Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Safety and efficacy of laparoscopic portal territory fluorescence navigation-guided anatomical liver resection in hepatocellular carcinoma patients.","authors":"An-Zhi Wang, Rui Zhou, Jie Chen, Fan Zhang, Jing-Yang Du, Ya-Jin Chen, Jun Cao","doi":"10.1007/s00464-025-11632-5","DOIUrl":"10.1007/s00464-025-11632-5","url":null,"abstract":"<p><strong>Background: </strong>The clinical effectiveness of classic anatomical resection (CAR) of the liver for hepatocellular carcinoma (HCC) has been controversial. Laparoscopic Portal Territory fluorescence navigation-guided anatomical liver resection (LPTAR) has been increasingly applied in clinical practice. However, evidence on the safety and efficacy of LPTAR is lacking.</p><p><strong>Methods: </strong>A retrospective cohort study of patients who underwent laparoscopic hepatectomy from December 2018 to December 2022 was conducted. Propensity score matching (PSM) was employed to match patients who underwent LPTAR with patients who underwent CAR. Differences in recurrence-free survival (RFS), overall survival (OS), and perioperative data were evaluated between the LPTAR and CAR groups. Cox regression models were used for univariate and multivariate analyses, as well as subgroup analyses.</p><p><strong>Results: </strong>Of the 234 patients included in this study, 70 underwent LRTAR, and 164 underwent CAR. After 1:1 PSM, each group contained 59 patients, and perioperative parameters were better in the LPTAR group. Specifically, the LPTAR group had wider resection margins (13.00 cm vs. 11.00 cm, P = 0.023), less blood loss (200 ml vs. 320 ml, P = 0.010), and fewer postoperative complications (33.90% vs. 57.62%, P = 0.016) than did the CAR group. The RFS rates of patients with HCC was also increased by LPTAR. The 1-, 3-, and 5-year RFS rates of the LPTAR group were significantly higher than those of the CAR group (P = 0.002).</p><p><strong>Conclusion: </strong>Accurate preoperative planning and standardized LPTAR technical criteria prolonged RFS in HCC patients, improved the safety of surgery, and reduced surgical stress.</p><p><strong>Trail registration: </strong>The study has been prospective registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn/, ChiCTR2400087661).</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2597-2608"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574024","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":"Treatment of Boerhaave syndrome: experience from a tertiary center.","authors":"Cezanne D Kooij, Eleni Boptsi, Bas L A M Weusten, D R de Vries, Jelle P Ruurda, Richard van Hillegersberg","doi":"10.1007/s00464-025-11540-8","DOIUrl":"10.1007/s00464-025-11540-8","url":null,"abstract":"<p><strong>Background: </strong>Boerhaave syndrome is a rare, life-threatening condition, characterized by spontaneous esophageal rupture. This study aims to share our 13-year experience in managing Boerhaave syndrome.</p><p><strong>Methods: </strong>A retrospective, observational study was conducted of consecutive patients with Boerhaave syndrome who presented at our tertiary referral center, between 2011 and 2023. Patients were categorized by time to diagnosis, to assess the impact of diagnostic delay.</p><p><strong>Results: </strong>Among 21 patients, 13 (62%) were diagnosed early (< 24 h) and 8 (38%) late (> 24 h). In the early-diagnosed group (n = 13), 6 patients (46%) received primary intervention with stent placement in combination with surgical drainage (5 with mediastinal and pleural drainage and 1 with only pleural drainage), while 5 patients (38%) were initially treated with only a stent. One patient (8%) underwent surgical pleural drainage alone and one (8%) underwent an esophagectomy. Among the 8 late-diagnosed patients, 4 (50%) were primarily treated with both stent placement and surgical drainage (2 with mediastinal drainage, 1 with pleural drainage and 1 with both), 3 (38%) with only stent placement, and one (13%) was managed conservatively. Additional interventions were required in 14 patients (67%). Additional surgical drainage was performed in 5 of 8 patients who had initially been treated with stent only (63%) and in 2 of 10 patients who had initially received both stent and surgical drainage (20%). Stent complications occurred in 7 patients (37%), including leakage (16%), migration (16%), and bleeding (5%). The median hospital stay was 32 days (IQR 15-37) and the overall 90-day mortality was 14%. Mortality was significantly higher in late-diagnosed patients (n = 3, 38%) compared to those early diagnosed (n = 0, 0%) (p = 0.042), with all 3 deceased patients either refusing or being unfit for treatment.</p><p><strong>Conclusion: </strong>Based on this study, we recommend prioritizing closure of the defect combined with drainage, while considering individual patient factors, including advanced age.