Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Endoscopic ultrasound-guided gallbladder drainage versus choledochoduodenostomy for distal malignant biliary obstruction.","authors":"Esteban Fuentes-Valenzuela, Antonio Martínez Ortega, Sergio Bazaga, Miguel Durá, Antonio J Velasco Guardado, Iñaki Casado, Alberto Álvarez, Carlos Chavarría","doi":"10.1007/s00464-026-13499-6","DOIUrl":"https://doi.org/10.1007/s00464-026-13499-6","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a potential alternative to endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) for distal malignant biliary obstruction (DMBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). Comparative evidence remains scarce.</p><p><strong>Methods: </strong>We performed a multicenter retrospective cohort study including consecutive patients who underwent EUS-GBD or EUS-CD using electrocautery-enhanced lumen-apposing metal stents after failed ERCP at four Spanish tertiary centers. The primary outcome was clinical success, defined as a ≥50% reduction in serum bilirubin within one week or normalization (< 2 mg/dL) within one month. Secondary outcomes included technical success, adverse events, endoscopic reintervention, hospital stay, and mortality.</p><p><strong>Results: </strong>Sixty patients were included, with 35 undergoing EUS-GBD and 25 EUS-CD. Baseline characteristics were comparable except for older age in the EUS-CD group (79.8 vs. 71.7 years; p = 0.01). Clinical success was achieved in 74.3% and 88.0% of patients, respectively (p = 0.33), while technical success was 100% and 96.0% (p = 0.40). Bilirubin reduction at 24 h, 48 h, 7, 14, and 30 days and median hospital stay were similar. Adverse events occurred in 20.0% in the EUS-CD group and 37.2% of patients in the EUS-GBD group (p = 0.25), and reintervention rates were 12.0%, and 28.6%, respectively (p = 0.20). Thirty-day mortality and overall survival did not differ significantly. Seven patients undergoing EUS-GBD subsequently underwent pancreatoduodenectomy without complications related to LAMS.</p><p><strong>Conclusions: </strong>In selected patients with DMBO after failed ERCP, EUS-GBD provides efficacy and safety comparable to EUS-CD and represents a feasible rescue option when choledochoduodenostomy is technically challenging or not feasible.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196838","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":"Prior abdominal surgery characteristics predict adhesion phenotype and adhesiolysis in robotic colorectal cancer resection while preserving short-term outcomes.","authors":"Toshinori Sueda, Yoshinori Kagawa, Junichi Nishimura, Tsuyoshi Hata, Masatoshi Kitakaze, Yuta Kobayashi, Hiroshi Miyata, Masayuki Ohue","doi":"10.1007/s00464-026-13513-x","DOIUrl":"https://doi.org/10.1007/s00464-026-13513-x","url":null,"abstract":"<p><strong>Background: </strong>Prior abdominal surgery (PAS) is common in patients undergoing robotic colorectal cancer (CRC) resection. Most studies have evaluated PAS as a binary exposure, leaving unclear which specific PAS characteristics are associated with technically relevant adhesions, adhesiolysis, and operative efficiency in robotic surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 746 consecutive patients who underwent robotic CRC resection at a single institution between January 2018 and December 2025; 200 patients (26.8%) had a history of PAS. Among patients with PAS, associations between detailed PAS characteristics and intraoperative adhesion phenotype or adhesiolysis were assessed using multivariable regression analyses. Short-term outcomes between PAS and non-PAS patients were compared after 1:1 propensity score matching using age, sex, body mass index, American Society of Anesthesiologists physical status, preoperative treatment, primary tumor site, and clinical T stage.</p><p><strong>Results: </strong>In the PAS cohort, adhesions were observed in 46.0 and 36.0% required adhesiolysis. Cancer-related PAS (adjusted odds ratio [aOR] 3.78, 95% confidence interval [CI] 1.36-11.4; p = 0.01) and prior open surgery (aOR 6.06, 95% CI 2.47-16.9; p < 0.01) independently predicted abdominal wall adhesions. Among adhesion-positive PAS patients, middle (aOR 15.2, 95% CI 1.34-172.9; p = 0.02) and lower abdominal PAS (aOR 12.2, 95% CI 3.05-48.9; p < 0.01) independently predicted adhesiolysis. After matching, operative time, console time, blood loss, conversion, and severe complications were comparable between groups. Mean differences were small for operative time (16.2 min, 95% CI -8.5 to 40.9), console time (10.6 min, 95% CI -7.6 to 28.8), and blood loss (12.9 mL, 95% CI -7.4 to 33.2).</p><p><strong>Conclusions: </strong>Specific PAS characteristics, rather than PAS presence alone, were associated with technically relevant adhesions and adhesiolysis in robotic CRC resection. Despite increased technical burden, short-term outcomes remained comparable, supporting a more individualized interpretation of prior surgical history in robotic colorectal surgery.