Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Comparison of endoscopic and radiologic drainage for symptomatic postoperative pancreatic fistula-associated collections after distal pancreatectomy.","authors":"Charlotte Rondé-Roupie, Safi Dokmak, Louis Romengas, Béatrice Aussilhou, Paul Rivallin, Gabriel Marcellier, Marco Dioguardi Burgio, Jeanne Dembinski, Vinciane Rebours, Frédéric Prat, Alain Sauvanet","doi":"10.1007/s00464-026-13497-8","DOIUrl":"https://doi.org/10.1007/s00464-026-13497-8","url":null,"abstract":"<p><strong>Background: </strong>After distal pancreatectomy (DP), symptomatic postoperative pancreatic fistula (POPF)-associated collections are common and lead to readmissions. The choice of drainage modality remains debated. This study compared endoscopic and radiologic drainage as first-line treatment.</p><p><strong>Methods: </strong>This retrospective, single-center study included patients undergoing DP with or without splenectomy from 2012 to 2024. Patients who underwent DP with a concomitant digestive or vascular procedure or pancreatic anastomosis were excluded. The primary outcome was total hospital stay, defined as the sum of the index hospitalization and readmissions.</p><p><strong>Results: </strong>Among 607 patients, 124 (20.4%) had POPF, including 94 (15.5%) with a symptomatic collection. Of these, 25 underwent endoscopic drainage (lumen-apposing metal stent, n = 19; double-pigtail stent, n = 6), 12 underwent radiologic drainage, and 57 received another treatment (medical treatment alone, n = 35; drain tract recanalization, n = 15; surgical reoperation, n = 4; endoscopic sphincterotomy, n = 3). The endoscopic and radiologic drainage groups were comparable, except for collection location adjacent to the pancreatic transection margin (endoscopic: 92% vs radiologic: 50%; p = 0.008). Total hospital stay within 90 days was shorter after endoscopic drainage (19 vs 31 days; p = 0.023), with no deaths within 90 days. The clinical success rate was higher after endoscopic drainage (76% vs 50%; p = 0.15), whereas drainage dysfunction was more frequent after radiologic drainage (17% vs 4%; p = 0.2). Four severe complications occurred: three after endoscopic drainage using a LAMS, including two hemorrhagic complications, and one after radiologic drainage. In univariable analysis, collection location adjacent to the pancreatic transection margin and endoscopic drainage were associated with shorter total hospital stay within 90 days (β = - 17 days; 95% CI - 29 to - 4.2; p = 0.010 and β = - 13 days; 95% CI - 24 to - 1.6; p = 0.026, respectively).</p><p><strong>Conclusions: </strong>After DP, first-line endoscopic drainage of symptomatic POPF-associated collections was associated with a shorter total hospital stay and a trend toward a higher clinical success rate but may carry a risk of bleeding.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167771","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":"Surgical outcomes and postoperative sexual function after vNOTES versus TU-LESS ovarian cystectomy: a randomized controlled trial.","authors":"Jiaxin Chen, Dan Feng, Tianjiao Liu, Xinyu Xiao, Min Xiang, Siqi Zeng, Han Hu, Yonghong Lin, Li He","doi":"10.1007/s00464-026-13501-1","DOIUrl":"https://doi.org/10.1007/s00464-026-13501-1","url":null,"abstract":"<p><strong>Objective: </strong>To compare surgical outcomes and sexual function after Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) versus transumbilical laparoendoscopic single-site surgery (TU-LESS) ovarian cystectomy.</p><p><strong>Design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>A university-affiliated tertiary women's and children's hospital.</p><p><strong>Population: </strong>160 women with benign ovarian cysts randomized 1:1 to vNOTES or TU-LESS.</p><p><strong>Methods: </strong>After written informed consent, candidates underwent two-step eligibility assessment before and after anesthesia to confirm suitability for both approaches. Participants were then randomly assigned to vNOTES or TU-LESS ovarian cystectomy. Perioperative outcomes were prospectively collected. Pain was assessed using a visual analogue scale at 12, 24, and 48 h. Cosmetic satisfaction was evaluated at 1 month, and sexual function was assessed preoperatively and at 3-6 months using the Female Sexual Function Index.</p><p><strong>Main outcome measures: </strong>Conversion, operative outcomes, complications, recovery, pain, cosmetic satisfaction, and sexual function.