Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Assessing patient satisfaction in a novel frontier: the model of ambulatory surgery center in rural eastern Uganda.","authors":"Brittany Sacks, Angellica Giibwa, Denis Hilary, Anna Kalumana, Michael L Marin, Linda P Zhang","doi":"10.1007/s00464-025-12183-5","DOIUrl":"https://doi.org/10.1007/s00464-025-12183-5","url":null,"abstract":"<p><strong>Background: </strong>Standalone ambulatory surgery centers (ASCs) are still an innovative concept in most low- and middle-income countries (LMICs), and patients' satisfaction with this model remains uninvestigated. In the US, patient satisfaction with ASCs is assessed by the validated Consumer Assessment of Healthcare Providers and Systems (CAHPS). This study leveraged the CAHPS to quantify patient satisfaction of ASCs in rural Uganda and assess key patient-related and institutional correlates.</p><p><strong>Methods: </strong>This prospective study was conducted at Kyabirwa Surgical Center (KSC), the first standalone ASC in rural Eastern Uganda, where patients were interviewed postoperatively regarding their perioperative experiences. A modified version of CAHPS with appropriate internal consistency was used to evaluate satisfaction, and SPSS 26 was used for binomial regression analyses.</p><p><strong>Results: </strong>Among 124 patients, 120 (97%) reported satisfaction across all care stages, scoring ≥ 80% on the modified CAHPS instrument. This level of satisfaction aligns with top-performing U.S. hospitals and resource-limited settings, where satisfaction rates have been as low as 33% and 8%, respectively. The mean age of the sample was 46 (SD = 16.3) and 70% of patients were male. Satisfaction was more prevalent among patients who had visited another healthcare facility within 2 months (p = 0.046); dissatisfaction was more prevalent among patients who felt providers didn't proactively give diagnoses or advice (p = 0.028), suggest exams (p = 0.028), or prepare them for recovery (p = 0.004). Significant barriers to care included 38.7% expressing insufficient income to address basic needs, 69.3% experiencing severe or very severe symptoms before presenting to KSC, and 33.1% having difficulty accessing the facility. Patients suggested improvements in staffing, wait times, a canteen, and beds in waiting areas.</p><p><strong>Conclusion: </strong>The ASC model can result in high patient satisfaction in rural, resource-limited LMICs, confirming its capability to fulfill patient expectations despite diverse living conditions, travel constraints, and lifestyle circumstances.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Robotic versus laparoscopic approaches to neonatal annular pancreas: a comparative analysis of surgical outcomes and innovation trade-offs.","authors":"Yuanzhu Gan, Zebing Zheng, Huijuan Wang, Yu Liao, Zeping Li, Chengyan Tang, Daiwei Zhu, Xingrong Xia, Lu Huang, Qing Du, Wankang Zhou, Yuan Gong, Xilin Liao, Yuanmei Liu, Zhu Jin","doi":"10.1007/s00464-025-12265-4","DOIUrl":"10.1007/s00464-025-12265-4","url":null,"abstract":"","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150603","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":"Risks and benefits of delaying hernia repair in patients with obesity: a retrospective case series of emergent hernia cases.","authors":"Helen W Li, Maya Weerasooriya, William Gerull, Arnab Majumder, Danny Mou, Jeffrey Blatnik","doi":"10.1007/s00464-025-12211-4","DOIUrl":"https://doi.org/10.1007/s00464-025-12211-4","url":null,"abstract":"<p><strong>Background: </strong>Emergent abdominal wall hernia repair is associated with higher rates of morbidity and mortality compared to elective repair. Patients with significant medical comorbidities, such as morbid obesity, experience higher rates of surgical site complications and hernia recurrence. Experts recommend pre-operative optimization to minimize complication risks; however, few guidelines exist for balancing optimization with the risks of a potential emergent operation. We sought to delineate the outcomes of patients who underwent urgent hernia repair at our center with specific attention to those who attempted pre-operative optimization.</p><p><strong>Methods: </strong>We performed a retrospective chart review of all patients who required emergent or urgent abdominal wall hernia repair with the division of Minimally Invasive Surgery, as identified through emergent or urgent case requests submitted at our tertiary academic medical center from 2018 to 2023. We utilized descriptive statistics to characterize patient demographics, hernia characteristics, prior medical history, operative details, and post-operative outcomes.</p><p><strong>Results: </strong>Of the 58 total patients enrolled, we noted multiple operative risk factors including advanced age (62 years ± 14.5), high BMI (32.9 kg/m²), numerous medical comorbidities, and high rates of incisional hernias. 