe and effective for the diagnosis of SBB and endoscopic treatment. The etiology of SBB is more common with small bowel ulcers, small bowel diverticula, vascular malformations, and hemangiomas.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041249","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":"Initial experience with a novel 2-mm needle-type intracorporeal assembly forceps for periareolar video-assisted thoracoscopic surgery.","authors":"Wei Wang, Shaowen Zhang, Ping Dong, Zhangfan Mao","doi":"10.1007/s00464-025-12177-3","DOIUrl":"https://doi.org/10.1007/s00464-025-12177-3","url":null,"abstract":"<p><strong>Background: </strong>Periareolar video-assisted thoracoscopic surgery (VATS) provides cosmetic advantages but poses technical challenges due to limited working space. The novel 2-mm needle-type intracorporeal assembly endoscopic forceps is designed to minimize incision size while retaining full surgical functionality. This study aimed to evaluate the feasibility, safety, and effectiveness of this novel endoscopic forceps in periareolar VATS.</p><p><strong>Methods: </strong>This single-center retrospective observational study included patients who underwent periareolar VATS using either the 2-mm forceps or a conventional 5-mm grasper between January and December 2024. Outcomes included operative time, complications, visual analog scale (VAS) pain scores at 1 week and 1 month, patient and observer scar assessment scale (POSAS) scores at 6 months, and surgeon feedback. Patients were stratified as follows: 2-mm group (n = 78; uniportal 45, biportal 33) and a historical 5-mm control (n = 37; all uniportal) from the same team under identical indications and perioperative protocols. Because the control contained only uniportal cases, all between-group comparisons were prespecified for the uniportal subset (2 mm: 45 vs. 5 mm: 37); 2-mm biportal cases were summarized descriptively.</p><p><strong>Results: </strong>A total of 115 periareolar VATS procedures were completed without severe complications or perioperative mortality. Instrument assembly and disassembly required 100 ± 28 s and 25 ± 11 s, respectively. The needle-type puncture sites required no suturing and showed minimal-to-virtually no scarring at follow-up. In the uniportal subset, the 2-mm group had significantly lower POSAS totals and early VAS scores than the 5-mm group, with comparable operative time and surgeon-reported difficulty. Three minor mammary gland injuries occurred overall (two in the 2-mm group and one in the 5-mm group), with no lasting sensory impairment.</p><p><strong>Conclusions: </strong>The novel 2-mm intracorporeal forceps is safe and effective for periareolar VATS, significantly enhancing cosmetic outcomes and surgical efficiency, suggesting broad clinical application potential.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041327","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 decade of impact: outcomes and insights from the SAGES ADOPT surgical education program.","authors":"Jonathan Dort, Erin Schwarz, Yong Choi, Alan Harzman, John Paige","doi":"10.1007/s00464-025-12139-9","DOIUrl":"https://doi.org/10.1007/s00464-025-12139-9","url":null,"abstract":"","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041284","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":"Preoperative chemotherapy reduces the accumulation of indocyanine green around colorectal liver metastases for use in fluorescence-guided surgery.","authors":"Okker D Bijlstra, Tom H Dijkhuis, Friso B Achterberg, Alexander Broersen, Jouke Dijkstra, Mats I Warmerdam, Rutger B Henrar, Jacobus Burggraaf, A Stijn L P Crobach, Rutger-Jan Swijnenburg, Peter J K Kuppen, Alexander L Vahrmeijer, J Sven D Mieog","doi":"10.1007/s00464-025-12034-3","DOIUrl":"https://doi.org/10.1007/s00464-025-12034-3","url":null,"abstract":"<p><strong>Background: </strong>Near-infrared fluorescence imaging using intravenously administered indocyanine green (ICG) improves colorectal liver metastases (CRLM) surgery by enhancing lesion detection and real-time tumor margin assessment. However, ICG accumulates in hepatocytes around CRLM with high variance between patients. This study evaluates the effects of tumor and patient characteristics on ICG accumulation using a standardized imaging and analysis workflow.</p><p><strong>Methods: </strong>This single-center study included patients with CRLM who received 10 mg of ICG intravenously 24 h before surgery. Resected lesions were sliced in 5-10-mm-thick sections and immediately imaged for standardized fluorescence analysis. Fluorescence parameters were compared based on chemotherapy treatment, tumor response, tumor size and superficiality, and degree of steatosis. Associations between the patient and tumor characteristics and fluorescence parameters were determined while correcting for confounders.</p><p><strong>Results: </strong>Thirty-two lesions from 32 patients were analyzed. Lesions from chemotherapy-pretreated patients exhibited a lower mean signal fluorescence intensity (MSFI, 0.23 vs. 0.65 a.u.; p = 0.002) and signal-to-background ratio (SBR, 2.28 vs. 6.08; p < 0.001) than lesions from patients without pretreatment. Tumor size correlated positively with MSFI (p = 0.003), SBR (p = 0.02), and maximum intensity (p < 0.001). After correcting for the other characteristics, chemotherapy showed statistically significant association with the fluorescence parameters. The tumor superficiality, degree of steatosis, and response to chemotherapy had no statistically significant associations with the fluorescence parameters.