Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Risk factors for ileus after enhanced recovery robotic colectomy mediated by postoperative opioids: a single institution analysis.","authors":"Erin Sheehan, Kara K Brockhaus, Marianne Huebner, Wenjuan Ma, Nivya Kolli, Robert K Cleary","doi":"10.1007/s00464-025-11752-y","DOIUrl":"10.1007/s00464-025-11752-y","url":null,"abstract":"<p><strong>Background: </strong>Postoperative ileus (POI) after colorectal surgery is associated with prolonged hospital length of stay, readmission, and higher costs of care. POI may be unpredictable and even uncomplicated enhanced recovery elective minimally invasive colorectal operations may be complicated by ileus and readmission related to ileus. Determining if there are modifiable factors associated with ileus may suggest quality improvement interventions designed to decrease ileus. The aim of this study was to identify patient characteristics associated with ileus and the relationship with postoperative opioids.</p><p><strong>Methods: </strong>This is a single institution retrospective analysis of robotic right and left colectomy in a prospectively maintained institutional colorectal surgery database from 1/1/2018 to 7/31/2024. The primary outcome was postoperative ileus. Mediation analysis was used to examine the association of patient factors with ileus mediated by postoperative opioids.</p><p><strong>Results: </strong>There were 394 left and 267 right colectomies that met inclusion criteria. Neoplasia was the operative diagnosis for 89.5% of right colectomies and diverticular disease for 78.7% of left colectomies (p < 0.001). Median postoperative hospital length of stay was 2.0 days. Ileus occurred in 5.6% of the patient population. An analysis with postoperative opioids (intravenous or oral) as mediating variable showed that postoperative opioids were associated with ileus (OR 2.83, CI 1.18-14.67). While older patients had less opioid requirements (OR 0.96, CI 0.95-0.98), the risk of ileus (OR 1.03, CI 1.00-1.06) was the same for older patients with and without opioids. A decrease in opioid prescriptions at discharge was seen over time (p < 0.001).</p><p><strong>Conclusion: </strong>Postoperative opioids were the only modifiable risk factor for ileus after robotic segmental colectomy. The risk of ileus for other factors associated with ileus did not increase when opioids were added postoperatively. Considering other opioid-sparing enhanced recovery pathway options and increased adoption of the minimally invasive surgical approach may lessen this vexing postoperative complication.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3727-3736"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035086","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":"R1 Endoscopic papillectomy for adenocarcinoma: is complementary pancreatoduodenectomy unavoidable?","authors":"Anais Palen, Jean Philippe Ratone, Jonathan Garnier, Fabrice Caillol, Flora Poizat, Jacques Ewald, Olivier Turrini, Marc Giovannini","doi":"10.1007/s00464-025-11747-9","DOIUrl":"10.1007/s00464-025-11747-9","url":null,"abstract":"<p><strong>Background: </strong>Research on the oncological outcomes of complementary pancreatoduodenectomy (PD) following incomplete (R1) endoscopic papillectomy (EP) for early-stage ampullary adenocarcinoma (AA) is limited, despite the increasing use of endoscopic approaches and the risks associated with PD. This study aimed to assess short- and long-term outcomes in patients undergoing complementary PD after EP R1 for AA.</p><p><strong>Methods: </strong>Between January 2010 and December 2022, four patient groups were compared: patients with complete endoscopic resection (EP R0), those with R1 margins after EP closely followed up without complementary surgery (EP R1), those who underwent complementary PD after R1 EP (EP + PD), and those who underwent upfront PD (uPD). The primary endpoint was the difference in survival rates (overall [OS] and disease-free [DFS]) between the EP R1 and EP + PD groups and morbidity and mortality rate comparison between the EP + PD and uPD groups.</p><p><strong>Results: </strong>In the EP cohort (n = 56), the major complication was intraluminal hemorrhage (29%), and the median duration of hospitalization was 4 days (range 2-17 days). The presence of biliary obstruction, manifested as jaundice (p < 0.01), abnormal liver biology test results (p = 0.022), or biliary duct dilatation during endoscopic ultrasound (p < 0.001), was significantly higher in the EP R1 group (n = 20) than in the EP R0 (n = 16) group. After PD (n = 92), Clavien-Dindo ≥ 3 complications occurred in 28 patients (31%), and the 90-day mortality rate was 5.5%. Postoperative outcomes were similar between the EP + PD (n = 20) and uPD (n = 72) groups. Regarding endoscopic and surgical resection for early stage (T1-T2) adenocarcinoma, there was no significant difference in OS (p = 0.074) and DFS (p = 0.16) between groups. The median survival was not reached.