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2228-2238"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391758","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":"Unforeseen nodal upstaging in patients undergoing segmentectomy without frozen section: a multicenter retrospective cohort study.","authors":"Lin Huang, Alessandro Brunelli, Demetrios Stefanou, Edoardo Zanfrini, Abid Donlagic, Michel Gonzalez, René Horsleben Petersen","doi":"10.1007/s00464-025-11612-9","DOIUrl":"10.1007/s00464-025-11612-9","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to evaluate the risk of unforeseen nodal upstaging (pN+) after pulmonary segmentectomy without intraoperative frozen section.</p><p><strong>Methods: </strong>We conducted a retrospective analysis for consecutive patients who underwent segmentectomy for clinical stage IA1-2 non-small cell lung cancer (cIA1-2 NSCLC) in three centers between January 2017 and December 2022. A backward stepwise logistic regression analysis for variables with P < 0.1 in univariable analysis was performed to predict pN+. Kaplan-Meier analysis with log-rank test evaluated the discrepancy for overall (OS) and recurrence-free survivals (RFS).</p><p><strong>Results: </strong>Among 478 patients included in the final analysis, 19 (4.0%) had pN+, including 10 (2.1%) pN1, 6 (1.3%) pN2, and 3 (0.6%) pN1+2. With a median follow-up of 23.5 months (interquartile range 12.6-39.0), patients with pN+ had poorer OS compared to those with pN0 (3-year OS: 70.2% vs. 89.7%, P = 0.002). However, there was no significant difference in RFS and recurrence. The maximum standardized uptake value (SUVmax) of tumor in positron emission tomography scan ≥ 4.5 (versus < 4.5) was the only independent factor for pN + (odds ratio 3.5). Patients with a SUVmax ≥ 4.5 had 7.3% pN+, which was associated with poorer OS and similar RFS and recurrence compared to pN0. In contrast, those with a SUVmax < 4.5 had 2.2% pN+, which had comparable recurrence and survival to pN0.</p><p><strong>Conclusion: </strong>Unforeseen nodal upstaging in segmentectomy for cIA1-2 NSCLC is low. Frozen section of lymph nodes may be necessary for lesions with high metabolic activity.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2296-2303"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414817","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":"Minimally invasive approach to peritonitis from left colonic perforation: a retrospective multicenter observational study.","authors":"Marco Ceresoli, Carola Anna Paolina Ferro, Antonio La Greca, Stefano Piero Bernardo Cioffi, Alan Biloslavo, Mauro Podda, Federico Coccolini","doi":"10.1007/s00464-025-11611-w","DOIUrl":"10.1007/s00464-025-11611-w","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic procedures have nowadays become the gold standard in multiple abdominal diseases, but in the emergency setting, especially in major surgery, laparoscopy still represents an obstacle for most surgeons. This multicentric study aims to define the surgical approach for emergency resective surgery in left colonic perforation peritonitis, determine the factors influencing the choice between MIS and open surgery, and identify factors associated with laparotomic conversion.</p><p><strong>Methods: </strong>Retrospective data from 516 patients treated for left colonic perforation between January 2019 and December 2023 across six Italian centers was collected. Variables analyzed included patient demographics, disease and surgical characteristics, post-operative complications, and long-term outcomes. Univariate and multivariate regression models were performed to identify factors associated with surgical choice and likelihood of conversion.</p><p><strong>Results: </strong>Only 24.5% of patients underwent laparoscopic approach, with a conversion rate of 52.8%. MIS was associated to lower CCI and MPI and less severe septic status at arrival. MIS was mostly performed by colorectal surgeons, compared to acute care surgeons. The post-operative outcome, considering LOS, ICU admission, post-operative complications and mortality rate, was better in the MIS group. The multivariate regression model revealed that CCI, MPI, and night-time surgery were negatively associated with MIS while colorectal surgeons had a positive association. Laparotomic conversion more commonly occurred in older patients with a higher MPI and CCI and more severe septic status; these patients had a worse post-operative outcome. MPI was the only factor with statistical significance in the univariate analysis, associated with conversion.</p><p><strong>Conclusion: </strong>Although MIS is associated with better post-operative outcomes, it is underutilized in the emergency setting. Patients requiring laparotomic conversion had higher morbidity and mortality compared to those who underwent successful laparoscopy. Limiting factors for MIS include logistic factors, patient severity, and surgical skills, therefore careful patient selection and surgical training is crucial.