</p><p><strong>Conclusion: </strong>Neoadjuvant chemotherapy significantly lowers ICG accumulation around CRLM resulting in suboptimal contrast. To optimize fluorescence-guided surgery protocols for chemotherapy-pretreated patients, future research should focus on adjusting ICG dose and timing and exploring specific fluorescence tumor-targeting imaging agents.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041340","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":"Acclimatising with 3D virtual reality video improves simulator performance: initial findings of a randomised controlled feasibility trial.","authors":"T Shakir, G Lingam, N Francis, M Chand","doi":"10.1007/s00464-025-12153-x","DOIUrl":"https://doi.org/10.1007/s00464-025-12153-x","url":null,"abstract":"<p><strong>Introduction: </strong>The transition from traditional laparoscopy to robotic surgery marks a significant chage in surgical practice. An understated aspect of this transition may be the three dimensional (3D) view from the surgical console. This study hypothesises that acclimatisation with 3D virtual reality (VR) video may enhance robotic simulator performance in novice robotic surgeons.</p><p><strong>Methods: </strong>This feasibility randomised controlled trial (RCT) involved 18 participants, randomly assigned to either a 3D VR video group or a 2D video group. The 3D group viewed a procedural video on a VR headset, while the 2D group watched the same video on a standard laptop screen. Participants then performed the initial 4 introductory robotic simulator exercises. Primary outcomes included automated performance metrics (APMs) including instrument path length, completion time, penalty scores, and overall performance score. Secondary outcomes were perceived mental workload using the NASA Task Load Index (NASA TLX) and cybersickness rates.</p><p><strong>Results: </strong>The 3D VR group demonstrated significantly better performance across all primary outcome measures. Mean overall performance scores for 3D VR was 52.75, compared to 29.78 for 2D (p < 0.01) Mean instrument path length for the 3D VR group was 305.09 cm, compared to 413.72 cm for the 2D group (p < 0.01) The 3D VR group incurred fewer penalty scores, with a mean of -8.16 compared to-23.99 for the 2D group (p = 0.03). 3 participants (21.4%) reported mild cybersickness symptoms with VR, which were transient. No significant differences were observed in perceived mental workload between the groups.</p><p><strong>Conclusion: </strong>Acclimatisation with 3D VR video significantly enhances simulator performance among novice robotic surgeons, suggesting its potential integration into standard robotic surgery training protocols. Further studies with larger sample sizes and clinical settings are warranted to confirm these findings.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034167","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":"Aortic hemorrhage following anastomotic leakage after esophagogastric surgery before and after implementation of endoscopic vacuum therapy.","authors":"Lisanne M D Pattynama, Roos E Pouw, Berrie Meijer, Mark I van Berge Henegouwen, Suzanne S Gisbertz, Kak Khee Yeung, Jacques J Bergman, Wietse J Eshuis","doi":"10.1007/s00464-025-12029-0","DOIUrl":"https://doi.org/10.1007/s00464-025-12029-0","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic vacuum therapy (EVT) has been established as a safe and effective treatment for anastomotic leakage. While rare, major aortic hemorrhage has been reported as a severe complication potentially associated with EVT. However, significant hemorrhages have also been observed in patients with transmural defects in the upper gastrointestinal tract, without the use of EVT. This raises questions about the role of EVT as a direct cause of aortic hemorrhage.</p><p><strong>Methods: </strong>The objective of this study was to further investigate the incidence of major aortic hemorrhage in patients with anastomotic leakage following esophagectomy, both before and after the introduction of EVT. This case series included all patients who experienced an aortic hemorrhage after an anastomotic leak over an 11-year period (January 2013-December 2023). Patients were identified from a prospectively maintained database at Amsterdam UMC and were categorized into two groups: the pre-EVT period and the EVT period.</p><p><strong>Results: </strong>In the pre-EVT period, 355 patients underwent a transthoracic esophagectomy, with 62 (17%) developing anastomotic leakage. In the EVT period, 527 patients underwent the same procedure, with 83 (16%) anastomotic leakages. A total of 7 patients developed a major aortic hemorrhage: 5 in the pre-EVT period (12%) and 2 in the EVT period (2%).</p><p><strong>Conclusion: </strong>Although EVT has been proposed in literature as a potential cause of major aortic hemorrhage, our findings provide a more nuanced perspective. In this cohort, aortic hemorrhages tend to occur in case of severe mediastinitis, also without treatment with EVT.