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196841","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":"Incidence of parastomal hernia after open versus minimally invasive surgery: a comparative systematic review.","authors":"V Bellato, T B Moojen, J A H Gooszen, Christianne J Buskens, W A Bemelman","doi":"10.1007/s00464-026-13432-x","DOIUrl":"https://doi.org/10.1007/s00464-026-13432-x","url":null,"abstract":"<p><strong>Background: </strong>Peristomal bulging and external stoma prolapse are the most common long-term complications following stoma formation. This systematic review aims to describe available evidence on the incidence of parastomal hernia, subcutaneous prolapse and external stomal prolapse following open versus minimally invasive intestinal resections with definitive stoma formation.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, a literature search was performed to include studies published in the last 15 years on intestinal resections with a definitive ileostomy or colostomy formation and a follow-up of more than 12 months, reporting on PSH and/or subcutaneous prolapse and/or external stoma prolapse after laparoscopic or robotic, and open surgery. The incidence of PSH after open versus minimally invasive surgery was the primary outcome, and secondary outcomes included other stoma-related complications such as subcutaneous stoma prolapse and external stoma prolapse, and outcomes.</p><p><strong>Results: </strong>In total six studies (one randomised controlled trial and five observational studies) on 1480 patients with a definitive stoma were included (731 open, 749 laparoscopic). All studies reported PSH as an outcome, no study reported the incidence of subcutaneous prolapse and one study reported on external stoma prolapse. There was consistent trend toward higher PSH rates following laparoscopic resections, both in clinically (RR 1.89 (95% CI 1.39-2.58)) and radiologically (RR 1.70 (95% CI 0.89-3.28)) assessed hernias.</p><p><strong>Conclusions: </strong>Minimally invasive intestinal resection may be associated with a higher incidence of PSH than open surgery, but the certainty of the evidence is very low. Subcutaneous prolapse is seldom recognised as a distinct form of stoma herniation. Clear differentiation is essential, as these conditions differ in their underlying mechanisms and management.</p><p><strong>Registration: </strong>PROSPERO CRD420251026395.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196787","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":"The patient perspective in benign foregut surgery guidelines: bridging evidence, values, and clinical decision-making.","authors":"Susheen Mahmood, Rhea Thomas, Keira Parr, Jigish Khamar, Dennis Hong, Yung Lee","doi":"10.1007/s00464-026-13493-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13493-y","url":null,"abstract":"<p><strong>Background: </strong>Patient values influence preference-sensitive decisions in benign foregut (upper gastrointestinal) surgery, but their incorporation into guideline development is unclear. This systematic review evaluated how patient perspectives are included in clinical practice guidelines (CPGs) and whether involvement is associated with quality.</p><p><strong>Methods: </strong>Databases and society websites were searched for CPGs addressing endoscopic or surgical management of benign foregut disease from January 2010 to March 2026. Two reviewers screened records, extracted data, mapped involvement across the 10-stage Armstrong framework, and assessed quality using AGREE II.</p><p><strong>Results: </strong>Twenty-six CPGs were included. All used evidence-grading methods, but only 8 (31%) reported direct patient involvement. Six additional CPGs (23%) considered patient values indirectly through literature review and clinician assumptions. No CPG published before 2018 reported direct involvement. Among patient-involved CPGs, engagement most often occurred during recommendation development (8/8), evidence interpretation (5/8), and question or outcome formulation (5/8). None reported patient involvement in dissemination, implementation, updating, or evaluation of engagement. Later publication year was associated with direct involvement (OR 1.54 per year). In unadjusted analyses patient-involved CPGs had higher AGREE II scores for clarity, applicability, and editorial independence, but this did not remain statistically significant in sensitivity analyses restricting publication year and methodologist involvement.</p><p><strong>Conclusions: </strong>Direct patient involvement remains uncommon and concentrated in recommendation development rather than the entirety of guideline development. Foregut-related surgical societies should combine patient-preference evidence with transparently reported patient partnership from priority setting through implementation and updating.