Surgical Endoscopy And Other Interventional Techniques最新文献

{"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}

{"title":"Preoperative prediction model for critical view of safety achievement in laparoscopic cholecystectomy: a retrospective cohort study.","authors":"Takahiro Gunji, Naokazu Chiba, Hirotaka Kojima, Ryota Suda, Hiroki Yamaguchi, Shoma Iida, Kanami Iwama, Takumi Seichi, Yoshihiro Nagae, Hiroyuki Higuchi, Akitoshi Ando, Itsuki Koganezawa, Masashi Nakagawa, Kei Yokozuka, Shigeto Ochiai, Toshimichi Kobayashi, Toru Sano, Koichi Tomita, Satoshi Tabuchi, Tetuo Ishizaki, Eiji Hidaka, Kisyo Mihara, Shigeyuki Kawachi","doi":"10.1007/s00464-026-13421-0","DOIUrl":"https://doi.org/10.1007/s00464-026-13421-0","url":null,"abstract":"<p><strong>Background: </strong>We developed and validated a preoperative model to predict the difficulty in achieving the critical view of safety (CVS) during laparoscopic cholecystectomy (LC).</p><p><strong>Methods: </strong>Patients who underwent LC with preoperative computed tomography (CT) and magnetic resonance cholangiopancreatography between January 2015 and December 2023 were retrospectively analyzed and randomly assigned to derivation and validation cohorts (8:2). Surgical difficulty was defined as failure to achieve CVS. Logistic regression analysis was used to identify independent predictors. Model performance was evaluated using the area under the receiver operating characteristic curve and Brier score.</p><p><strong>Results: </strong>Independent preoperative risk factors included age ≥ 65 years, American Society of Anesthesiologists physical status ≥ 3, preoperative endoscopic gallbladder drainage or stenting, CT attenuation of the CVS window ≥ - 26 HU, and common bile duct disruption on magnetic resonance cholangiopancreatography (all p < 0.05). The prediction score (0-13) demonstrated an area under the receiver operating characteristic curve of 0.732 (95% confidence interval 0.528-0.936) in the validation cohort. Risk stratification identified low-, moderate-, and high-risk groups with increasing rates of failure to achieve CVS.</p><p><strong>Conclusions: </strong>This preoperative imaging-based scoring system may help predict CVS failure in LC and guide surgical decision-making.</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":"149169124","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":"Effects of immersive virtual reality and non-immersive video distraction on preoperative anxiety in patients undergoing elective abdominal surgery: a three-arm randomised controlled trial.","authors":"Sevim Akbal, Seher Ünver, Doğan Albayrak","doi":"10.1007/s00464-026-13417-w","DOIUrl":"https://doi.org/10.1007/s00464-026-13417-w","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety negatively impacts surgical outcomes. This study evaluated the effects of immersive virtual reality (VR) vs non-immersive video distraction on preoperative anxiety, physiological stress, and heart rate in elective abdominal surgery.</p><p><strong>Methods: </strong>In this three-arm randomized controlled trial (NCT05718661), 96 elective abdominal surgery patients were allocated to immersive VR, non-immersive video, or a control group ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>32</mn></mrow> </math> per group). Both intervention groups viewed identical relaxing audiovisual content for 15 min via a VR headset or a smartphone screen; controls received standard care. Preoperative anxiety was measured with the Visual Analogue Scale-Anxiety (VAS-A). Physiological stress scores and heart rate were tracked using a wearable smart band before and after the intervention.</p><p><strong>Results: </strong>VAS-A scores worsened in controls (p < 0.001) but decreased significantly in both the VR (p < 0.001) and video (p = 0.002) groups, with no significant difference between the two active interventions (p > 0.05). Device-derived stress scores increased in controls (p = 0.018) and decreased in the video group (p = 0.017), with no change in the VR group (p = 0.568). Heart rate changes did not differ significantly among groups (p < 0.206).</p><p><strong>Conclusions: </strong>Both immersive VR and non-immersive video distraction significantly reduce preoperative anxiety compared with standard care; however, VR is not superior to conventional video viewing. Given its equivalent efficacy, lower cost, and simpler implementation, non-immersive video represents a practical, scalable non-pharmacological strategy for perioperative anxiety management.