</p><p><strong>Results: </strong>No conversion occurred. Intraoperative complications, operative time, blood loss, postoperative complications (5.0% vs 3.8%), rescue analgesic use, wound events, incisional hernia, and postoperative FSFI scores between 3rd and 6th postoperative months were comparable between vNOTES and TU-LESS groups. vNOTES yielded lower pain scores at 12, 24, and 48 h, shorter total and postoperative hospital stay, and higher cosmetic satisfaction (all p < 0.001).</p><p><strong>Conclusion: </strong>vNOTES ovarian cystectomy demonstrated perioperative safety and postoperative sex function comparable to TU-LESS, while offering superior early postoperative pain control, shorter hospitalization, and better cosmetic satisfaction.</p><p><strong>Trial registration: </strong>ChiCTR2100053483, registered on 22 November 2021 ( https://www.chictr.org.cn/showprojEN.html?proj=136407 ).</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168146","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":"TRIDENT: inTRaoperative Imaging DEvice based on endogeNous opTical properties to evaluate bowel oxygenation in left-sided colorectal resections. Observational first-in-human pilot safety trial.","authors":"Alfonso Lapergola, Luca Baratelli, Gabriel Szydlo Shein, Guillaume Philouze, Sylvain Kpekou, Arturo Pardo, Frédéric Triponez, Didier Mutter, Sylvain Gioux, Michele Diana","doi":"10.1007/s00464-026-13429-6","DOIUrl":"https://doi.org/10.1007/s00464-026-13429-6","url":null,"abstract":"<p><strong>Background: </strong>Adequate tissue oxygenation at the anastomotic site is a key determinant of healing after colorectal surgery. Current intraoperative imaging technologies aimed at assessing bowel perfusion present several limitations, including the need for exogenous contrast agents, limited quantification capabilities, or suboptimal integration within the surgical workflow. Single Snapshot Imaging of Optical Properties (SSOP) is a contrast-free optical imaging technology capable of quantifying tissue oxygen saturation (StO₂) in real time. This first-in-human observational study aimed to evaluate the intraoperative safety and technical feasibility of SSOP imaging using the Trident system during left-sided colorectal resections.</p><p><strong>Methods: </strong>In this prospective, single-center feasibility trial, patients undergoing elective left-sided colorectal resection with primary anastomosis were enrolled. After bowel exteriorization, surgeons identified the intended proximal transection line based on their clinical judgement. SSOP imaging was then performed to quantify tissue oxygenation along the exposed colon segment before resection. The primary endpoints of the study were assessing the overall intraoperative safety and workflow feasibility of the Trident system. The secondary endpoint was to obtain wide-field oxygen saturation (StO₂) status images of exteriorized human colon and studying the relationship between oxygen saturation images and a priori surgeon-determined transection lines.</p><p><strong>Results: </strong>Between September 2023 and April 2024, 10 patients were enrolled (8 males; mean age 65.5 ± 11.8 years; mean BMI 27.5 ± 4.6 kg/m²). SSOP imaging was successfully completed in 9 patients. The mean time required for device positioning and image acquisition was 4.45 ± 0.53 min. Surgeons rated the overall workflow as excellent or good in 100% of cases and no sterility breaches occurred. Quantitative SSOP analysis demonstrated that a priori surgeon-defined transection lines coincided with regions presenting maximal oxygenation in one of the nine cases; in all other cases, transection lines were located well within perfused tissue or proximal to oxygenation transition zones identified by SSOP. No anastomotic leaks were observed.</p><p><strong>Conclusions: </strong>This first-in-human study demonstrated that SSOP imaging using Trident is safe, feasible, and compatible with standard surgical workflow during left-sided colorectal resections. The ability to provide real-time, quantitative, contrast-free mapping of bowel oxygenation may represent a promising tool for intraoperative perfusion assessment. Larger prospective studies are needed to evaluate whether SSOP-guided surgery can improve anastomotic outcomes (NCT05973227).