Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Efficacy of prophylactic hemoclip placement for preventing delayed post-polypectomy bleeding in nonpedunculated colorectal lesions: updated meta-analysis and trial sequential analysis of randomized controlled trials.","authors":"Yaping Wei, Haojie He, Hawa Suleiman Mabenga, Brenda John Ngowi, Zheng Jin","doi":"10.1007/s00464-026-13452-7","DOIUrl":"https://doi.org/10.1007/s00464-026-13452-7","url":null,"abstract":"<p><strong>Background and aims: </strong>Evidence regarding prophylactic hemoclip (HC) for preventing delayed post-polypectomy bleeding (DPPB) remains inconsistent. This meta-analysis with trial sequential analysis (TSA) aimed to evaluate HC after thermal resection of nonpedunculated colorectal polyps.</p><p><strong>Methods: </strong>MEDLINE, Embase, and the Cochrane Library were searched through 28 July 2026 for randomized controlled trials (RCTs) comparing HC with non-HC after thermal resection of nonpedunculated colorectal polyps ≥ 5 mm. The primary outcome was DPPB. Secondary outcomes included DPPB for proximal large (≥ 20 mm) nonpedunculated colorectal polyps (LNPCPs), other adverse events, and procedure time. Random-effects models, subgroup analyses, GRADE, and TSA were applied.</p><p><strong>Results: </strong>Ten RCTs involving 4,588 patients were included. HC reduced DPPB overall (3.4 vs. 6.5%; RR 0.51; 95% CI 0.34-0.76; P < 0.001; I² = 45%; GRADE: High) and after resection of proximal LNPCPs (4.4 vs. 8.1%; RR 0.54; 95% CI 0.32-0.91; P = 0.02; I² = 52%; GRADE: moderate). TSA supported both findings. Patients receiving antithrombotic therapy may experience greater absolute risk reduction because of higher baseline bleeding risk. HC was also associated with reduced DPPB in adenomatous lesions; however, interaction tests were nonsignificant, and subgroup findings remain exploratory. Other outcomes did not differ significantly.</p><p><strong>Conclusions: </strong>Prophylactic HC closure reduces DPPB after thermal resection of nonpedunculated colorectal polyps ≥ 5 mm, including proximal LNPCPs. Clinical use should consider lesion characteristics, procedural factors, and individualized bleeding risk.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184385","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 100 consecutive minimally invasive operations for median arcuate ligament syndrome: a single surgeon experience.","authors":"Gabriela V Lozano, Nevyn A Santillan, Elliot I Shiwota, Steve C Chen, Daniel Shouhed","doi":"10.1007/s00464-026-13364-6","DOIUrl":"https://doi.org/10.1007/s00464-026-13364-6","url":null,"abstract":"<p><strong>Introduction: </strong>Reported outcomes after surgical treatment for Median Arcuate Ligament Syndrome (MALS) vary, with treatment success ranging from 40 to 90.3%. We describe our diagnostic algorithm, predictors of success, and evaluate the safety and efficacy of surgical treatment by a single surgeon through a robotic-assisted approach.</p><p><strong>Methods and procedure: </strong>Retrospective chart review was performed for patients who underwent minimally invasive surgery for MALS from November 2016 to October 2024. 100 consecutive patients qualified for inclusion. Patients undergoing revisional surgery after a primary procedure by another surgeon were excluded. Patients were diagnosed with MALS based on CT/MR abdomen/pelvis, mesenteric duplex, or positive response to a celiac nerve ganglion block (CGNB), and clinical symptoms. Data on patient demographics, preoperative evaluation, peri- and postoperative outcomes were collected.</p><p><strong>Results: </strong>All patients underwent minimally invasive celiac artery decompression and median arcuate ligament release. Ninety five also underwent celiac ganglion nerve plexus resection. Average age was 29 years. Mean operative time was 126 min. Average length of stay was 2.8 days. There were three intraoperative complications, including one conversion to open surgery, and one postoperative complication, which required reoperation for chylous ascites. Average length of follow-up was 10.7 months (range 2 weeks to 5.8 years). 94.9% experienced relief of chronic abdominal pain. Only five patients did not experience any improvement. Forty seven patients presented with chronic epigastric abdominal pain worsened with all foods, significant weight loss (> 10 pounds), and a CGNB that provided relief, of which 95.7% experienced significant(≥ 50%) postoperative pain score improvement.