</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":"149169768","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":"Built-in waste: a narrative analysis of the hidden environmental impact of battery-containing surgical devices.","authors":"Vittoria Bellato, Benjamin Miller, Stefania Marconi, Shaneeta Johnson, Myrthe Eussen, Sheetal Nijhawan, Manuel Sanchez-Casalongue, Alberto Arezzo, Patricia Sylla, Nicole Bouvy","doi":"10.1007/s00464-026-13409-w","DOIUrl":"https://doi.org/10.1007/s00464-026-13409-w","url":null,"abstract":"<p><strong>Background: </strong>Efforts to align surgical practice with environmental sustainability has highlighted the need to address overlooked sources of waste in surgical practice. Single-use surgical devices containing embedded batteries are widely used across specialties and are frequently discarded in clinical waste streams without separation or recycling. The environmental and regulatory implications of this practice remain poorly characterized.</p><p><strong>Methods: </strong>We conducted a structured exploratory mapping of battery-containing single-use surgical devices currently in clinical use across multiple surgical specialties. Devices were identified through a combination of clinical expertise, targeted web-based searches, and review of publicly available manufacturer documentation, including instructions for use (IFU), product catalogues, and technical data sheets. For each device, battery chemistry, integration type, removability, and availability of manufacturer-provided disposal instructions were recorded based solely on publicly accessible documentation.</p><p><strong>Results: </strong>A total of 23 battery-containing single-use surgical devices were identified across 9 technological categories. Battery chemistry was specified in publicly accessible documentation for 13 devices (alkaline, n = 7; lithium-based primary cells, n = 3; silver oxide, n = 3). Explicit manufacturer-provided disposal instructions were available for 9 devices (39%), partial guidance for 9 (39%), and no guidance was identified for 5 (22%). A marked disparity was observed between integration types: devices with user-removable batteries provided explicit disposal guidance in 88% of cases (7/8), whereas no sealed single-use device provided explicit guidance (0/11). In 3 of 23 devices, no publicly accessible regulatory documentation was retrievable. Regulatory analysis revealed a structural tension between mandatory separate battery collection under EU regulation 2023/1542 and the infectious waste exemption that permits routine incineration of contaminated surgical devices, resulting in systematic loss of recoverable battery materials.</p><p><strong>Conclusions: </strong>Battery-containing surgical disposables represent a regulatory and environmental blind spot at the intersection of infection control and circular economy policy. Clearer reporting standards, improved device design, and stronger manufacturer accountability are required to reconcile patient safety with sustainable resource management. Professional societies, regulators, and procurement bodies should prioritize transparent battery disclosure and explicit end-of-life guidance as part of sustainability frameworks for surgical care.</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":"149167733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of mesh infection management following ventral hernia repair with poly-4-hydroxybutyrate, synthetic, and biologic mesh: a retrospective review.","authors":"Kelly Dickerson, Kartik S Akkihal, Anya Ittiruck, Gerald O Ogola, Christine Wang, Steven G Leeds, Marc A Ward, Cedric W Spak, Bola Aladegbami","doi":"10.1007/s00464-026-13480-3","DOIUrl":"https://doi.org/10.1007/s00464-026-13480-3","url":null,"abstract":"<p><strong>Background: </strong>Mesh infections are a feared complication of ventral hernia repair. This retrospective review compares infection characteristics and management among patients with poly-4-hydroxybutyrate (Phasix) and synthetic mesh while presenting biologic cases descriptively.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients undergoing ventral hernia repair from 2014 to 2025. Outcomes were evaluated among patients receiving Phasix, synthetic, or biologic mesh. Primary outcomes included infection rates, microbiology, antibiotic therapy, readmission, length of stay, and need for intervention. Risk factors such as wound class, immunosuppression, and prior mesh infection were assessed.