</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166579","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":"Implementation of a single-port robotic platform into your colorectal surgery practice: a SAGES colorectal committee task force review of evolving robotic technology and innovations.","authors":"Ankit Sarin, Justin Dourado, Christopher M Seffren, Upinder S Sidhu, Poya Pourghaderi, Nathan Aminpour, Elisabeth C McLemore, Giovanni Dapri, Nawar A Alkhamesi, Sherief Shawki, Brooklyn Williams, Muhammed Elhadi, Scott Nguyen, Alison Wenholz, Patricia Sylla, Laila Rashidi","doi":"10.1007/s00464-026-13471-4","DOIUrl":"https://doi.org/10.1007/s00464-026-13471-4","url":null,"abstract":"<p><strong>Background: </strong>Robotic and endoscopic techniques continue to revolutionize minimally invasive surgery. Single-port (SP) robotic platforms mark a new era in minimally invasive colorectal surgery, combining single-incision/site access with full robotic articulation through a single access point. This manuscript, as a part of a four-part series, outlines specific technical considerations of the SP robotic platform including details of the platform, instrumentation, docking, and operative maneuvers.</p><p><strong>Methods: </strong>Subject matter experts from the SAGES Colorectal Committee SP Task Force performed a structured review of the currently FDA-approved SP robotic platform, assessing technical features, instrumentation, and workflow considerations for several key representative operations relevant to colorectal surgery. Three clinical areas of SP implementation included transanal robotic surgery, right colectomy, and low anterior resection (LAR). Task Force members (subject matter experts with early experience in SP robotic platforms) analyzed technical details, patient selection, and operative workflows. Representative procedural techniques were detailed with emphasis on instrumentation choice, docking strategies, and key operative steps specific to single-port colorectal surgery.</p><p><strong>Results: </strong>The technical aspects of the SP platform include full robotic articulation through a single 25 mm port. A SP approach also enables triangulation and dexterity within confined spaces using three wristed instruments and a flexible 3-D camera. The current 360-degree boom rotation facilitates multi-quadrant manipulation without redocking. Current limitations may include continued reliance on bedside assistance for certain energy and stapling operative steps, although stapling capability has expanded with FDA clearance of an SP-compatible 45 mm stapler as of April 2025. Training of the entire operative team and gradual progression of case complexity is recommended as the surgeon implements this new technology into clinical practice.</p><p><strong>Conclusions: </strong>A SP robotic approach to minimally invasive colorectal surgical procedures is feasible for a range of colorectal surgery operations. In select procedures like SP TAMIS, SP right colectomy, and SP-LAR, the single-port platform appears to offer advantages related to reduced invasiveness and improved surgeon ergonomics compared to other minimally invasive approaches. Successful implementation requires structured training, careful patient selection, and adherence to evidence-based adoption principles.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169721","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":"Modified Glissonean pedicle transection vs. hilar dissection in laparoscopic left hemihepatectomy for hepatolithiasis: a propensity score analysis (with video).","authors":"Zhi Liu, Yuping Yao, Yongzhi Chen, Chao Jiang, Wei Cheng, Bingzhang Tian","doi":"10.1007/s00464-026-13456-3","DOIUrl":"https://doi.org/10.1007/s00464-026-13456-3","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic anatomical liver resection for hepatolithiasis is frequently complicated by dense hilar adhesions. Traditional hilar dissection (LHDA) is associated with biliary and vascular injury, whereas the standard Glissonean approach can be compromised by stapler failure when impacted stones are present. This study assessed the safety and efficacy of a two-step laparoscopic modified Glissonean approach (LMGA) for left-sided hepatolithiasis.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated 215 consecutive patients who underwent laparoscopic anatomical left hemihepatectomy for hepatolithiasis between October 2018 and September 2025 (149 LHDA vs. 66 LMGA). Propensity score matching (1:1) yielded 48 well-balanced pairs. Perioperative outcomes, early liver function, stone clearance, and recurrence-free survival (RFS) were compared.</p><p><strong>Results: </strong>After matching, baseline characteristics were similar between groups. The LMGA group had a shorter median operative time than the LHDA group (275 vs. 315 min, P = 0.035) and lower AST levels on postoperative day 3 (40.75 vs. 69.95 U/L, P < 0.001). Blood loss, conversion rates, and morbidity were comparable. The residual stone rate was numerically lower with LMGA, though the difference did not reach statistical significance (2.1 vs. 14.6%, P = 0.065). RFS did not differ significantly between groups (log-rank P = 0.66). In univariable Cox analysis, Child-Pugh class B, elevated preoperative bilirubin, high AST, and longer operative time were associated with shorter RFS, whereas the surgical approach was not.