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030565","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":"Minimally invasive versus open pancreaticoduodenectomy for periampullary tumors: a systematic review and meta-analysis of randomized controlled trials.","authors":"Jie Zhang, Fang Chen, Gang Tang, Rui Chen, Rongxing Zhou","doi":"10.1007/s00464-025-12163-9","DOIUrl":"https://doi.org/10.1007/s00464-025-12163-9","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive pancreaticoduodenectomy (MIPD) is used more commonly, but this surge is mostly based on observational data. This meta-analysis aimed to compare the short-term outcomes between MIPD and open pancreaticoduodenectomy (OPD) using data collected from randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>We searched PubMed, Cochrane Library, Embase, and Web of Science databases for RCTs comparing MIPD and OPD published before December 10, 2024. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>A total of eight studies were included, including two studies evaluating robotic PD (RPD) and six studies evaluating laparoscopic PD (LPD). Although MIPD was associated with a longer operative time (MD, 49.90 min; 95% CI, 27.53, 72.27, P < 0.0001), patients may benefit from reduced blood loss (MD, - 96.55 mL; 95% CI, - 145.25, - 47.86, P = 0.0001), and shorter length of stay (MD, - 1.01 days; 95% CI, - 1.74, - 0.27, P = 0.007). There were no significant differences observed in readmission (RR, 1.04), 90-day mortality (RR, 1.13), overall morbidity (RR, 0.99), major complications (RR, 1.04), postoperative pancreatic fistula (RR, 0.98), postpancreatectomy hemorrhage (RR, 0.98), delayed gastric emptying (RR, 0.93), number of harvested lymph nodes (MD, 0.39), and R0 resection (RR, 1.00) between the groups. In addition, the subgroup results showed that both RPD (MD, -90.54 mL; 95% CI, - 125.39, - 55.69, P < 0.00001) and LPD (MD, - 100.64 mL; 95% CI, - 163.23, - 38.06, P = 0.002) reduced the intraoperative blood loss.</p><p><strong>Conclusions: </strong>Although some short-term outcomes were similar between MIPD and OPD, MIPD exhibited reduced intraoperative blood loss and shorter hospital stay. In the future, MIPD may become a safe and effective alternative to OPD.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034176","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":"Minimally invasive liver surgery for perihilar and intrahepatic cholangiocarcinoma: systematic review and meta-analysis of comparative studies.","authors":"Joey de Hondt, Maurice J W Zwart, Bas A Uijterwijk, George L Burchell, Burak Görgeç, Babs Zonderhuis, Geert Kazemier, Joris Erdmann, Marc G Besselink, Rutger-Jan Swijnenburg","doi":"10.1007/s00464-025-11900-4","DOIUrl":"https://doi.org/10.1007/s00464-025-11900-4","url":null,"abstract":"<p><strong>Background: </strong>The implementation of minimally invasive liver surgery (MILS) for perihilar (PHC) and intrahepatic cholangiocarcinoma (IHC) remains limited and a systematic review including only comparative studies of MILS versus the open approach is lacking. This systematic review and meta-analysis aimed to assess the safety and efficacy of minimally invasive surgery in patients with hilar and intrahepatic cholangiocarcinomas.</p><p><strong>Methods: </strong>Systematic review in the PubMed, Embase, and Cochrane databases for original studies comparing at least five patients undergoing MILS with open liver surgery for PHC and IHC. Meta-analysis included the primary outcomes of morbidity and mortality. Secondary outcomes included post-operative outcomes, recurrence, disease-free survival, and resection margins.</p><p><strong>Results: </strong>Overall, 37 comparative non-randomised studies with 4863 patients were included, of which 24% PHC and 76% IHC. In 21 studies, propensity score matching was performed. In total, 2106 laparoscopic, 75 robotic, and 2662 open procedures were analysed. The conversion rate was median 11.5% [IQR 10.0-12.5]. MILS probably resulted in reduced rates of major morbidity, 13.3% vs 18.8% (OR 0.75, 95%CI 0.62-0.90), mortality, 3.0% vs 4.5% (OR 0.69, 95%CI 0.49-0.97), and shorter hospital stay, 8.0 vs 10.9 days (MD -2.1, 95%CI -2.8 - -1.5). MILS resulted in higher rate of R0 resections in PSM cohort, 90.4% vs 81.4%, (OR 1.40, 95%CI 1.13-1.74) and better 3-year disease-free survival rate (49.9% vs 38.5%, HR_3-year 3.2, 95%CI 3.1-3.3). In the subgroup of 1180 patients in whom a hepatico-jejunostomy was performed (498 laparoscopic, 65 robotic, 617 open) MILS remained associated with reduced major morbidity, 20.9% vs 27.6% (OR 0.88, 95%CI 0.64-1.21) and resulted in better mortality, 4.2% vs 4.9% (OR 0.51, 95%CI 0.30-0.86), as compared to the open approach. Overall, the rate of biliary leakage was likely similar, 10.6% versus 11.7% (OR 0.83, 95%CI 0.52-0.77).</p><p><strong>Conclusion: </strong>This systematic review of non-randomised comparative studies suggests that MILS for PHC and IHC may result in a similar safety profile with benefits in patient recovery and oncological outcomes as compared to OLS. Prospective comparative studies, especially including robotic MILS, are warranted.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034190","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}