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2370-2379"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449566","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":"Learning curve analysis of 100 consecutive robotic liver resections.","authors":"Mirhasan Rahimli, Andrew A Gumbs, Aristotelis Perrakis, Sara Al-Madhi, Maximilian Dölling, Frederike Stelter, Eric Lorenz, Mihailo Andric, Mareike Franz, Jörg Arend, Roland S Croner","doi":"10.1007/s00464-025-11551-5","DOIUrl":"10.1007/s00464-025-11551-5","url":null,"abstract":"<p><strong>Background: </strong>Robotic liver surgery, as part of minimally invasive liver surgery (MILS), offers advantages like enhanced dexterity and stable camera and instrument control. However, the learning curve - particularly the number of cases required for proficiency - remains underexplored. This study analyzes 100 consecutive robotic liver resections performed by a single surgeon to assess the learning curve and outcomes.</p><p><strong>Patients and methods: </strong>This retrospective analysis reviewed data from the Magdeburg registry of minimally invasive liver surgery (MD-MILS) from June 2013 to July 2024, to identify surgeons who performed at least 100 robotic liver resections. Operation time and Iwate difficulty score were used as indicators of surgical proficiency and learning progression.</p><p><strong>Results: </strong>One surgeon fulfilled the inclusion criteria of performing 100 robotic liver resections. Of these, 41 (41%) were major and 59 (59%) were minor liver resections. A significant reduction in average operation time was observed across the series, decreasing from an initial average of 450 min to approximately 300 min by the 100th operation. Similarly, the Iwate difficulty score showed a significant upward trend, reflecting the increasing technical challenges of the procedures. The learning curve was divided into four distinct phases: Competency (Cases 1-20), Proficiency (Cases 21-30), Early Mastery (Cases 31-65), and Full Mastery (Cases 66-100), highlighting the progression in skill acquisition and case complexity. Major complications (21%), such as bile leak, bilioma, and pulmonary embolism, were observed during the study period.</p><p><strong>Conclusion: </strong>Over 100 robotic liver resections, significant learning curve progression was evident, with marked improvements in operation time and handling of complex cases. The results suggest that approximately 65 cases are needed for a surgeon experienced in open and laparoscopic liver surgery to achieve consistent proficiency in robotic liver resections. These findings underscore the importance of standardized training protocols to support the learning curve in robotic liver surgery.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2512-2522"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516594","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":"Impact of a robotic approach on hypoattenuated area formation leading to postoperative pancreatic fistula in patients after pancreatoduodenectomy.","authors":"Yoshito Tomimaru, Shogo Kobayashi, Kazuki Sasaki, Shinichiro Hasegawa, Daisaku Yamada, Hirofumi Akita, Takehiro Noda, Hidenori Takahashi, Hiroki Imamura, Yuichiro Doki, Hidetoshi Eguchi","doi":"10.1007/s00464-025-11635-2","DOIUrl":"10.1007/s00464-025-11635-2","url":null,"abstract":"<p><strong>Background: </strong>Hypoattenuated area (HA) formation at the pancreatojejunostomy (PJ) site on contrast-enhanced computed tomography (CE-CT) is significantly associated with clinically relevant postoperative pancreatic fistula (CR-POPF) after open pancreaticoduodenectomy (PD) (O-PD). Here, we evaluated the impact of HA formation in robotic PD (R-PD) and surgical factors predictive of HA formation.</p><p><strong>Methods: </strong>The study retrospectively analyzed 66 patients who underwent either O-PD or R-PD and exhibited a drain amylase level exceeding three times the upper limit of normal range, with CE-CT assessment performed on postoperative days 3-14. Patients were divided into two groups, with evident HA (≥ 5 mm) (E-HA) and subtle HA (< 5 mm) (S-HA), and their data were analyzed by multivariate and propensity-score matching analyses.</p><p><strong>Results: </strong>Among the patients, 24 (36.3%) exhibited E-HA and 42 (63.7%) S-HA. The percentages of R-PD and CR-POPF in E-HA group were significantly lower and higher, respectively, than S-HA group (R-PD: 29.2% vs 54.8%, p = 0.0446; CR-POPF: 70.8% vs 4.8%, p < 0.0001). Multivariate analysis revealed the surgical approach as a significant factor associated with E-HA formation (odds ratio: 0.26; p = 0.0223). Propensity-score matching analysis revealed significantly fewer patients with E-HA formation and CR-POPF in R-PD group than O-PD group (E-HA: 14.3% vs 64.3%, p = 0.0068; CR-POPF: 14.3% vs 57.1%, p = 0.0180).</p><p><strong>Conclusion: </strong>The impact of HA formation in predicting CR-POPF was confirmed in the patients undergoing PD, including O-PD and R-PD. Furthermore, the data suggest that R-PD, compared with O-PD, significantly decreased the incidence of E-HA formation, indicating an advantage of R-PD over O-PD in reducing CR-POPF via HA formation.