</p><p><strong>Conclusions: </strong>The \"incise‑verify‑transect\" LMGA strategy offers a safe and efficient approach to laparoscopic left hemihepatectomy. Direct-vision clearance of impacted stones helps to reduce stapler-related risks, shorten operative time, and promote earlier functional recovery, without increasing perioperative morbidity.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171307","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 of the transanal approach with the accuracy of distal margin achievement in rectal cancer surgery.","authors":"Takuya Shiraishi, Mizuki Endo, Naoya Ozawa, Chika Komine, Takuhisa Okada, Akiharu Kimura, Akihiko Sano, Makoto Sakai, Ken Shirabe, Hiroshi Saeki","doi":"10.1007/s00464-026-13519-5","DOIUrl":"https://doi.org/10.1007/s00464-026-13519-5","url":null,"abstract":"<p><strong>Background: </strong>Adequate distal margin (DM) achievement is essential in oncological rectal cancer surgery. In conventional transabdominal surgery, however, the intraluminal location of the distal tumor edge must be translated to an externally applied transection line; this potentially causes discrepancies between intended and achieved margins. This study aimed to evaluate the discrepancy between the planned intraoperative DM and the margin achieved in rectal cancer resection, identify factors associated with DM discrepancy, and evaluate the association between the transanal approach, specifically transanal total mesorectal excision, and DM accuracy.</p><p><strong>Methods: </strong>This retrospective cohort study included 171 consecutive patients who underwent curative-intent laparoscopic or robot-assisted low anterior resection (LAR) or intersphincteric resection between July 2019 and June 2025. The intended DM in operative records was compared with the pathological DM measured in formalin-fixed specimens. The primary outcome was the absolute DM discrepancy. As the distribution was skewed, adjusted median regression was performed using the transanal approach, intended DM, tumor distance from the anal verge, maximum tumor size, surgical platform, and surgical era as covariates.</p><p><strong>Results: </strong>The median absolute DM discrepancy was 4.0 mm and was smaller with than without the transanal approach (3.0 vs. 6.0 mm; p < 0.001). After adjustment, transanal approach omission was associated with greater absolute DM discrepancy (β, 3.938 mm; 95% confidence interval [CI] 1.848-6.027; p < 0.001). Greater maximum tumor size was also associated with greater discrepancy (β per 1-mm increase, 0.075 mm; 95% CI 0.040-0.110; p < 0.001). This association remained consistent in sensitivity analyses restricted to LAR and after exclusion of scar-based pathological DM measurements.</p><p><strong>Conclusions: </strong>The transanal approach was associated with a smaller discrepancy between intended and achieved DMs after adjustment for tumor characteristics, surgical platform, and surgical era. Assessing the distal tumor edge and intended transection line within the same transanal operative field may facilitate more precise DM control.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166590","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":"Feasibility of a tubeless enhanced recovery strategy in non-high-risk patients undergoing laparoscopy-assisted gastrectomy for gastric cancer.","authors":"Gengyuan Zhang, Huinian Zhou, Hongwei Yu, Jie Mao, Bo Long, Xiping Shen, Hanteng Yang, Lingyun Guo, Juanjuan Zhou, Jianqin Xie, Ying Xu, Changjiang Luo, Junmin Zhu, Zeyuan Yu, Zuoyi Jiao","doi":"10.1007/s00464-026-13467-0","DOIUrl":"https://doi.org/10.1007/s00464-026-13467-0","url":null,"abstract":"<p><strong>Background: </strong>Although nasogastric decompression, nasojejunal feeding, and abdominal drainage tubes are not routinely recommended in Enhanced Recovery After Surgery (ERAS) guidelines for gastrectomy, evidence regarding the avoidance of any inserted tubes after laparoscopic gastrectomy remains limited. This study aimed to evaluate the short-term feasibility and clinical outcomes of an ERAS-tubeless protocol in gastric cancer patients undergoing non-high-risk laparoscopy-assisted gastrectomy.