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196834","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 between technical difficulty and patient prognosis after transanal total mesorectal excision for middle and low rectal cancer: a multicenter cohort study.","authors":"Weixiang Chen, Jingtao Zhu, Haipeng Weng, Jun You, Chunlin Lin, Yanchang Xu, Guangwei Zhu, Jianxin Ye","doi":"10.1007/s00464-026-13392-2","DOIUrl":"https://doi.org/10.1007/s00464-026-13392-2","url":null,"abstract":"<p><strong>Background: </strong>Whether technical difficulty influences outcomes after transanal total mesorectal excision (TaTME) for middle and low rectal cancer remains unclear. This study evaluated the association between technical difficulty and patient outcomes.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included 210 consecutive patients with middle and low rectal cancer who underwent TaTME at three centers in China. A five-item technical difficulty score was constructed using male sex, body mass index ≥ 25 kg/m², distance from the anal verge ≤5 cm, tumor diameter ≥ 4 cm, and neoadjuvant therapy. Patients were classified into low (0-2 points) and high (3-5 points) technical difficulty groups. Surgical outcomes, recurrence patterns, disease-free survival (DFS), overall survival (OS), and conditional survival were compared.</p><p><strong>Results: </strong>Overall, 130 patients were classified into the low technical difficulty group and 80 into the high technical difficulty group. The high technical difficulty group had a longer operative time (249.0 ± 60.0 vs. 220.3 ± 50.1 min, P < 0.001), but major short-term outcomes did not differ significantly. The 3-year DFS and OS rates were 80.2% and 89.0%, respectively. Forty postoperative recurrences were recorded, mainly distant metastases, with most occurring within 2 years. Overall recurrence (17.7% vs. 21.2%, P = 0.588) and local recurrence (3.8% vs. 2.5%, P = 0.711) were comparable between groups. High technical difficulty was not independently associated with DFS (HR 1.06, 95% CI 0.57-2.00, P = 0.849) or OS (HR 1.21, 95% CI 0.52-2.81, P = 0.664).</p><p><strong>Conclusion: </strong>Technical difficulty in TaTME was mainly reflected by prolonged operative time and was not significantly associated with increased local recurrence or reduced 3-year DFS/OS. Early surveillance for systemic recurrence remains important.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196720","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":"Six-month comparative outcomes of endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: an MBSAQIP analysis.","authors":"Valentin Mocanu, Mélissa V Wills, Xinlei Zhu, Juan S Barajas-Gamboa, Yung Lee, Andrew Strong, Ricard Corcelles, Matthew Kroh, Jerry Dang, Salvador Navarrete","doi":"10.1007/s00464-026-13489-8","DOIUrl":"https://doi.org/10.1007/s00464-026-13489-8","url":null,"abstract":"<p><strong>Background: </strong>North American data regarding long-term efficacy and durability of endoscopic sleeve gastroplasty (ESG) are remarkably scarce outside of clinical trial settings hampering our understanding of its optimal role in the obesity care continuum. The aims of this study are to compare safety and efficacy of elective ESG versus laparoscopic sleeve gastrectomy (LSG) at 6 months using accredited MBSAQIP centers.</p><p><strong>Methods: </strong>Data were obtained from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for 2023 and merged with the 6‑month follow‑up data file. The primary objectives of the study were to characterize the long-term six-month changes in weight and metabolic comorbidities of ESG patients in contrast to their LSG counterparts. Logistic regression models were to evaluate for differences in six-month serious complications and emergency department readmissions between ESG and LSG.</p><p><strong>Results: </strong>A total of 115,476 patients were included, comprising 114,967 LSG and 509 ESG procedures. Patients undergoing ESG were slightly older (44.5 ± 11.2 vs. 42.4 ± 11.9 years, p = 0.0001) and had lower baseline BMI (40.9 ± 8.6 vs. 45.0 ± 7.8 kg/m², p < 0.0001) and mean body weight (113.2 ± 28 vs. 124.5 ± 26.3 kg). At 6 months, LSG resulted in greater weight reduction, with larger BMI loss (8.2 ± 10.8 vs. 3.9 ± 12.0 kg/m², p < 0.0001), and total weight loss (22.6 ± 35.6 vs. 11.1 ± 37.7 kg, p < 0.0001). For patients undergoing LSG, there was a near 50% reduction in medication/insulin-dependent diabetes along with improvements in rates of dyslipidemia, hypertension, and sleep apnea. Importantly, no clinically meaningful comorbidity improvements from baseline to 6 months were seen following ESG.</p><p><strong>Conclusion: </strong>When compared to ESG at 6 months, LSG provides an improvement in total body weight loss, has a reduced operative time, and is associated with dramatic metabolic comorbidity improvement including a reduction in resolution of medication and insulin-dependent diabetes. No clinically meaningful comorbidity resolution was seen in patients receiving ESG compared to LSG at 6 months although this cohort was less comorbid at baseline.