</p><p><strong>Conclusions: </strong>EP before complementary PD did not increase the incidence of postoperative complications or mortality rate. However, complementary PD after R1 EP did not improve long-term outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3671-3680"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035712","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":"Outcomes of esophagectomy in patients with previous foregut surgery: a matched retrospective cohort study.","authors":"Agustina A Pontecorvo, Jorge Cornejo, Mohammad Alomari, Tamar Tsenteradze, Mathew Thomas, Steven Bowers, Enrique F Elli","doi":"10.1007/s00464-025-11757-7","DOIUrl":"10.1007/s00464-025-11757-7","url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy is a challenging procedure indicated for esophageal cancer and complex benign esophageal conditions. The primary aim of this study was to determine the impact of previous foregut surgeries on postoperative outcomes following esophagectomy.</p><p><strong>Methods: </strong>A retrospective cohort study was performed on patients undergoing esophagectomy between March 1st, 2008, and December 17th, 2024. Two groups were identified, patients with previous foregut surgery (PFS) and patients without previous foregut surgery (No-PFS). PFS (N = 37) was matched in a 3:1 ratio to patients with No-PFS (N = 111) by age, gender, race, and smoking status with \"nearest neighbor\" method. Demographics and perioperative variables were collected and compared between both groups. Kaplan-Meier method estimated survival and freedom from long-term complications, such as anastomotic stricture and paraconduit hernia.</p><p><strong>Results: </strong>Of 349 patients undergoing esophagectomy, 37 had PFS. These included 43% anti-reflux procedures, 35% Heller myotomy for achalasia, and 14% bariatric surgeries. Diagnosis of cancer was an indication for esophagectomy in 59.5% of cases. After matching, significant difference was found regarding operative time (PFS: 463 vs No-PFS: 426 min; p = 0.038). No difference was observed in conversions to open, early complications, reinterventions or leak rate (p value > 0.05). In 3 cases, an interposition graft (colon, jejunum) was used as conduit instead of stomach. As regards freedom from late anastomotic stricture, although not statistically significant, a trend toward a lower freedom from anastomotic stricture was observed in PFS group. The survival analysis, limited to patients with esophageal cancer, indicated higher survival rates in the PFS group (p = 0.06).</p><p><strong>Conclusions: </strong>PFS does not impact the approach or outcomes of esophagectomy and is safe with no increased risk of complications. Patients with PFS who had indication of esophagectomy for cancer tended to have better survival rates due to earlier detection and lower clinical stages at diagnosis because of more frequent follow-ups.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3970-3978"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043405","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":"TIPS versus endoscopic cyanoacrylate injection for the treatment of gastric fundal variceal rebleeding: a propensity score-matched retrospective cohort study.","authors":"Junyuan Zhu, Yifu Xia, Guangchuan Wang, Guangjun Huang, Mingyan Zhang, Zhen Li, Chunqing Zhang","doi":"10.1007/s00464-025-11761-x","DOIUrl":"10.1007/s00464-025-11761-x","url":null,"abstract":"<p><strong>Background: </strong>The optimal strategy for preventing rebleeding with gastroesophageal varices type 2 (GOV2) and isolated gastric varices type 1 (IGV1) is unclear. In this retrospective study, we aimed to compare the effectiveness and safety of transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic cyanoacrylate injection (ECI) on GOV2 and IGV1 varices.</p><p><strong>Methods: </strong>In this retrospective cohort study, we collected data from patients with cirrhosis with GOV2 and IGV1 varices who received TIPS or ECI treatment between June 2018 and June 2023. The primary endpoint was rebleeding, and the secondary endpoints were death and overt hepatic encephalopathy (OHE). Propensity score matching (PSM) and adjusted survival curves were used to assess the robustness of the results.</p><p><strong>Results: </strong>A total of 111 eligible patients were included, of whom, 35 patients received TIPS and 76 patients received ECI. The median follow-up time for the TIPS and ECI groups were 746 and 683 days, respectively. TIPS reduced the all-cause rebleeding rate (14.3% versus 33.8%, p = 0.033; after PSM, 16.7% versus 40.0%, p = 0.045) compared with ECI, with lower risk of ectopic embolism (all were in the ECI group). The Incidence of OHE in the TIPS group was higher than that in the ECI group (28.6% versus 1.4%, p < 0.001; after PSM, 33.3% versus 3.3%, p < 0.001). However, no significant difference was found in mortality (17.1% versus 12.2%, p = 0.684; after PSM, 16.7% versus 16.7%, p = 1.000). The results were not affected by the adjusted survival curve.