</p><p><strong>Methods: </strong>At a high-volume center, eligible patients of gastric cancer (cT1-4N0-3M0) who lacked protocol-defined high-risk features were enrolled in this prospective non-randomized controlled study. Patients were allocated to either the ERAS-tubeless group or the ERAS-tube group at a predefined 1:1 ratio according to a team-level allocation protocol. All patients underwent laparoscopy-assisted gastrectomy following strict and consistent quality control standards and received distinct ERAS-based postoperative tube-management strategies. The primary outcome was postoperative hospital stay, and secondary outcomes included postoperative quality of life scores and the incidence of complications.</p><p><strong>Results: </strong>Between March 2023 and September 2024, 220 patients were allocated, and 205 were included in the per-protocol population after post-allocation exclusions. The ERAS-tubeless group had a shorter mean postoperative hospital stay (6.0 vs. 7.3 days; P < 0.001). After Benjamini-Hochberg adjustment for multiple comparisons, QoR-15 scores remained significantly higher on postoperative days 1 and 3. For the EORTC QLQ-C30, significant between-group differences persisted in global health and QoL, emotional functioning, and social functioning domains. No increase in the incidence of early postoperative complications was observed; however, the study was underpowered to exclude rare but serious adverse events.</p><p><strong>Conclusions: </strong>In non-high-risk patients with gastric cancer, implementation of the ERAS-tubeless strategy following laparoscopy-assisted gastrectomy under a rigorous surgical quality control system can facilitate postoperative recovery, enhance patient experience, and not increase the risk of early postoperative complications, which warrants further validation.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169857","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":"Optimizing drain management following distal pancreatectomy: fewer drains and earlier removal guided by drain fluid amylase and C-reactive protein levels.","authors":"Genki Watanabe, Kenjiro Kimura, Shigeaki Kurihara, Ryota Tanaka, Masahiko Kinoshita, Kohei Nishio, Hiroji Shinkawa, Takeaki Ishizawa","doi":"10.1007/s00464-026-13492-z","DOIUrl":"https://doi.org/10.1007/s00464-026-13492-z","url":null,"abstract":"<p><strong>Background: </strong>Appropriate postoperative drain management, including early drain removal, is crucial following distal pancreatectomy (DP). This study aimed to investigate reliable criteria for early drain removal and the optimal drain placement site.</p><p><strong>Methods: </strong>We retrospectively analyzed patients undergoing DP from 2014 to 2024, with drains placed at the pancreatic stump and/or the left subphrenic space. Short-term outcomes were compared according to clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence, and the risk factors were identified.</p><p><strong>Results: </strong>Among 258 patients who underwent DP, 85.7% (n = 221) used two drains. CR-POPF developed in 28.3% (n = 73). The CR-POPF group demonstrated higher body mass index, less frequent minimally invasive surgery, greater blood loss, and more transfusions than the no CR-POPF group. The CR-POPF group exhibited significantly higher drain fluid amylase and C-reactive protein levels on postoperative days (POD) 1 and 3 (DFA1/3 and CRP1/3). Multivariable analysis identified DFA3 ≥ 1,000 U/L (odds ratio [OR] 8.21; P < 0.001), CRP3 ≥ 12 mg/dL (OR 3.37; P = 0.004), laparotomy (OR 3.26; P = 0.007), age (OR 1.04; P = 0.049), and operative time (OR 1.01; P = 0.006) as independent predictors for CR-POPF. The left subphrenic drain showed lower DFA1/3 values and a lesser association with CR-POPF than the pancreatic stump drain.</p><p><strong>Conclusion: </strong>DFA3 and CRP3 may function as practical indicators for early drain removal. Left subphrenic drain may be considered for omission when an effective drain is placed at the pancreatic stump.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171456","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":"Feasibility and clinical outcomes of omental buttress-and-wrapping to reduce postoperative complications following minimally invasive spleen-preserving distal pancreatectomy: a retrospective cohort study.","authors":"Yuhong Pan, Long Huang, Dihang Wu, Jianlin Lai, Liquan Shen, Yifeng Tian, Shi Chen","doi":"10.1007/s00464-026-13509-7","DOIUrl":"https://doi.org/10.1007/s00464-026-13509-7","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive spleen-preserving distal pancreatectomy (MISPDP) is widely performed for benign and low-grade malignant lesions of the pancreatic body and tail while preserving splenic function. Although the Kimura technique maintains splenic perfusion by preserving splenic vessels, it requires meticulous dissection and management of the splenic vasculature and its branches. Clinically relevant postoperative pancreatic fistula (CR-POPF) and