20 (34%) patients were previously evaluated in our MIS clinic prior to their urgent repair, and 12 (60%) of these patients had surgery deferred for excess weight. Some patients attended multiple clinic visits, but there were no significant trends between the number of prior visits and weight change. 37 (64%) patients did not receive definitive mesh repair. Of these, 20 (54%) cases cited concern for a contaminated field. Of the total group, 16 (33%) patients ultimately developed a recurrent hernia, including 3 patients who underwent a mesh repair and 13 patients who did not receive a mesh repair.</p><p><strong>Conclusion: </strong>The timing of an abdominal wall hernia repair remains challenging, particularly in patients with morbid obesity. For these high-risk patients, recognizing decreasing gains in pre-operative weight optimization is a key for avoiding unproductive delays of definitive repair.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150825","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 impact of BMI on frailty screening and the frailty phenotype in ventral hernia patients.","authors":"Braxton Goodnight, Danielle Wilder, Ashley Huggins, Cameron Casson, Tim Holden, Arnab Majumder, Jeffrey Blatnik, Sara E Holden","doi":"10.1007/s00464-025-12260-9","DOIUrl":"https://doi.org/10.1007/s00464-025-12260-9","url":null,"abstract":"<p><strong>Background: </strong>Ventral hernia repair (VHR) is a common procedure, but assessing surgical candidacy remains complex, particularly in the setting of obesity. Frailty is a well-established predictor of poor surgical outcomes and is traditionally associated with underweight phenotypes. However, obesity is increasingly recognized as a risk factor for frailty as well. Given the lack of consensus on the optimal frailty screening tool and the high prevalence of obesity in the VHR population, understanding how frailty presents in VHR patients with high BMI is essential. This study examines how obesity influences the frailty phenotype in VHR patients and evaluates how different screening tools classify frailty in this population.</p><p><strong>Methods: </strong>Patients evaluated for VHR at an academic medical center between January and June 2023 were prospectively enrolled. Frailty was assessed using the Modified Frailty Index (mFI-11), Fried Frailty Index (FFI), FRAIL Scale, and SARC-F. The association between BMI and each frailty screening tool was assessed.</p><p><strong>Results: </strong>Sixty-two patients were enrolled (mean age: 60 years, mean BMI: 32.5 kg/m², 58% obese). BMI demonstrated weak positive correlations with FFI (r = 0.284, p = 0.026) and FRAIL Scale (r = 0.332, p = 0.008). In univariate regression, higher BMI was significantly associated with screening positive on FRAIL Scale (OR: 1.10, 95% CI: 1.02-1.21) and SARC-F (OR: 1.09, 95% CI: 1.01-1.19). In multivariate regression, BMI independently predicted FRAIL Scale positivity (aOR: 1.44, 95% CI: 1.06-1.95) but no other frailty screening tools. Higher BMI was also significantly associated with specific frailty components, including fatigue and mobility limitations.</p><p><strong>Conclusion: </strong>Frailty is highly prevalent in obese VHR patients, and high BMI increases the risk of presenting with functional mobility impairments. Frailty screening tools vary in their ability to capture these functional limitations. Future research is needed to compare the ability of different frailty screening tools to predict postoperative outcomes in larger VHR cohorts.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150744","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":"Real-time image-guided and computer augmented reality in minimally invasive hepatopancreatobiliary surgery cutting edge technology transforming HPB surgery.","authors":"Camila Ortiz Gomez, Jason Hawksworth, Christoph Tschuor, Nobuyuki Takemura, Daisuke Fukumori, Erin Baker, Osamu Yoshino","doi":"10.1007/s00464-025-12202-5","DOIUrl":"https://doi.org/10.1007/s00464-025-12202-5","url":null,"abstract":"<p><strong>Background: </strong>The minimally invasive hepatopancreatobiliary (MI-HPB) surgery demands a greater depth of concentration and a thorough understanding of anatomy, along with advanced technical skills for precise tissue manipulation. Robotic surgery, with its precision and refined control, is increasingly replacing conventional laparoscopic approaches in MI-HPB procedures. Modern robotic systems serve as intuitive extensions of the surgeon's hands, offering exceptional dexterity and enhanced sensory feedback, though they remain functionally limited in some respects. The integration of augmented reality features is now feasible and holds promise as a safety enhancement, providing real-time intraoperative support to surgeons.