</p><p><strong>Conclusion: </strong>In this series of 100 patients, 94 experienced symptomatic relief after surgical treatment for MALS. Proper patient selection and accurate diagnosis are crucial for successful outcomes. Patients with classic symptoms of MALS, namely, epigastric abdominal pain with all foods, significant weight loss, and relief with a preoperative CGNB, will have a 95% chance of symptomatic improvement.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184380","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":"EAES-SAGES clinical practice guideline update: multi-society recommendations on key controversies in the management of diverticular disease.","authors":"Bright Huo, Maher Al Khaldi, Dena Shehata, Elisa C Calabrese, Caroline Reinke, Francesco Carrano, Stephanie Breukink, Andreas M Kaiser, James Kimble, Nicole Buchenholz, Irene Marafini, Walter Biffl, Fausto Catena, Frank Frizelle, Triantafyllos Doulias, Antonio Tursi, Sophie Miller, Iro Ntaga, Justin Dourado, Joe Broderick, Gita Lingam, Anse de Sadeleer, Elizabeth Barbera, Xiaomei Yao, Gordon Guyatt, Marina Yiasemidou, Danique Heuvelings, Richard Garfinkle, Maria Abou-Khalil, Bethany J Slater, Stavros A Antoniou, Nicole Bouvy, Patricia Sylla, Nader Francis, Marylise Boutros","doi":"10.1007/s00464-026-13296-1","DOIUrl":"https://doi.org/10.1007/s00464-026-13296-1","url":null,"abstract":"<p><strong>Background: </strong>We identified areas of controversy in the management of patients with diverticular disease to develop key questions addressing the management of symptomatic uncomplicated diverticular disease (SUDD), uncomplicated diverticulitis, and complicated diverticulitis.</p><p><strong>Methods: </strong>We performed a systematic review to identify randomized trials and cohort studies addressing our key questions. Informed by an updated evidence synthesis, an international, multidisciplinary panel of gastrointestinal surgeons, gastroenterologists, patient partners, and methodologists applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework during panel consensus meetings to derive recommendations for the management of patients with diverticular disease.</p><p><strong>Results: </strong>The systematic review identified 27 studies representing very low to moderate certainty evidence. The panel made the following recommendations: 1. In patients with SUDD, we suggest rifaximin or mesalamine over standard supportive care (conditional recommendation); 2. In patients with uncomplicated diverticulitis, we suggest no routine antibiotics (conditional recommendation); 3. In patients with persistent symptoms following an episode of recurrent uncomplicated diverticulitis, we suggest elective resection over observation (conditional recommendation); 4. In patients who have recovered from a first episode of uncomplicated diverticulitis, we suggest no routine follow-up colonoscopy (conditional recommendation); 5. In patients who have recovered from a first episode of diverticulitis complicated by an abscess, we suggest elective resection over surveillance (conditional recommendation). The panel judged that a significant proportion of patients would place a high value in reducing the risk of recurrence at 1 year but also acknowledged the lack of evidence addressing prioritized outcomes including 30-day major complications, need for emergency surgery, stoma-free survival at 1 year, and quality of life at 1 year. Given that patient values and preferences may vary, clinicians are encouraged to apply patient-centered decision-making and discuss the alternatives.</p><p><strong>Conclusion: </strong>This clinical practice guideline update provides evidence-informed recommendations to support patients and clinicians in the management of diverticular disease.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184394","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":"Robotic liver resection learning curves stratified by IWATE criteria.","authors":"Yee L Cheah, Michelle E McCarthy, Mohamed E Akoad, Yifan Wang, Caroline J Simon, Ashish Saharia, Constance M Mobley, Ashton A Connor, Roger L Jenkins, A Osama Gaber, R Mark Ghobrial","doi":"10.1007/s00464-026-13325-z","DOIUrl":"https://doi.org/10.1007/s00464-026-13325-z","url":null,"abstract":"<p><strong>Background: </strong>Characterizing the learning curve of robotic hepatectomy is important to facilitate safe adoption; however, variability in case complexity can confound the interpretation of non-stratified learning curve analyses. This study evaluated learning curves for robotic hepatectomy stratified according to procedural difficulty.