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2561-2570"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558093","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":"Endoscopic ultrasound-based radiomics for predicting pathologic upgrade in esophageal low-grade intraepithelial neoplasia.","authors":"Yajing Chen, Shuhan Sun, Shumei Miao, Han Chen, Xiaoying Zhou, Feihong Yu","doi":"10.1007/s00464-025-11573-z","DOIUrl":"10.1007/s00464-025-11573-z","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on managing patients with endoscopic suspicion of early esophageal squamous cell carcinoma (ESCC) but biopsy-confirmed low-grade intraepithelial neoplasia (LGIN). The aim of this study is to evaluate the utility of an endoscopic ultrasound (EUS)-based radiomics nomogram for predicting esophageal LGIN pathological progression before diagnostic endoscopic submucosal dissection (ESD).</p><p><strong>Methods: </strong>In the development phase, EUS images of 535 patients who had biopsy-confirmed LGIN and were undergoing ESD were retrospectively included. Concurrently, 251 patients were prospectively included for independent model validation. A radiomics signature (RS) was constructed using Pearson test and the least absolute shrinkage and selection operator (LASSO) algorithm. A radiomics nomogram was then developed with multivariate logistic regression to predict pathologic upgrade before ESD. Model performance was assessed with receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Following stepwise multivariate logistic regression analysis, statistically significant clinical features were incorporated into the clinical predictive model. From EUS images, 105 radiomic features were extracted, with 11 key features selected for RS development. The RS showed strong predictive performance in identifying pathologic upgrade (AUC = 0.786). Moreover, when integrated with the clinical model (AUC = 0.648), the RS performance remarkably improved (AUC = 0.818). These results were subsequently validated in the prospective test cohort (RS: AUC = 0.792; Clinical model: AUC = 0.669; Combined model: AUC = 0.821). The combined model presented as a nomogram also excelled in calibration tests and DCA, underlining its potential for clinical application.</p><p><strong>Conclusion: </strong>The EUS-based radiomics nomogram showed potential for predicting pathologic upgrade in esophageal LGIN, which helps to distinguish high-risk from low-risk cases and assists clinicians in assessing the necessity of diagnostic ESD.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2239-2249"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390463","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 visceral fat area predicts intraoperative adverse events during lymphadenectomy in laparoscopic gastrectomy for gastric cancer: a post hoc analysis.","authors":"Ling-Hua Wei, Hua-Long Zheng, Zhi-Yu Liu, Xiao-Qiang Du, Chun-Sen Chen, Bin-Bin Xu, Hong-Hong Zheng, Guang-Tan Lin, Jian-Wei Xie, Chao-Hui Zheng, Jia-Bin Wang, Chang-Ming Huang, Ping Li","doi":"10.1007/s00464-025-11602-x","DOIUrl":"10.1007/s00464-025-11602-x","url":null,"abstract":"<p><strong>Background: </strong>Visceral obesity has been increasingly recognized as a potential risk factor for surgical complications in gastric cancer surgery, yet its impact on lymphadenectomy during laparoscopic gastrectomy remains undefined. This study aimed to investigate the influence of visceral fat area (VFA) on intraoperative adverse events (iAEs) during lymphadenectomy in laparoscopic gastrectomy.</p><p><strong>Methods: </strong>A post hoc analysis was performed using data from two previous prospective studies ([NCT02327481] and [NCT01609309]). The patients were divided into high and low VFA groups based on preoperative computed tomography images at the umbilical level. All iAEs were reviewed from the surgical videos and graded using ClassIntra. The factors influencing iAEs were identified, and predictive models for iAEs were constructed.</p><p><strong>Results: </strong>This study included 490 patients, with 244 and 246 patients in the high and low VFA groups, respectively. Restricted cubic splines demonstrated a positive linear association between VFA and iAEs. Compared with the low VFA group, the high VFA group exhibited a significantly higher incidence of iAEs (29% vs. 12%, p < 0.001), primarily in the infrapyloric (9.0% vs. 2.0%) and suprapancreatic (23.4% vs. 9.3%) regions and higher rates of ClassIntra I-III. Multivariate logistic regression identified high VFA as an independent risk factor for iAEs (hazard ratio [HR] 2.16, 95% confidence interval [CI]: 1.22 - 3.83). Based on the VFA, nomograms were developed to predict iAEs (training area under the curve [AUC] 0.722, validation AUC 0.730). Meanwhile, a web-based calculator was developed to facilitate clinical application.