</p><p><strong>Method: </strong>In this review article, we describe currently available real-time image technologies and their clinical applications in HPB surgery, including an indocyanine-green fluorescence view, integrated intraoperative ultrasound using a miniature drop-in probe, and novel 3D simulation imaging system.</p><p><strong>Results: </strong>The technology described in this article is readily available to support surgeons in perceiving and understanding relevant anatomy and serves as a navigation system in surgery. Technology and its users are mutually intertwined, continuously shaping and influencing one another.</p><p><strong>Conclusion: </strong>These innovations are not only redefining safety standards in minimally invasive HPB surgery but also ushering in a new era of digital surgery in HPB through increasingly advanced application of augmented reality.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150561","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":"Cord lipoma: how does it impacts on MIS inguinal hernia repairs.","authors":"Christiano Marlo Paggi Claus, João Bora Ruggeri, Danielle Keith Ono, Julio Coelho","doi":"10.1007/s00464-025-12259-2","DOIUrl":"https://doi.org/10.1007/s00464-025-12259-2","url":null,"abstract":"<p><strong>Introduction: </strong>Despite advances in understanding anatomy and steps for MIS inguinal hernia repair, controversies still remain. Spermatic cord lipoma (SCL), which is easily recognized in open repairs, has been neglected in MIS repairs. SCL has been considered the main cause of misdiagnosis of \"hernia recurrence\" after MIS.</p><p><strong>Aim: </strong>Purpose of this study was to evaluate the incidence of SCL and the implications of its dissection on postoperative outcome.</p><p><strong>Methods: </strong>Prospective cohort study of 200 consecutive patients who underwent MIS repairs between May 2022 and October 2023. Visual Analogue Scale (VAS) for pain and complications is evaluated.</p><p><strong>Results: </strong>Three hundred and eleven hernias were repaired. SCL was found in 39% of patients and in 37.6% of hernia repairs. BMI was significantly associated with the probability of having SCL. The risk of patients with BMI >30 was 2.84 times higher than those with BMI <30. Gender or EHS hernia classification was not related to the incidence of SCL. Mean additional time to dissect the lipoma was 2.6 min, which represents only 4% of total time. Although VAS in the inguinal region was statistically higher (or showed statistical trend) in the postoperative evaluations comparing lipoma dissection versus no lipoma groups (0.5 vs. 0.2; 1.3 vs. 1.0; 0.3 vs. 0.1 on days 7 and 30 and at 6 months, respectively), from a clinical point of view, this difference can be considered not relevant (mean difference inferior than 0.5 points on VAS). For the testicular region, there was no difference in VAS between the groups. There was no difference regarding complications comparing the lipoma dissection group versus no lipoma.</p><p><strong>Conclusion: </strong>Incidence of SCL is high in patients undergoing inguinal hernia repair, even higher in obese patients, and cannot be \"missed\" during the surgery. SCL dissection is simple and does not significantly increase operative time or cause perioperative surgical complications.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150411","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":"Cutting through the p-value: evaluating clinical relevance in surgical literature analyzing the approaches for inguinal hernia repair.","authors":"Carlos A Balthazar da Silveira, Ana Caroline D Rasador, Raquel Nogueira, Shan Lansing, W Scott Melvin, Vahagn Nikolian, Diego Camacho, Leandro T Cavazzola, Diego L Lima","doi":"10.1007/s00464-025-12213-2","DOIUrl":"https://doi.org/10.1007/s00464-025-12213-2","url":null,"abstract":"<p><strong>Background: </strong>The introduction of evidence-based medicine has challenged many concepts. In analyzing comparative study results, it is common to find narratives highlighting favorable outcomes based on a p-value of < 0.05, without understanding the clinical impact of the observed difference. Given the prevalence of this issue in hernia surgery research, we aimed to evaluate the prevalence of studies reporting a cutoff for clinical relevance in published comparisons of open, laparoscopic, and robotic inguinal hernia repair (IHR).</p><p><strong>Methods: </strong>We searched Hernia, Surgical Endoscopy, Annals of Surgery, Surgery, World Journal of Surgery, and JAMA Surgery for articles comparing open, laparoscopic, and robotic IHR. Our search was performed according to the recent guidelines, comprising articles published since 2018. Articles analyzing non-clinical outcomes, such as cost-effectiveness, were excluded. Two authors independently screened the articles analyzing the presence of a clinical relevance cutoff definition of statistical significance, and if it suggested a superiority of a technique among others based solely on the p-value.