</p><p><strong>Methods: </strong>We included consecutive robotic hepatectomies performed by a single surgical team at two institutions between 2017 and 2025. Cases were classified as low-, intermediate-, advanced-, and expert-level based on the IWATE criteria. Cumulative sum (CUSUM) analysis of operative time was performed to define the learning curve for each complexity level.</p><p><strong>Results: </strong>Among a total of 174 cases (31 low-, 70 intermediate-, 34 advanced-, and 39 expert-level), the median age was 63 years, and 57% of patients were female. Mean operative time correlated with case complexity, ranging from 165 min in low-level cases to 368 min in expert-level cases (p<0.0001). Throughout the study period, lower-complexity resections continued to be performed while progressively more complex procedures were incorporated. CUSUM analysis demonstrated distinct competency thresholds: 14 cases for low-difficulty procedures and 29 cases for intermediate-level cases. The learning curves were shorter for advanced- and expert-level resections: 17 and 23 cases, respectively. The overall non-stratified learning curve stabilized at 89 cases. The 90-day major morbidity rate was 4%, and overall complication rates were comparable between the pre- and post-competency cohorts.</p><p><strong>Conclusions: </strong>IWATE-stratified analysis identified distinct learning curves across procedural complexity levels. The shorter competency thresholds observed for higher-complexity resections suggest that experience gained during lower-complexity procedures accelerates proficiency in complex resections, resulting in overlapping rather than sequential learning curves. These metrics should be interpreted as estimates derived from a real-world practice with an evolving case mix, rather than successive milestones, and may provide a practical framework for implementing robotic hepatectomy.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184405","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":"Short-term outcomes of a novel anti-reflux biologic flap technique versus double flap technique after laparoscopic proximal gastrectomy: a retrospective cohort study.","authors":"Lindi Cai, Guanglin Qiu, Pengwei Zhao, Gan Li, Junxiang Zhang, Enmeng Li, Yongtai Ma, Yanjun Sun, Mengke Zhu, Xinhua Liao, Xiangming Che, Xuqi Li, Lin Fan","doi":"10.1007/s00464-026-13465-2","DOIUrl":"https://doi.org/10.1007/s00464-026-13465-2","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of proximal gastric cancer continues to rise. Proximal gastrectomy is effective in preserving a favorable postoperative nutritional status, but mitigating postoperative reflux esophagitis poses a formidable challenge.</p><p><strong>Method: </strong>We developed a novel anti-reflux procedure for laparoscopic proximal gastrectomy (LPG) using a biologic patch to construct a mechanical anti-reflux barrier, termed the biologic flap technique (BFT). In this retrospective cohort study, patients who underwent LPG at our center between January 2020 and June 2024 were reviewed. Among them, 25 received BFT reconstruction and 54 underwent double flap technique (DFT) reconstruction. Short-term outcomes of the patients were compared to evaluate the clinical application value of BFT.</p><p><strong>Results: </strong>Tumors were more frequently located at the esophagogastric junction and were larger in the LPG-BFT group than in the LPG-DFT group (60.0% vs. 27.8%, P = 0.006; median size 2.5 cm vs. 1.5 cm, P < 0.001). The median operation and anastomosis times were significantly shorter with LPG-BFT (170 min vs. 235 min and 28.0 min vs. 62.5 min, respectively; both P < 0.001). No statistically significant differences were observed in the rates of early and late postoperative complications between the groups, although anastomotic stenosis was less frequent in LPG-BFT (4.0% vs. 9.3%, P = 0.716). Multivariate analysis identified tumor location at the esophagogastric junction and the use of LPG-DFT as independent predictors of longer operation time. Los Angeles grade B or higher reflux esophagitis was observed in 8.7% of LPG-BFT patients and 7.5% of LPG-DFT patients (P = 1.000).