</p><p><strong>Conclusion: </strong>TIPS was more effective than ECI in preventing rebleeding in patients with GOV2 and IGV1 varices with similar survival rates and lower risk of ectopic embolism, although TIPS was associated with a higher incidence of OHE.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3662-3670"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047508","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":"Vascularity of the gastric conduit predicts complications after Ivor-Lewis esophagectomy.","authors":"Julian Lemties, Carolin Scheidt, Jin-On Jung, Naita M Wirsik, Leandra Lukomski, Dolores Krauss, Anders Grabenkamp, Alexander R Stier, Su Ir Lyu, Alexander I Damanakis, Benjamin Babic, Alexander Quaas, Thomas Schmidt, Hans F Fuchs, Christiane J Bruns, Wolfgang Schröder, Lars M Schiffmann","doi":"10.1007/s00464-025-11780-8","DOIUrl":"10.1007/s00464-025-11780-8","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leakage (AL) contributes to postoperative morbidity and mortality after Ivor-Lewis esophagectomy. Vascular high-risk patients show a significantly increased risk of AL. We previously showed that laparoscopic ischemic conditioning (ISCON) of the stomach prior esophagectomy in these high-risk patients is a safe procedure that induces neoangiogenesis at the anastomotic site. Our data also suggested that this directly impacts on anastomotic healing. To further investigate the hypothesis that gastric conduit vascularization directly influences postoperative morbidity, we evaluated gastric conduit vascularity in a cohort of patients undergoing two-stage esophagectomy prior to the ISCON era.</p><p><strong>Material and methods: </strong>Seventy-nine patients who underwent two-stage esophagectomy from 2016 to 2021 at our center were retrospectively analyzed from a prospectively maintained database. Microvessel density (MVD) of the gastric conduit at the anastomotic region was evaluated by CD34 staining of the gastric stapler ring. Analysis of microvessel density (MVD) was performed using ImageJ. Patients were stratified into low- and high-MVD groups, and MVD was correlated with clinical outcomes.</p><p><strong>Results: </strong>Patients with a high MVD showed a significantly lower rate of anastomotic leakage (AL) in comparison to patients with low MVD (6.25% vs. 22.58% p=0.043). Furthermore, a high MVD was associated with a lower rate of major complications (Clavien Dindo ≥ IIIb) (12.50% vs. 38.71% p=0.012) and a shorter hospital stay (17.9 days vs. 23.1 days, p=0.045).</p><p><strong>Conclusion: </strong>Vascularization of the stomach might function as surgical biomarker of AL in patients undergoing two-stage esophagectomy. Prospective trials have to further substantiate this finding.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3839-3847"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of surgical site infection rates between transumbilical and periumbilical incisions in laparoscopic cholecystectomy: a randomized controlled trial.","authors":"Vorapatu Tangsirapat, Mati Rattanasakalwong, Jantaluck Nuchanatanon, Vittawat Ohmpornnuwat, Papot Charutragulchai, Singha Sripreechapattana, Panutchaya Kongon, Kitti Wongta","doi":"10.1007/s00464-025-11770-w","DOIUrl":"10.1007/s00464-025-11770-w","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic cholecystectomy is the standard treatment for gallstone disease offering advantages such as minimal incision size and rapid recovery. The study compares the surgical site infection (SSI) rates between transumbilical (TUI) and periumbilical incisions (PUI) in this method.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted from December 2021 to December 2023 at Panyananthaphikkhu Chonprathan Medical Center, Thailand. Patients undergoing laparoscopic cholecystectomy were randomly assigned to TUI or PUI groups. The primary endpoint was SSI rate, with secondary endpoints including length of hospital stay, operative time, blood loss, conversion rate, complications, cosmetic satisfaction, pain score, wound hypersensitivity, and numbness.</p><p><strong>Results: </strong>A total of 156 patients were enrolled, with 78 patients in each group. The incidence of SSI was 14.1% in the TUI group and 10.3% in the PUI group (p = 0.46). There were no conversions to open surgery, bile leaks, intra-abdominal infections, reoperations, or mortalities observed in either group. Outcomes related to cosmetic satisfaction, wound numbness, and wound hypersensitivity were comparable between the groups. Patients who developed SSI demonstrated lower cosmetic satisfaction scores on postoperative day 7 surgery (8.47 ± 1.3) compared to those without SSI (9.5 ± 0.8) (p < 0.001), although these scores were similar by day 30. Additionally, the SSI group exhibited a higher prevalence of umbilical wound hypersensitivity on day 30 post-surgery [11 (57.9%) vs. 35 (25.7%), p = 0.04].