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196845","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":"Gastric peroral endoscopic pyloromyotomy for delayed gastric conduit emptying: outcomes and predictors of treatment response.","authors":"L S Boer, C A C 't Hoen, I N Beaufort, B A J Bastiaansen, P Fockens, L Noteboom, C M G Saleh, S S Gisbertz, B L A M Weusten","doi":"10.1007/s00464-026-13500-2","DOIUrl":"https://doi.org/10.1007/s00464-026-13500-2","url":null,"abstract":"<p><strong>Background: </strong>Delayed gastric conduit emptying (DGCE) is common in patients following esophagectomy, and its treatment remains challenging. This study evaluated efficacy and safety of gastric peroral endoscopic pyloromyotomy (GPOEM) and predictors of treatment response.</p><p><strong>Methods: </strong>We prospectively included patients with symptoms of DGCE following esophagectomy scheduled for GPOEM in two tertiary referral centers. EndoFLIP measurements were conducted before and 3 months after GPOEM. Gastric emptying scintigraphy (GES) was performed prior to, 3 and 12 months after GPOEM. Efficacy was evaluated by clinical success, defined as a score of 1 or 2 on a six-point Likert scale 3 months after GPOEM. Predictive factors for clinical success, including pyloric distensibility, GES and response to prior pylorus-directed therapy (botulinum injection and pyloric dilatation), were evaluated by exploratory analyses.</p><p><strong>Results: </strong>The technical success rate of GPOEM was 95% (19/20; 95% CI 75-100). At 3-, and 12-months post-procedure, the clinical success rates were 68% (13/19; 95% CI 37-84) and 44% (8/18; 95% CI 22-67). Distensibility prior to GPOEM did not differ significantly between patients with and without clinical success (3.7 vs. 4.0 mm²/mmHg, p = 0.70). Pre-GPOEM 4-h gastric retention was greater in patients with clinical success than those without, but this was not significant (33 vs 16%, p = 0.12). Although there was no significant association between prior response to pylorus-directed therapy and GPOEM success (p = 0.10), the positive and negative predictive value were 100% (9/9; 95% CI 66-100) and 40% (2/5; 95% CI 5-85).</p><p><strong>Conclusion: </strong>GPOEM is feasible and safe in patients with DGCE following esophagectomy, demonstrating initial efficacy in two-thirds of patients, although this declined to less than half at 1-year follow-up. In exploratory analyses, no predictors of treatment response were identified. Larger studies are needed to investigate if response to pylorus-directed therapy may predict an increased likelihood of treatment response.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196823","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":"Efficacy, safety, and cost of immediate versus on-demand endoscopic necrosectomy in infected necrotizing pancreatitis: a systematic review and meta-analysis.","authors":"Mohammad Al Hayek, Bisher Sawaf, Osamah Al Hayek, Mohammed Abu-Rumaileh, Elias Batikh, Mohamedhen Vall Nounou, Muhammed Elhadi, Mohammad Al-Haddad","doi":"10.1007/s00464-026-13433-w","DOIUrl":"https://doi.org/10.1007/s00464-026-13433-w","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound (EUS)-guided drainage is the standard of care for walled-off necrosis (WON); however, the optimal timing of subsequent endoscopic necrosectomy remains uncertain. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing immediate versus on-demand necrosectomy following EUS-guided drainage.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, and the Cochrane Library through March 2026 for RCTs comparing immediate (≤ 72 h) versus on-demand necrosectomy in adults with necrotizing pancreatitis. Primary outcomes were technical success, clinical success, and the proportion of patients undergoing necrosectomy. Secondary outcomes included length of hospital stay, costs, need for percutaneous or multigate drainage, and adverse events. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models.</p><p><strong>Results: </strong>Four RCTs comprising 215 patients, of whom 192 (89.3%) had WON, were included. Immediate and on-demand approaches demonstrated similar technical success (RR 1.01, 95%CI 0.98-1.05) and clinical success (RR 1.17, 95%CI 0.98-1.40). Immediate necrosectomy was associated with a higher proportion of patients undergoing necrosectomy (RR 1.65, 95%CI 1.13-2.41). No significant differences were observed in length of hospital stay, costs, need for additional drainage, procedure- or disease-related adverse events, mortality, bleeding, stent migration, or pneumoperitoneum.</p><p><strong>Conclusions: </strong>Immediate endoscopic necrosectomy did not demonstrate a consistent clinical advantage over an on-demand approach. Low- to very-low-certainty evidence suggests little or no difference in clinical efficacy or safety outcomes, while very-low-certainty evidence suggests that immediate necrosectomy may increase the proportion of patients undergoing necrosectomy. However, the magnitude and clinical significance of this effect remain uncertain. These findings should be interpreted cautiously given the limited number of randomized trials, modest sample sizes, and low or very low certainty of evidence for several outcomes.</p><p><strong>Trial registration: </strong>This study was prospectively registered in PROSPERO (CRD420261366884).