</p><p><strong>Conclusion: </strong>BFT following LPG is a safe and feasible procedure that can reduce operation time and may provide an alternative for anti-reflux reconstruction when DFT is technically challenging. Favorable short-term clinical outcomes support further evaluation of BFT as an alternative reconstruction technique.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184482","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":"Long-term objective hiatal hernia recurrence after magnetic sphincter augmentation versus laparoscopic fundoplication: a multicenter cohort study of moderate and large hiatal hernias.","authors":"Shahin Ayazi, F P Buckley, John C Lipham, Philip Woodworth, Mark S Shachner, Carlos J Anciano, Vineeth Sadda, Kate Freeman, Rachel Heidrick, Reginald C W Bell","doi":"10.1007/s00464-026-13503-z","DOIUrl":"https://doi.org/10.1007/s00464-026-13503-z","url":null,"abstract":"<p><strong>Background: </strong>Recurrent hiatal hernia is a leading cause of long-term failure after antireflux surgery and the most common indication for revisional surgery. Although magnetic sphincter augmentation (MSA) has demonstrated favorable outcomes following repair of moderate and large hiatal hernias, its long-term anatomical durability compared with laparoscopic fundoplication remains unclear. We compared the durability of hiatal hernia repair following MSA versus fundoplication in patients with moderate and large hiatal hernias using objective assessment of postoperative hiatal hernia recurrence.</p><p><strong>Methods: </strong>This multicenter observational cohort study analyzed prospectively maintained registries from six high-volume foregut centers. Adult patients undergoing primary repair of moderate (3-5 cm) or large (> 5 cm or paraesophageal) hiatal hernias with MSA or laparoscopic fundoplication who underwent protocol-directed objective follow-up 3 years after surgery were included. The primary outcome was objective hiatal hernia recurrence. Secondary outcomes included GERD-HRQL, proton pump inhibitor use, patient satisfaction, and revisional surgery.</p><p><strong>Results: </strong>A total of 258 patients underwent antireflux surgery, including 196 (76.0%) treated with MSA and 62 (24.0%) with fundoplication. At 3 years, objective hiatal hernia recurrence was significantly lower following MSA than fundoplication (6.1% vs 21.0%; P = 0.002). On multivariable analysis, fundoplication was significantly associated with 3-year objective hiatal hernia recurrence (OR, 4.67; 95% CI, 1.11-19.59; P = 0.035). Despite lower recurrence after MSA, GERD-HRQL, dysphagia, bloating, patient satisfaction, and revisional surgery rates were similar between groups, whereas postoperative proton pump inhibitor use was lower following MSA (11.5% vs 27.5%; P = 0.022).</p><p><strong>Conclusions: </strong>MSA was associated with lower objective hiatal hernia recurrence than laparoscopic fundoplication, but patient-reported outcomes were similar between procedure groups. Long-term anatomical durability should be considered alongside patient-reported outcomes when selecting the optimal antireflux procedure.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184392","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 non-surgical versus upfront surgical management of ERCP-related perforations by Stapfer type: a systematic review and meta-analysis.","authors":"Eyad Jamileh, Omar Farooq, Mohamed Xamza, Daren Subar, Joel Lambert","doi":"10.1007/s00464-026-13504-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13504-y","url":null,"abstract":"<p><strong>Background: </strong>ERCP-related perforation is uncommon but potentially fatal, and optimal initial management remains uncertain across Stapfer subtypes. We compared initial non-surgical management with upfront surgery overall and by Stapfer type, retaining patients requiring rescue surgery within their original strategy.</p><p><strong>Methods: </strong>Databases were searched to 30 June 2026. Treatment success was standardised as survival to discharge without operative rescue after initial non-surgical management and survival to discharge after upfront surgery. Random-effects risk ratios (RRs) were pooled overall and by Stapfer type; certainty was assessed using GRADE.