</p><p><strong>Results: </strong>The initial search resulted in 62 articles, of which 8 were excluded, resulting in 54 included manuscripts. Among the included studies, 8 (14.8%) were randomized controlled trials (RCTs), while 46 (85.2%) were comparative cohort studies. Surprisingly, none of the studies defined a clinical relevance cutoff for the outcomes analyzed. Furthermore, only 6 (11.1%) studies highlighted that their findings may not be of clinical relevance. However, even among those 6 studies, 3 (50%) suggested a superiority of the approach based solely on the p-value, while the other 3 (50%) studies, despite finding a statistically significant difference, did not make this suggestion. 16 (29.6%) studies showed no statistically significant differences between the groups, but 2 (12.5%) of those still suggested a superiority of one of the surgical approaches. Among the RCTs, only 1 (12.5%) reported that their findings may not be of clinical relevance, while 1 (12.5%) suggested a benefit despite not finding statistically significant results.</p><p><strong>Conclusion: </strong>Our study, encompassing the main journals in the surgical literature, demonstrated that the distinction between statistical and clinical relevance in hernia surgery, even in RCTs, remains inadequately addressed. There is a need for studies to define what difference in association measure is necessary to achieve clinical relevance for key outcomes in hernia surgery, such as recurrence, wound-related morbidity, and postoperative pain.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131916","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":"External validation of tampa difficulty scoring system for robotic liver resection using Americas Minimally Invasive Liver Surgery Registry (AMILES).","authors":"Hasan Ai-Harakeh, Sharona B Ross, Kristina Milivojev Covilo, Melanie Mendez, Edwin Onkendi, Mihir Shah, Parit T Mavani, Patricio Polanco, John Martinie, David Iannitti, Melissa Hogg, Sarah Hays, Syed Abbas Mehdi, Scott Helton, David Geller, Kerri Simo, Kevin El-Hayek, Susanne Warner, Hallbera Gudmundsdottir, Sean Cleary, Adnan Alseidi, Samer Tohme, Samy Castillo, Garnet Vanterpool, Giuseppe Esposito, Iswanto Sucandy","doi":"10.1007/s00464-025-12191-5","DOIUrl":"https://doi.org/10.1007/s00464-025-12191-5","url":null,"abstract":"<p><strong>Background: </strong>The adoption of robotic hepatectomy continues to expand due to its technical advantages over conventional laparoscopy. The Tampa Difficulty Score (TDS) was the first scoring system designed specifically to predict the technical complexity of robotic hepatectomy and assist in preoperative planning. Following its internal validation, external validation is necessary to assess its accuracy and applicability across different institutions and patient populations. This study aimed to externally validate the TDS using data from the Americas Minimally Invasive Liver Surgery Registry (AMILES).</p><p><strong>Methods: </strong>With Institutional Review Board (IRB) approval, a retrospective analysis was conducted on AMILES registry patients who underwent robotic hepatectomy for liver tumors between 2019 and 2024. After excluding cases with missing data, 147 patients were analyzed using the TDS. Key clinical variables were compared across TDS groups, with data presented as frequency (%) and median (mean ± standard deviation). Statistical significance was set at p ≤ 0.05.</p><p><strong>Results: </strong>Patients were stratified into four TDS groups: Group 1 (Less demanding, n = 19), Group 2 (Intermediate, n = 105), Group 3 (More demanding, n = 18), and Group 4 (Most demanding, n = 5). While demographic and preoperative variables were comparable, Child-Pugh scores trended higher with increasing TDS. Estimated blood loss varied significantly across the groups (p < 0.0003).</p><p><strong>Conclusion: </strong>TDS effectively stratifies the complexity of robotic hepatectomy and correlates with intraoperative and postoperative outcomes. Its external validation across North American institutions confirms its utility in preoperative planning and risk assessment.