</p><p><strong>Conclusions: </strong>High preoperative VFA is independently correlated with iAEs after laparoscopic gastrectomy for gastric cancer. Nomograms based on VFA showed potential in predicting iAEs, helping identify high-risk patients early and facilitating tailored perioperative management.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2275-2287"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400037","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":"Comparison of robotic versus laparoscopic cyst excision and hepaticojejunostomy for choledochal cyst in children: a propensity score-matched study.","authors":"Hyunhee Kwon, Jung-Man Namgoong, Dae Yeon Kim, Seong Chul Kim","doi":"10.1007/s00464-025-11594-8","DOIUrl":"10.1007/s00464-025-11594-8","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery (MIS) has become a standard approach in pediatric surgery, including for the treatment of choledochal cysts (CC). This study compared the long-term outcomes of laparoscopic (LA) and robot-assisted (RA) surgeries for pediatric CC. Propensity score matching (PSM) was used to control for potential confounding variables that could influence surgical outcomes.</p><p><strong>Methods: </strong>A retrospective review of 159 pediatric patients who underwent MIS for CC at our tertiary referral center between June 2008 and December 2020 was conducted. PSM was used to minimize selection bias, resulting in 63 matched pairs of patients in the RA and LA groups. Key outcomes, including operative time, complication rates, and post-operative recovery, were compared between the two groups.</p><p><strong>Results: </strong>After PSM, the RA group had a longer mean operative time compared to the LA group (359 vs. 319 min, p = 0.006). However, the RA group had a significantly lower incidence of anastomotic leaks (0% vs. 7.9%, p = 0.023). There were no statistically significant differences between the groups in terms of conversion to open surgery, length of hospital stay, or severe complications. The RA group had a shorter time to start feeding and to achieve full feeding postoperatively.</p><p><strong>Conclusion: </strong>RA significantly enhances the quality of anastomosis, contributing to more secure anastomoses compared to LA, and provides the benefit of faster bowel movement recovery in pediatric choledochal cysts.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2506-2511"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516672","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":"Laparoscopic versus open mesh repairs for small-sized ventral and incisional hernias: a propensity score analysis of a retrospective cohort of patients.","authors":"Koy Min Chue, Tousif Kabir, Choon Chieh Tan, Jeremy Tian Hui Tan, Juinn Huar Kam, Wai Keong Wong, Huiwen Chua, Alvin Yong Hui Tan, Lester Wei Lin Ong, Faith Qi Hui Leong, Frederick Hong Xiang Koh, Baldwin Po Man Yeung","doi":"10.1007/s00464-025-11627-2","DOIUrl":"10.1007/s00464-025-11627-2","url":null,"abstract":"<p><strong>Introduction: </strong>For ventral/incisional hernias between 1 and 4 cm, there is still controversy regarding open or laparoscopic mesh repairs. The study evaluated via a propensity-score adjusted analysis, the differences in outcomes between a laparoscopic and open ventral hernia mesh repair.</p><p><strong>Methodology: </strong>A single institution retrospective cohort study was performed. All patients with a ventral or incisional hernia between 1 and ≤ 4 cm, with a mesh repair, were reviewed. A propensity-score adjusted analysis was performed to account for baseline differences. Subgroup analyses were also performed. Outcome measures included recurrence, chronic pain, complications, postoperative adhesive occurrences, length of stay and operative duration.</p><p><strong>Results: </strong>Over a 6-year period, 194 patients (91 laparoscopic; 103 open) were included. Mean follow-up duration and defect size were 8.0 months and 2.6 cm, respectively. Baseline differences in the univariate analysis between groups were adjusted for via propensity scoring. In the propensity-score adjusted analysis, a laparoscopic mesh repair was significantly associated with a lower likelihood of postoperative adhesive occurrences, with no differences in recurrence, chronic pain, complications, length of stay and operative duration. This association remained for hernia defects down to ≤ 3 cm. There were no significant differences between the laparoscopic and open groups when stratified for hernia defects of 1-2 cm. For the subgroup analysis, in contrast to an intraperitoneal on-lay mesh placement, open on-lay mesh placement was associated with a higher likelihood of postoperative adhesive occurrences.</p><p><strong>Conclusion: </strong>For patients with small-sized ventral/incisional hernias between 1 and 4 cm, laparoscopic mesh repairs may be associated with reduced postoperative adhesive occurrences, with no difference in other outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"2579-2587"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568297","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}