</p><p><strong>Results: </strong>Twenty-three retrospective studies included 681 perforations. In 15 reconstructable cohorts, initial-strategy success was 227/273 (83.2%) after initial non-surgical management and 75/89 (84.3%) after upfront surgery (RR 0.97, 95% CI 0.81-1.17; I² = 25%). Mortality was 16/273 (5.9%) vs. 14/89 (15.7%) (RR 0.53, 95% CI 0.25-1.15). Length of stay was heterogeneous and clinically inconclusive (MD 1.03 days, 95% CI - 3.35 to 5.40; I² = 83%; prediction interval - 11.24 to 13.30). Type I success (RR 1.04, 95% CI 0.77-1.41) and mortality (RR 1.47, 95% CI 0.56-3.86) were non-significant. Contemporary endoscopic closure succeeded in 10/10 highly selected Type I cases (100%; exact 95% CI 69.2-100.0%), but was too small to establish superiority. Type II success (RR 0.69, 95% CI 0.41-1.16) and mortality (RR 1.44, 95% CI 0.23-8.90) were also non-significant. Type III and IV non-surgical success was 46/49 (93.9%) and 34/34 (100%). Rescue surgery occurred in 14.3, 12.9, 5.4, and 0% of Types I-IV. Certainty was very low.</p><p><strong>Conclusion: </strong>Very-low-certainty evidence suggests management should be tailored to Stapfer subtype, physiological stability and source control, with prompt operative rescue when non-surgical management fails.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184387","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":"Tissue effects of advanced energy devices: a systematic review and descriptive analysis of vascular sealing and lateral thermal damage in human tissue.","authors":"D Marshall, N Kahar, C Challand, L Wyld","doi":"10.1007/s00464-026-13485-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13485-y","url":null,"abstract":"<p><strong>Introduction: </strong>Advanced energy devices such as bipolar and ultrasonic devices are used ubiquitously in all aspects of surgery. Despite studies demonstrating differences between animal and human tissues, existing human studies have only been conducted in terms of operative outcomes such as blood loss, with a paucity of data on vessel sealing and lateral thermal spread. This study aims to consolidate all existing literature on these characteristics for each device in human tissues to inform clinician decision making.</p><p><strong>Methods: </strong>A systematic review of the literature was carried out using PRISMA guidelines. Papers which discussed vessel sealing or lateral thermal spread with any methodology were included. Exclusion criteria included animal studies, conference abstracts or papers where full text English language papers were not available. Risk of bias was assessed using ROB2, ROBINS-I v2, CASP case-control and JBI case series checklists as appropriate for the study design. A descriptive analysis was undertaken.</p><p><strong>Results and discussion: </strong>Across the twenty-eight included studies, most vessel seals with bipolar and ultrasonic devices exceeded physiological burst pressures. Seal failures occurred unpredictably. Lateral thermal spread varied widely (0-7.64 mm) depending on the device and tissue examined as well as the testing methodology and definitions of lateral thermal spread. Due to substantial variation in study methods, direct statistical comparisons were not possible and a reliable device-to-device comparison cannot currently be made from the available literature. This highlights the need for standardized testing methodology. PROSPERO registration and full protocol availability: CRD420251239034.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184488","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":"Barriers and facilitators to implementing laparoscopic surgery in low- and middle-income countries: a systematic review using the consolidated framework for implementation research.","authors":"Ali Yasen Mohamedahmed, Mohammed A Adam, Seddig Adam Jebril Saleh, Malaz A E Dafallah, Omar Elfaroug Salim, Kayla Bagg, Johnelize Louw, Tiffany E Chao, Kathryn Chu","doi":"10.1007/s00464-026-13414-z","DOIUrl":"https://doi.org/10.1007/s00464-026-13414-z","url":null,"abstract":"<p><strong>Background: </strong>Although laparoscopic surgery delivers substantial clinical benefits, its adoption across low- and middle-income countries (LMICs) remains inconsistent and incomplete. This systematic review aims to synthesise the barriers and facilitators of laparoscopic surgery adoption within LMICs healthcare systems using the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Methods: </strong>A comprehensive systematic search was conducted in PubMed, MEDLINE, ScienceDirect, Embase, and Scopus to identify studies reporting barriers and facilitators to the adoption of laparoscopic surgery in LMICs, as defined by the World Bank classification. Data were extracted using standardised forms, and all implementation factors were mapped to CFIR domains. Additionally, a systematic thematic analysis was then conducted to refine and interpret the extracted data.