</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196799","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":"Proprietary platform artificial intelligence-based segmentation of surgical videos facilitates review and rating of operative recordings.","authors":"Nathanael Haynes, William Archie, Blake Stephens, Damien Huckleberry, Lon Eskind, David Levi, Jose R Soto, Maria Baimas-George, Dionisios Vrochides","doi":"10.1007/s00464-026-13321-3","DOIUrl":"https://doi.org/10.1007/s00464-026-13321-3","url":null,"abstract":"<p><strong>Background: </strong>Implementation of artificial intelligence (AI) in surgery may revolutionize assessment of operative techniques through video capture, auto-segmentation and auto-analysis. The aim of this study was to utilize recordings of a highly standardized surgical intervention, testing the ability of commercially available AI software to auto-segment operative footage in a clinically meaningful way.</p><p><strong>Methods: </strong>Twenty-five critical steps in liver graft back-table preparations for connection to a commercially available normothermic perfusion liver pump were determined. Five operative videos were captured manually edited. In addition, using the AI-based GoPro auto-edit feature, the last two recordings were auto-segmented for separate analysis and comparison against the manually edited footage. Each manual and auto-segmented video was assessed for: a) inclusion of each one of the 25 steps, (b) technical performance and completion. The assessment was conducted by an independent experienced transplant surgeon using a modified Likert scale (0-not captured, 1-poor, 2-average, 3-excellent).</p><p><strong>Results: </strong>Reviewing and rating AI auto-segmented videos was 16 times faster compared to raw video review. Reviewing and rating AI auto-segmented videos was 96 times faster compared to manually segmented recordings, accounting for time needed to edit raw videos. The average number of steps captured between both raw videos and the manually edited videos was 22.5. The average number of steps captured across the AI auto-segmented videos was 19.5 (87%). The average technical grade for the raw and the manually edited videos was 2.58 ± 0.71, and 2.14 ± 0.99 for the AI auto-segmented videos, denoting a rating congruency of 82.9%.</p><p><strong>Conclusion: </strong>AI-based auto-segmentation is an attractive tool for assessment of surgical performance, as it significantly expedites the editing process to prepare footage for review by subject matter experts. To which extent this approach will be applicable outside highly standardized surgical interventions must be further studied.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196877","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 medium-weight vs heavy-weight mesh in minimally invasive extraperitoneal ventral hernia repairs.","authors":"Ayesha Siddiq, Nicolette M Winder, Xinyan Zheng, Jeffrey Marks, Joshua L Lyons, Samuel J Zolin","doi":"10.1007/s00464-026-13476-z","DOIUrl":"https://doi.org/10.1007/s00464-026-13476-z","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive (MIS) extraperitoneal ventral hernia repair (VHR) has become increasingly common, however, limited data exist comparing medium-weight (MW) versus heavyweight (HW) mesh in this setting. We hypothesized that HW mesh in this context would be associated with decreased rates of hernia recurrence at 1 year and beyond compared to MW mesh.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of prospectively collected data from the Abdominal Core Health Quality Collaborative database, identifying adults who underwent MIS extraperitoneal (preperitoneal and/or retromuscular) VHR with either MW (40-60 g/m²) or HW (> 75 g/m²) uncoated permanent synthetic mesh from the inception of the registry to May 2025, with ≥1 year clinical or patient-reported follow-up. Propensity score matching was used to adjust for imbalances in baseline patient characteristics. The primary outcome was 1-year pragmatic hernia recurrence, defined as recurrence based on available elements of patient-reported, clinical and/or radiographic recurrence. Secondary outcomes included 30-day surgical site infection (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI).</p><p><strong>Results: </strong>821 patients were identified. After propensity score matching, 238 patients remained (119 MW, 119 HW). Most baseline covariates were well-matched. Patients with umbilical hernias were more likely to receive MW mesh (80% vs. 65%, p =0.009), while patients receiving HW mesh were more likely to have subxiphoid hernias (5.9% vs 15%, p =0.020). There were no documented SSI at 30 days. The rates of SSO (p =0.696), SSOPI (p =0.498), and 30-day reoperation (p =0.999) were similar between groups. At 1-year, pragmatic recurrence was similar between MW and HW patients (7.6% vs 12.6%, p =0.196).</p><p><strong>Conclusions: </strong>MW and HW mesh demonstrate comparable early and mid-term outcomes following MIS extraperitoneal VHR. Further prospective study and long-term follow-up are necessary as these techniques proliferate.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196853","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}