</p><p><strong>Results: </strong>A total of 407 patients underwent ventral hernia repair with Phasix (n = 47), synthetic (n = 337), and biologic (n = 23) mesh. Mesh infections developed in six patients with Phasix, seven with synthetic, and two with biologic. Of the people with mesh infections, the Phasix group demonstrated higher rates of risk factors compared to the synthetic and biologic groups: pre-existing mesh infections (33% vs. 0% vs. 0%), CDC wound class <math><mo>≥</mo></math>  3 (83% vs. 29% vs. 0%), and immunosuppression (33% vs. 0% vs. 0%). The bacterial profile of these mesh infections includes E. coli, Proteus mirabilis, Stenotrophomonas maltophilia, and Klebsiella pneumoniae in the Phasix group, Staphylococcus, Enterococcus faecium, and Streptococcus in the synthetic group, and Staph aureus in the biologic group. Phasix infections required a mean of 36 days of antibiotic therapy versus 15 days for synthetic and 23 days for biologic mesh (p = 0.25). Readmission rates were 67, 86, and 100%, respectively (p = 0.56). Mean hospital stays were 11, 9, and 4 days (p = 0.4). No Phasix patients required mesh excision, whereas 71.4% of synthetic mesh patients and 50% of biologic mesh patients underwent mesh explantation (p = 0.04).</p><p><strong>Conclusion: </strong>Infections involving poly-4-hydroxybutyrate mesh were successfully managed without mesh explantation in this series despite occurring in higher-risk patients. Because of the retrospective design, small sample size, and potential selection bias, these findings should be considered hypothesis-generating rather than evidence of superiority.</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":"149167869","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":"Quantification of tension during cruroplasty of robotic-assisted hiatal hernia repairs using force feedback instruments on the da Vinci surgical platform (dV5).","authors":"Khang Ngo, Marzieh Ershad Langroodi, Prakash Gatta","doi":"10.1007/s00464-026-13462-5","DOIUrl":"https://doi.org/10.1007/s00464-026-13462-5","url":null,"abstract":"<p><strong>Background: </strong>Tension-free crural closure is critical for durable hiatal hernia repair. Historically, quantifying crural closure tension (CCT) required workflow-disrupting external gauges. The da Vinci 5 (dV5) platform's integrated force feedback allows instantaneous, device-free tension monitoring. This study quantifies in vivo CCT during robotic hiatal hernia repair (RHHR) and introduces an exploratory metric, the Crural Stiffness Index (CSI), defined as peak force per centimeter of crural displacement.</p><p><strong>Methods: </strong>A retrospective cohort analysis evaluated 76 patients undergoing RHHR at a single institution by a single surgeon using the dV5 system with force feedback instruments between January 2024 and December 2025. Using a standardized tension measurement protocol (TMP), controlled traction was applied to approximate the crura while recording continuous force telemetry. Primary outcomes were mean force, peak force, and CSI during closure.</p><p><strong>Results: </strong>Mean hiatal defect width was 2.16 ± 0.75 cm. Mean force within the calibrated measurement range (≤ 6.5 N) (2.92 ± 0.75 N) remained consistent regardless of defect size (p = 0.276). Peak force averaged 9.60 ± 2.79 N, significantly correlating with defect width; large hernias (> 2.0 cm) required higher tension than small hernias (10.38 vs. 8.78 N, p = 0.011). The cohort's mean CSI was 6.09 ± 2.12 N/cm. CSI did not significantly differ between large and small defects (p = 0.888), suggesting intrinsic compliance is independent of initial hernia size.</p><p><strong>Conclusions: </strong>Using the dV5 and a standardized TMP, this study reliably quantified, in vivo, CCT during robotic hiatal hernia repairs. While mean forces remained uniform, peak forces significantly increased with larger defect widths. CSI suggested that crural compliance may be independent of hernia size. As a proof of concept, crural tensiometry is feasible within standard robotic workflow. The exploratory CSI requires prospective validation against clinical outcomes before it can guide operative decisions.</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":"149168905","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":"Hospital capacity and operating room access for emergency general surgery patients : OR access and LOS for short-stay MIS EGS.","authors":"Alexis Miranda, Lynnette Schiffern, William Sherrill, Hongmei Yang, Caroline E Reinke","doi":"10.1007/s00464-026-13453-6","DOIUrl":"https://doi.org/10.1007/s00464-026-13453-6","url":null,"abstract":"<p><strong>Background: </strong>Emergency general surgery (EGS) is a major driver of hospital utilization, yet system-level contributors to hospital length of stay (LOS) remain poorly defined. While delayed operative intervention may be clinically acceptable in stable patients, its impact on hospital throughput is unclear. We evaluated the association between time to operating room (OR) and LOS for common minimally invasive (MIS) EGS procedures.