</p><p><strong>Results: </strong>Across 18 studies, 417 factors were identified, including 222 barriers and 195 facilitators. Predominant barriers were high equipment costs (n = 24, 11%), structural limitations (n = 18, 8%), and limited training capacity (n = 27, 12%). Key facilitators included perceived clinical advantage (n = 26, 13%), institutional leadership engagement (n = 18, 9%), international collaboration (n = 13, 7%), and technical adaptability (n = 11, 6%). Inner-setting factors were most frequently represented (n = 114, 27%), reflecting institutional readiness as a critical determinant.</p><p><strong>Conclusions: </strong>Implementation of minimally invasive surgery in LMICs is shaped by barriers including infrastructure and training limitations and facilitators such as leadership, collaboration, and adaptability-with inner-setting factors most frequent, indicating that strengthening institutional readiness is pivotal. Strategic deployment of international partnerships and locally tailored implementation pathways can accelerate equitable access to this essential surgical innovation.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184348","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":"AI enhanced surgeons' faster responses to intraoperative bleeding in laparoscopic surgery: a preclinical randomized controlled trial.","authors":"Jing Zhang, He Cai, Junjie Zhang, Zixin Chen, Yang Zhou, Ran Hu, Ming Tang, Lingli Wu, Songlin Cai, Jianzheng Jie, Rui Shi, WenJing Gong, Bing Peng, Xin Wang","doi":"10.1007/s00464-026-13490-1","DOIUrl":"https://doi.org/10.1007/s00464-026-13490-1","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate an artificial intelligence (AI) model for real-time detection and tracking of intraoperative bleeding sites during laparoscopic surgery, and to evaluate whether AI assistance improves surgeons' bleeding‑identification performance.</p><p><strong>Methods: </strong>From January to September 2023, laparoscopic surgical videos were retrospectively collected from 20 medical centers in China. Senior surgeons identified bleeding events, extracted relevant video clips, and manually annotated bleeding frames to train the AI model. Model performance was evaluated using the F1-score, mean absolute error (MAE), and mean distance error (MDE). A preclinical randomized controlled trial was subsequently conducted. Eligible surgeons were randomly assigned to the AI-assisted (experimental) group or the control group. The primary outcome was reaction time, defined as the time elapsed from the onset of bleeding to the participant's first successful click on the bleeding site.</p><p><strong>Results: </strong>A total of 257 laparoscopic surgical videos were collected from 20 medical centers. The training, validation, and test sets comprised 145 (56.42%), 55 (21.40%), and 57 (22.18%) videos, respectively. The model achieved an F1-score of 0.860 (95% CI, 0.838-0.878). The MAE was 3.315 (95% CI, 3.051-3.614), and the MDE was 0.087 (95% CI, 0.086-0.088). A total of 77 surgeons were randomly assigned to the experimental group (n = 38) and the control group (n = 39). Compared with the control group, the experimental group demonstrated a significantly shorter reaction time (2.53 s vs. 3.23 s, P < 0.001) and a lower negative emotion score (1.68 vs. 2.95, P < 0.001).</p><p><strong>Conclusion: </strong>The AI model achieves high accuracy in real‑time detection and tracking of bleeding‑site targets within laparoscopic surgical videos. Furthermore, AI‑assisted support significantly shortens surgeons' reaction time for bleeding‑site identification and reduces their negative emotional burden when confronted with bleeding events.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR2600118185).</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184360","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}