associated complications remain major determinants of postoperative recovery. This study evaluated the feasibility of the omental buttress-and-wrapping (OBW) technique during Kimura-MISPDP and assessed its impact on CR-POPF and short-term perioperative outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who had undergone splenic vessel-preserving MISPDP at our institution between 2020 and 2025. Patients were classified into the OBW-Kimura group or the conventional Kimura group according to OBW use. Stabilized weighting (SW) was applied to mitigate potential selection bias by balancing measured covariates. Intraoperative and postoperative outcomes were compared using weighted analyses, and Firth penalized logistic regression was conducted to identify factors associated with CR-POPF.</p><p><strong>Results: </strong>In total, 189 patients were enrolled, with 85 in the OBW-Kimura group and 104 in the conventional Kimura group. After SW adjustment, a significantly lower incidence of CR-POPF was observed in the OBW-Kimura group than in the conventional Kimura group (4.77% [95% CI 1.64-13.11%] vs 19.87% [95% CI 13.22-28.76%], P = 0.005). Patients treated with the OBW technique also had shorter postoperative drainage duration (8.00 [7.00, 11.00] vs. 11.00 [8.00, 14.00] days, P < 0.001) and shorter hospital stay (10.00 [8.00, 11.00] vs. 12.00 [9.00, 15.00] days, P < 0.001).</p><p><strong>Conclusion: </strong>Incorporating the OBW technique into Kimura-MISPDP was associated with a lower incidence of CR-POPF and shorter postoperative drainage duration and hospital stay. This approach may represent a promising adjunctive technique for decreasing pancreatic fistula and related postoperative complications following Kimura-MISPDP.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166459","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":"A multidisciplinary analysis of 8-mm port-site hernias in 2,337 robotic ports and the realities of its risk factors.","authors":"Shintaro Ozawa, Masatsune Shibutani, Yuki Seki, Kenji Kuroda, Hiroaki Kasashima, Yuichiro Miki, Mami Yoshii, Hiroji Shinkawa, Takeshi Yamasaki, Takeshi Fukuda, Takeaki Ishizawa, Junji Uchida, Toshiyuki Sumi, Kiyoshi Maeda","doi":"10.1007/s00464-026-13477-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13477-y","url":null,"abstract":"<p><strong>Background: </strong>Port-site hernia (PSH) at 8-mm robotic trocar sites is considered uncommon, and routine fascial closure is generally not recommended. However, clinically significant PSH continues to occur, and its underlying mechanisms remain incompletely understood. This study aimed to evaluate the incidence and risk factors of 8-mm PSH after robotic-assisted surgery and to explore practical preventive strategies.</p><p><strong>Methods: </strong>We retrospectively analyzed 816 patients who underwent robotic-assisted surgery across the gastrointestinal, hepatobiliary-pancreatic, urological, and gynecological specialties between January 2020 and December 2024. A total of 2337 8-mm ports were included, all of which were left without fascial closure. Patient characteristics, port locations, drain placement and size, operative times, and perioperative factors were evaluated in patients who developed PSH.</p><p><strong>Results: </strong>The median BMI of the overall cohort was 22.9 kg/m² (range 11.0-48.9 kg/m²). The incidence of 8-mm PSH was 0.49% per patient (4/816) and 0.17% per port (4/2337). All PSH cases occurred at lateral abdominal wall port sites in non-obese patients (body mass index <25 kg/m²). Three of the four cases (75%) developed at drain insertion sites, and symptoms appeared shortly after drain removal. The median total operative time was 323.5 min in the PSH group versus 317 min in the non-PSH group. All hernias were Richter-type hernias. Clinical findings suggested a multifactorial mechanism involving mechanical enlargement of the fascial defect by robotic torque, impaired muscular shutter mechanisms at lateral abdominal sites, and drain-related factors that prevented spontaneous fascial closure.</p><p><strong>Conclusions: </strong>Eight-millimeter PSH is a rare but potentially preventable complication of robotic-assisted surgery. The risk appears to be concentrated in non-obese patients with lateral abdominal wall ports, particularly when these sites are used for drain placement. Intraoperative digital assessment of the fascial defect using the \"pinky test\" may facilitate selective fascial closure of high-risk port sites and help reduce the occurrence of this complication.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168937","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}