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adult patients undergoing non-elective MIS appendectomy or cholecystectomy on a dedicated EGS service at two community hospitals (2023-2025) using EGS-targeted NSQIP data. Time-to-OR was defined as the interval from emergency department registration to procedure start. LOS was defined as admission to discharge (LOS=0 for outpatient cases). A two-part hurdle model assessed association between time-to-OR and LOS, and multivariable logistic regression evaluated the associations between time-to-OR and 30-day readmission and 30-day emergency department (ED) visits.</p><p><strong>Results: </strong>Among 1355 patients, median time-to-OR was 16 h (IQR 8-30); 38% underwent surgery ≤12 h and 67% within 24 h. Median LOS was 0 days. Mean LOS increased from 0.68 days among patients undergoing surgery ≤12 h to 4.62 days with delays ≥48 h (p<0.001). Adjusted hurdle models indicated that increasing time to surgery was associated with higher likelihood of inpatient admission. Among admitted patients, surgery delayed ≥48 h were associated with longer expected LOS than other categories, with an adjusted mean LOS of 6.19 days (95% CI 4.94-7.44) compared with 3.43-3.78 days for shorter delays. No association was identified between time-to-OR and 30-day readmission or 30-day ED visits.</p><p><strong>Conclusions: </strong>For MIS appendectomy and cholecystectomy, longer time-to-OR was independently associated with increased LOS. The increase in LOS was concentrated in the preoperative interval; postoperative LOS did not lengthen with preoperative delay. OR access represents a modifiable, system-level target for improving hospital capacity.</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":"149166412","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":"Frailty and abdominal wall hernias: a Mendelian randomization and retrospective study.","authors":"Pengfei Bo, Tengfei Shang, Lei Gao, Zhitong Li, Yang Fu, Dianchen Wang","doi":"10.1007/s00464-026-13473-2","DOIUrl":"https://doi.org/10.1007/s00464-026-13473-2","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty, measured by frailty index (FI), involves a decline in the function of multiple physiological systems. It is known that the dysfunction of abdominal wall is related to the occurrence of abdominal wall hernias. In this research, we conducted a two-sample Mendelian randomization analysis to explore the causal relationship between frailty and abdominal wall hernias and did a retrospective study to evaluate the association between preoperative frailty and postoperative complications following hiatal hernia repair.</p><p><strong>Methods: </strong>Summary data of FI, hiatal hernia, femoral hernia, inguinal hernia, and other unspecified abdominal hernias were extracted from genome-wide association study. The inverse variance weighted (IVW) method was used as the core approach to assess causal effects, and other sensitivity analyses were also carried out. We conducted a retrospective analysis on patients who underwent hiatal hernia repair. Demographic, operative, and follow-up data were collected.</p><p><strong>Results: </strong>Genetically predicted higher FI was associated with an increased risk of hiatal hernia (OR 1.020, 95% CI 1.010-1.030, P < 0.001) and remained stable in sensitivity analyses. However, there was no evidence to suggest an association between FI and an increased risk of femoral hernia (P = 0.958), inguinal hernia (P = 0.874), or other unspecified abdominal hernias (P = 0.403). In the retrospective study, severe frailty was an independent risk factor for dysphagia (P < 0.001). However, no significant associations were found between frailty and hospital stay (P = 0.419), epigastric pain (P = 0.283), gas-bloat syndrome (P = 0.926), diarrhea (P = 0.083), recurrence (P = 0.618), or quality of life (P = 0.071).</p><p><strong>Conclusions: </strong>Frailty is associated with an increased risk of hiatal hernia but has no causal association with femoral hernia, inguinal hernia, or other unspecified abdominal hernias. Frail patients are more likely to have dysphagia following hiatal hernia repair.</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":"149168523","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":"Awake laparoscopic surgery under combined spinal-epidural anesthesia: a consecutive series of 52 patients across multiple general surgical procedures.","authors":"Hamzeh M Halawani, Farah Khalifeh, Mohammad Saleh","doi":"10.1007/s00464-026-13512-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13512-y","url":null,"abstract":"<p><strong>Background: </strong>General anesthesia (GA) remains the standard anesthetic technique for laparoscopic surgery; however, alternative anesthetic approaches may be considered in selected patients with significant comorbidities or severe anxiety related to GA. We evaluated the feasibility and observed perioperative outcomes of awake laparoscopic surgery performed under a standardized combined spinal-epidural (CSE) anesthesia protocol across multiple general surgical procedures.