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132005","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":"Open preperitoneal abdominal wall reconstruction (AWR) for patients with deep inferior epigastric perforator (DIEP) or transverse rectus abdominis myocutaneous (TRAM) flap hernias.","authors":"Alynna J Wiley, Alexis M Holland, William R Lorenz, Brittany S Mead, Gregory T Scarola, Kent W Kercher, Sullivan A Ayuso, Vedra A Augenstein, B Todd Heniford","doi":"10.1007/s00464-025-12216-z","DOIUrl":"https://doi.org/10.1007/s00464-025-12216-z","url":null,"abstract":"<p><strong>Background: </strong>Donor site hernias or eventrations are a known complication of DIEP or TRAM flap breast reconstruction. Surgical management of these complex hernias can be challenging due to missing or atrophic rectus muscle. The purpose of this study was to evaluate outcomes of preperitoneal AWR in patients with a history of DIEP or TRAM flap hernias.</p><p><strong>Methods: </strong>and procedures. A prospectively-maintained institutional database was queried for patients undergoing open preperitoneal ventral hernia repair (OVHR) with DIEP or TRAM flap hernias. Patient demographics, operative details, and wound complications were analyzed descriptively.</p><p><strong>Results: </strong>A total of 35 patients met inclusion criteria. All patients were women, and the majority had a TRAM flap hernia (68.6%). The average age was 58.6 ± 10.2 years, and mean BMI was 29.7 ± 4.1 kg/m². One quarter (25.8%) of patients had a history of smoking, 17.1% had diabetes, and 54.3% had history of prior, failed hernia repair. Preoperatively, there were 5.7% who received Botulinum A injections. The majority of the cases were clean (82.6%). The mean defect size was large at 222.8 ± 164.5cm² and mesh size averaged 839.7 ± 361.1cm². Synthetic mesh was used in most cases (80%). Fascial closure rate was 97.1% with 14.3% of cases requiring component separation technique. Postoperatively, 5.7% of patients experienced superficial wound breakdown, 5.7% experienced wound cellulitis, and 14.3% experienced a wound infection, two of which were required OR. There were 20.0% of patients who had a seroma requiring intervention. There was only a single mesh infection (2.9%) requiring mesh removal, accounting for half of the 5.7% who developed a hernia recurrence over a follow-up of 36.8 ± 48.2 months.</p><p><strong>Conclusions: </strong>DIEP and TRAM flap hernia management is complex due to missing or dysfunctional rectus muscle(s). A preperitoneal OVHR is an effective approach to repair these hernias with limited post-operative complications and low recurrences with long term follow up.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138680","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":"Intracholecystic versus intravenous indocyanine green for visualization of biliary anatomy during laparoscopic cholecystectomy: a randomized controlled study.","authors":"Anubhav Vindal, Durlabh J Gogoi, Manu Vats, Pawanindra Lal","doi":"10.1007/s00464-025-12164-8","DOIUrl":"https://doi.org/10.1007/s00464-025-12164-8","url":null,"abstract":"<p><strong>Background: </strong>Use of Indocyanine green (ICG) dye and near infrared fluorescence has been recently described for visualizing the extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC). The popular route for administration of ICG is intravenous (IV), 30-60 min before surgery. Direct injection of ICG into gall bladder (intracholecystic) (IC) is not commonly used. This study is designed to compare these two routes of ICG for visualization of extrahepatic biliary anatomy.</p><p><strong>Methods and procedure: </strong>Forty patients undergoing elective LC were included and randomized into two groups of 20 patients each: IV-ICG and IC-ICG. In the IV-ICG group, ICG was administered in a dose of 0.01 mg/kg, 30-45 min before induction of anesthesia. In the IC-ICG group, ICG was injected directly into the gall bladder fundus using an 18-gauge needle. The two groups were compared with respect to the time of appearance of fluorescence in the biliary tree. A 5-point score was designed to compare the visualization of the biliary anatomy in the two groups.</p><p><strong>Results: </strong>The mean visualization score in the IV-ICG group was 4.25 ± 1.17, while that in the IC-ICG group was 4.1 ± 1.18. The cystic duct could be delineated pre-dissection in 70% patients in IV-ICG and in 85% patients in IC-ICG, which changed to 85% and 95%, respectively, after dissection of Calot's triangle. IV-ICG was found to be better at delineating the common hepatic duct (85%) compared to IC-ICG (45%), while CBD could be seen in 95% and 100% patients, respectively. Two patients in the IC-ICG group had minor leakage of bile from the puncture hole in the fundus.</p><p><strong>Conclusions: </strong>This study found that the IC-ICG provides a faster visualization of extrahepatic biliary ducts during LC, with a better signal-to-background ratio compared to the IV-ICG. It can be utilized immediately without the need to wait for the dye to be excreted by the liver.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138589","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}