</p><p><strong>Conclusions: </strong>SSI rates and other surgical outcomes were comparable between TUI and PUI in laparoscopic cholecystectomy, encouraging the use of either technique based on surgeon preference and patient-specific factors.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3807-3813"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing pancreatic enucleation for benign tumors: the role of pre-placed pancreatic duct stents-a retrospective cohort study.","authors":"Baoyang Hu, Yiming Yin, Chun Liu, Chao He, Heng Zou, Zhongtao Liu, Fang Lv, Yu Wen, Wei Liu","doi":"10.1007/s00464-025-11748-8","DOIUrl":"10.1007/s00464-025-11748-8","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effectiveness of pre-placed pancreatic duct stents on improving outcomes of pancreatic enucleation for benign tumors, a procedure often discouraged by postoperative complications, such as pancreatic fistulae.</p><p><strong>Methods: </strong>This single-center retrospective cohort study analyzed 148 patients with benign tumors located in the head, neck, and body of the pancreas between February 2021 and February 2024. Thirty-four patients received stent placement by endoscopic retrograde cholangiopancreatography 1-2 days before surgery, while 114 did not. Propensity score matching resulted in two groups: stent (n = 30) and non-stent (n = 60). Outcomes compared included enucleation success rate, incidence of pancreatic fistulae, hospital stay, procedural costs, pancreatic function deficiency, and quality of life.</p><p><strong>Results: </strong>Pre-placement of stents significantly increased enucleation success rate (86.7% vs. 28.3%, p = 1.763 × 10^-7), facilitated more laparoscopic surgeries (86.7% vs. 41.7%, p = 4.9 × 10^-5), and shortened hospital stays (median 7.5 days vs. 11 days, p = 0.001). The stent group also showed a lower incidence of pancreatic exocrine dysfunction (10.3% vs. 35.7%, p = 0.016) and higher quality of life scores (91.2 ± 5.8 vs. 85.5 ± 13.6, p = 0.019). No significant differences were observed in postoperative complications or overall costs. Additionally, the distance between tumor and main pancreatic duct was shorter in the stent group (4.2 ± 2.2 mm vs. 6.2 ± 2.5 mm, p = 0.008).</p><p><strong>Conclusion: </strong>Pre-placement of pancreatic duct stents significantly enhances enucleation success rate, reduces hospital stays, preserves pancreatic function, and improves quality of life. These findings advocate the use of pre-placed stents in enucleation procedures. Further prospective studies are warranted to validate these outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3775-3785"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986895","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":"Evaluation of hemorrhage risk and the volume-outcome relationship following vertical sleeve gastrectomy amidst robotic-assisted surgery adoption.","authors":"Katharine P Playter, Hayley Reddington, Zachary C Ballinger, Donald R Czerniach, Gil S Freitas, John J Kelly, Nicole B Cherng, Richard A Perugini","doi":"10.1007/s00464-025-11737-x","DOIUrl":"10.1007/s00464-025-11737-x","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted surgery (RAS) holds promise for maintaining bariatric outcomes, while offering a shorter adoption learning curve relative to conventional laparoscopy. However, low RAS procedure volume relative to a laparoscopic approach has limited our understanding of its impact, and the transition from laparoscopic to RAS entails a volume-outcome relationship that is not fully characterized.</p><p><strong>Methods: </strong>This is a retrospective cohort study in a MBSAQIP accredited, bariatric surgery program. The incidence of hemorrhage following vertical sleeve gastrectomy (VSG) was observed from 2020 to 2023. This period was divided into an early adoption period (RAS 31% of cases) and a late adoption period (RAS 82% of cases).</p><p><strong>Results: </strong>A total of 1250 patients underwent VSG over the study period. Laparoscopic VSG (L-VSG) and robotic-assisted VSG (RA-VSG) groups were similar in age, sex, and risk factors for postoperative bleeding. They differed in race (P < 0.0001) and ASA category (P = 0.007). The overall postoperative hemorrhage rate was 1.04% (n = 13). Hyperlipidemia was predictive of hemorrhage on univariate analysis (P = 0.045). The relative risk of hemorrhage in the robotic group dropped from 4.38 (CI 0.577-3.24) during the early adoption period to 0.28 (CI 0.083-0.96, P = 0.063) during the late adoption period. This shift with respect to hemorrhage risk was not associated with a significant reduction of hemorrhage in the RA-VSG approach (1.5% vs. 0.98%; P = 0.636), but with an increase in L-VSG risk (0.35% vs. 3.5%, P = 0.0245).