</p><p><strong>Methods: </strong>We conducted a retrospective single-center case series of consecutive patients undergoing laparoscopic surgery under CSE anesthesia between September 2017 and August 2026. All procedures were performed by the same experienced laparoscopic surgeon and senior anesthesiologist using a standardized multidisciplinary protocol. The primary outcome was successful completion of the laparoscopic procedure without conversion to GA. Secondary outcomes included conversion to open surgery, postoperative complications, length of hospital stay, 30 day readmission, and mortality.</p><p><strong>Results: </strong>Fifty-two patients were included; the mean age was 62.2 ± 19.0 years, 32 (61.5%) were male, and 29 (55.8%) were ASA physical status III. Forty-four patients (84.6%) had at least one comorbidity. Procedures included laparoscopic cholecystectomy (n = 33), inguinal hernia repair (n = 10), sleeve gastrectomy (n = 6), appendectomy (n = 2), and ventral hernia repair (n = 1). Fifty procedures (96.2%) were completed without conversion to GA. Two patients (3.8%) required conversion to GA, and one (1.9%) required conversion to open surgery without GA. Postoperative complications occurred in five patients (9.6%), including one Clavien-Dindo grade IVa complication. Median hospital stay was 1 day (IQR, 1-1). There were no 30-day readmissions or deaths.</p><p><strong>Conclusion: </strong>Laparoscopic surgery under CSE anesthesia appears feasible in carefully selected patients when performed by an experienced multidisciplinary team using a standardized perioperative protocol. The technique was successfully applied across multiple general surgical laparoscopic procedures and patients with varying degrees of anesthetic risk, with a 96.2% completion rate without conversion to GA. Prospective controlled multicenter studies are warranted to further evaluate comparative safety, procedure-specific outcomes, and optimal patient selection.</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":"149172146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative diabetes status, circulating GDF15, and weight loss after sleeve gastrectomy.","authors":"Yu-Yang Lee, Young-Jen Lin, Wei-Shiung Yang, Po-Chu Lee, Chiung-Nien Chen, Ming-Tsan Lin, Po-Jen Yang","doi":"10.1007/s00464-026-13491-0","DOIUrl":"https://doi.org/10.1007/s00464-026-13491-0","url":null,"abstract":"<p><strong>Background: </strong>Growth differentiation factor 15 (GDF15) is a stress-responsive cytokine implicated in metabolic stress, appetite regulation, and energy homeostasis. However, longitudinal GDF15 changes after metabolic bariatric surgery remain inconsistent, and whether preoperative type 2 diabetes (T2D) modifies postoperative GDF15 trajectories after sleeve gastrectomy (SG) is unclear.</p><p><strong>Methods: </strong>In this prospective, single-center observational cohort, 105 patients with severe obesity undergoing laparoscopic SG between 2018 and 2022 were studied. Circulating GDF15 and clinical variables were measured preoperatively and at 6 months and 1 year after SG. Patients were stratified by preoperative T2D status. Associations between baseline GDF15 and 1-year total weight loss percentage (TWL%) were assessed using stepwise multivariable linear regression.</p><p><strong>Results: </strong>Participants were 53 males, mean age 39.3 ± 10.4 years, and BMI 40.4 ± 5.4 kg/m²; 52 had preoperative T2D. GDF15 increased at 6 months after SG (699.3 ± 454.7 to 849.2 ± 596.2 pg/mL, p = 0.002) but returned toward baseline at 1 year (739.3 ± 490.3 pg/mL, p = 0.327). Patients with preoperative T2D had higher baseline GDF15 levels compared to those without diabetes (843.8 ± 503.4 vs. 557.5 ± 351.6 pg/mL, p = 0.001), with a transient increase at 6 months (1020.6 ± 678.2 pg/mL, p = 0.018) that returned to baseline at 1 year (830.6 ± 581.5 pg/mL, p = 0.854). In contrast, patients without T2D exhibited a sustained increase of GDF15 levels at 6 months (681.0 ± 449.0 pg/mL, p = 0.037) and 1 year (649.7 ± 364.3 pg/mL, p = 0.022). Mean 1-year TWL% was 32.1 ± 7.7%. Higher baseline GDF15 independently predicted lower 1-year TWL% in multivariate analyses.</p><p><strong>Conclusions: </strong>After SG, circulating GDF15 follows distinct trajectories according to preoperative T2D status. Baseline GDF15 may help characterize individual variability in metabolic adaptation and weight loss after SG.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149431","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}