</p><p><strong>Conclusion: </strong>As RA-VSG became the more frequently utilized approach within a single program, the risk of hemorrhage with L-VSG significantly increased. This suggests an unanticipated risk associated with a transition to the robotic approach. Specifically, the risk of complication increased when performing L-VSG in a practice dominated by RA-VSG.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3702-3709"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052302","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":"Outcomes of laparoscopic sleeve gastrectomy performed by senior surgical residents as compared to bariatric surgeons.","authors":"Mohammad Mostafa, Raneem Bader, George Asfour, Ashraf Imam, Rafael Miller, Shimon Sapojnikov, Barak-Bar Zakai, Harbi Khalayleh","doi":"10.1007/s00464-025-11698-1","DOIUrl":"10.1007/s00464-025-11698-1","url":null,"abstract":"<p><strong>Background: </strong>Limited data are available on the safety and outcomes of LSG performed by senior surgical residents (SSR). This study aimed to compare the outcomes of laparoscopic sleeve gastrectomy (LSG) performed by SSR under the supervision of a senior bariatric surgeon (SBS) with those performed solely by SBS.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent LSG. Patients were divided into two groups: Consultant group surgery performed using SBS. Supervised resident group comprised surgeries performed by SSR under the supervision of SBS. Data collected included demographics, body mass index (BMI), excessive body weight loss (EBWL), complications, and follow-up results.</p><p><strong>Results: </strong>Of the 480 patients, 350 (72.9%) underwent surgery by SBS (Consultant Group), and 130 (27.1%) by SSR with supervision (Supervised resident Group). Operative times were longer in supervised resident group (104.13 min) than in consultant group (82.63 min, P < 0.001). Early complications occurred in 3.1% of the cases, with no significant difference between the groups. Postoperative BMI and EBWL showed slightly better short-term results in supervised resident group, although differences diminished in the long term.</p><p><strong>Discussion: </strong>LSG performed using SSR under the supervision of SBS is safe and effective. While operative times were longer for residents, short-term outcomes were comparable and there were no adverse effects on long-term results. These findings support the integration of LSG training into surgical residency programs.</p><p><strong>Conclusion: </strong>LSG can be safely performed using SSR with appropriate supervision, with no detrimental impact on the outcomes. This highlights the feasibility of involving residents in LSG while maintaining a high standard of care.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3640-3647"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064760","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 of robotic-assisted pancreaticoduodenectomy using the da Vinci SP system.","authors":"Yoo Jin Choi, Su Min Jeon, Sehyeon Yu, Hye-Sung Jo, Dong-Sik Kim, Young-Dong Yu","doi":"10.1007/s00464-025-11695-4","DOIUrl":"10.1007/s00464-025-11695-4","url":null,"abstract":"<p><strong>Background: </strong>In the era of robotic surgery, pancreatoduodenectomy (PD) has been performed with the Xi system. Recently, the advent of the SP system has allowed more minimally invasive surgery with reduced ports. We have applied the SP system to perform PD. We aimed to report our initial experience of robotic-assisted PD using the da Vinci single-port (SP) system to demonstrate the safety and feasibility of this platform.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent robotic-assisted pylorus-preserving pancreaticoduodenectomy (PPPD) between 2021 and 2023 at a single center. Robotic PPPD was performed using the da Vinci SP system with either four or two additional ports, utilizing a laparoscopic hybrid technique.</p><p><strong>Results: </strong>Of the 14 patients, six underwent the SP + 4 ports approach, and eight underwent the SP + 2 ports approach. The mean patient age was 60.2 years, and the mean body mass index was 22.5 ± 2.3 kg/m². The mean operative time was 444.29 ± 59.6 min, with an estimated intraoperative blood loss of < 500 ml in all cases. There were two cases of postoperative pancreatic fistula and one case of bile leak.</p><p><strong>Conclusion: </strong>Robot-assisted PPPD using the da Vinci SP system is safe and feasible, with acceptable perioperative outcomes. We also report a successful SP + 2 port PPPD. Owing to the unique structure of the da Vinci SP system, our method has the potential to reduce the number of trocar sites and provide a gateway for better, minimally invasive surgeries. However, further reports assessing the experience are essential to establish its wide clinical practice.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"4017-4025"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018903","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}