Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Using virtual reality simulation to ensure laparoscopic camera navigation skills of new surgical assistants-a validation study.","authors":"Yu Jiongbiao, Yang Yunran, Tang Lidong, Wang Wentao, Ma Jinhuo, Li Xiaowu, Zheng Wang, Lars Konge, Liu Wei","doi":"10.1007/s00464-025-12073-w","DOIUrl":"https://doi.org/10.1007/s00464-025-12073-w","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to develop and validate a virtual reality (VR) simulation-based test for assessing laparoscopic camera navigation skills, using Messick's contemporary framework to gather validity evidence and establish an evidence-based pass/fail standard.</p><p><strong>Methods: </strong>The test was developed through consensus among surgical experts and included eight clinically relevant metrics. A total of 24 participants, comprising 12 novice medical students and 12 experienced surgical residents, were recruited.</p><p><strong>Results: </strong>The test demonstrated high internal consistency reliability (Cronbach's α = 0.88) and test-retest reliability (Pearson's r = 0.84). Significant differences in performance were observed between novices (51.8 ± 13.9) and experienced participants (81.7 ± 6.0, p < 0.001), indicating strong discriminative ability.A pass/fail score of 70% was established using the contrasting groups' method, with one novice passing and no experienced participants failing. Participants perceived the simulator as realistic and beneficial for skill improvement, though experienced participants were less inclined to use it for further practice.</p><p><strong>Conclusions: </strong>The study concludes that the VR laparoscopic camera navigation test provides a valid and reliable tool for training and assessing surgical assistants, supporting its integration into mastery learning programs to ensure proficiency before clinical practice.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092406","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 novel prognostic system for locally advanced gastrointestinal stromal tumors after neoadjuvant imatinib therapy based on the metro-ticket paradigm: a retrospective dual-center study.","authors":"Zhiming Cai, Jinhu Chen, Xincheng Su, Lv Lin, Zhenrong Yang, Tao Lin, Weibin Song, Xinyu Chen, Yongjian Zhou","doi":"10.1007/s00464-025-12245-8","DOIUrl":"https://doi.org/10.1007/s00464-025-12245-8","url":null,"abstract":"<p><strong>Background: </strong>Accurately assessing the mitotic index after neoadjuvant therapy remains challenging, which limits the prognostic utility of the NIH criteria. The tumor regression grade (TRG), which evaluates therapeutic efficacy on the basis of tumor necrosis, can increase the prognostic capacity when integrated with ypT staging in patients receiving preoperative imatinib therapy. The aim of this study was to develop a staging system incorporating TRG and ypT staging to assess patient outcomes and guide surgical strategies and postoperative adjuvant therapy in patients with locally advanced gastrointestinal stromal tumors (LA-GIST) treated with preoperative imatinib.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 200 patients with LA-GIST who received preoperative imatinib therapy at two high-volume centers. The ypT-TRG staging system was constructed by computing the Euclidean distance of each TRG (x-axis) and ypT stage (y-axis) coordinate from the origin in a Cartesian plane.</p><p><strong>Results: </strong>Compared with the NIH criteria, the ypT-TRG staging system provided a more balanced distribution of patients, with 61% (n = 122) experiencing risk reclassification. The ypT-TRG system demonstrated superior discriminatory ability (concordance index), model fit (Akaike information criterion, Bayesian information criterion), risk reclassification improvement (net reclassification improvement, integrated discrimination improvement), dynamic predictive performance (time-dependent receiver operating characteristic curve), and clinical utility (decision curve analysis). Furthermore, multivariate Cox regression analysis confirmed that ypT-TRG stage could replace the NIH criteria as an independent prognostic factor. Notably, patients classified as ypT-TRG stages I-II had a significantly higher rate of minimally invasive surgery (83.9% vs. 45.1%, P < 0.001). In addition, patients with stages III-IV disease achieved significant survival benefits from prolonged postoperative imatinib therapy.</p><p><strong>Conclusion: </strong>Compared with the NIH criteria, the ypT-TRG staging system provides superior prognostic stratification for patients with LA-GIST. This system offers valuable insights for selecting candidates for minimally invasive surgery and facilitates the optimization of postoperative imatinib treatment strategies.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092374","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":"Evaluation of the Master's program: A SAGES pilot educational initiative.","authors":"M Michael Awad, E Matthew Ritter, R James Korndorffer, John Dwyer, Divya Jahagirdar, Nataniel Jayaram, Deena Sukhon, Jonathan Williams, A Dana Telem, A Michael Rubyan","doi":"10.1007/s00464-025-12200-7","DOIUrl":"https://doi.org/10.1007/s00464-025-12200-7","url":null,"abstract":"<p><strong>Background: </strong>High-quality program development in surgical education is essential for ensuring that training initiatives are both effective and scalable. Implementing such programs requires careful consideration of their long-term sustainability and impact on diverse clinical settings. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) developed the Master's Program as a structured, competency-based online curriculum designed to provide high-quality continuing education for surgeons at various career stages. This study evaluates the pilot phase of the Master's Program, emphasizing its effectiveness in training surgeons while assessing its scalability and implementation challenges within surgical education frameworks.</p><p><strong>Methods: </strong>A mixed-methods approach was used, combining qualitative and quantitative assessments. A purposive sample of U.S.-based surgeons was recruited through SAGES membership outreach and snowball sampling. Participants engaged in video-conferenced usability testing and completed the Theoretical Framework of Acceptability (TFA) questionnaire. Data were collected via semi-structured interviews, which were analyzed using thematic analysis, while quantitative responses were evaluated using descriptive statistics.</p><p><strong>Results: </strong>A total of 27 surgeons participated. Participant demographics: Of the 27 participants, 16 (59%) were practicing surgeons and 41% were trainees. Sixty-three percent of practicing surgeons were in community hospitals, and half had less than five years of experience. Participants rated the program highly in overall acceptability (mean: 4.7/5), confidence in applying the material (4.6/5), and ease of navigation (2.0/5 indicating low burden). Qualitative themes identified included content accessibility, navigational challenges, and recommendations for deeper, more advanced material for experienced surgeons.</p><p><strong>Conclusions: </strong>The SAGES Master's Program demonstrated strong acceptability, particularly among early-career surgeons. While the modular, structured approach was well received, refinements are needed to better cater to advanced practitioners. To enhance adoption and scale this program, future iterations should focus on the planned expanded content depth, improved navigation, and institutional purchasing models to enhance adoption.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087391","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 minimally invasive distal pancreatectomy in patients with a history of major upper abdominal surgery.","authors":"Yejong Park, Dae Wook Hwang, Jae Hoon Lee, Ki Byung Song, Eunsung Jun, Woohyung Lee, Minkyu Sung, Song Cheol Kim","doi":"10.1007/s00464-025-12234-x","DOIUrl":"https://doi.org/10.1007/s00464-025-12234-x","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive distal pancreatectomy (MIDP) is favored for left-sided pancreatic tumors, but its safety and feasibility in patients with prior upper abdominal surgery (PUAS), especially major PUAS, remain uncertain.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 1713 patients undergoing MIDP at a single tertiary center from 2009 to 2020. Patients were divided into three groups: those with no prior abdominal surgery (no-PAS, n = 1612), those with minor PUAS (n = 58), and those with major PUAS (n = 43). Primary and secondary endpoints included complications of Clavien-Dindo grade III or higher, conversion to open surgery, length of hospital stay, 90-day mortality, and readmission rates.</p><p><strong>Results: </strong>Among the 1713 patients who underwent MIDP, no significant differences in the rate of severe complications (Clavien-Dindo grade III or higher) were observed between the no-PAS group (9.4%) and either the minor-PUAS (10.3%, p = 0.991) or major-PUAS (7.0%, p = 0.792) groups. Conversion to open surgery occurred in 3.5% of patients in the no-PAS group, with slightly higher rates in the minor-PUAS (5.2%, p = 0.266) and major-PUAS (7.0%, p = 0.202) groups; however, these differences were not statistically significant. Length of hospital stay, 90-day mortality, and readmission rates were comparable across groups.</p><p><strong>Conclusion: </strong>MIDP appears to be a safe and feasible option for selected patients with PUAS, including major procedures, without significantly increasing the risks of severe complications or conversion to open surgery. These findings support the broader use of MIDP in patients with complex surgical histories.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087394","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":"Dual-function robotic gripper for traction and closure in gastric endoscopic submucosal dissection: an in vivo porcine model study (with video).","authors":"Sang Hyun Kim, Ye Chan Seo, Bora Keum, Han Jo Jeon, Jae Min Lee, Hyuk Soon Choi, Eun Sun Kim, Yoon Tae Jeen, Hong Sik Lee, Joo Ha Hwang, Hoon Jai Chun","doi":"10.1007/s00464-025-12182-6","DOIUrl":"https://doi.org/10.1007/s00464-025-12182-6","url":null,"abstract":"<p><strong>Objectives: </strong>Endoscopic submucosal dissection (ESD) is a technically complex procedure associated with prolonged operative duration and a heightened risk of complications. To enhance procedural efficiency and safety, various adjunctive techniques have been introduced, particularly for tissue traction and mucosal defect closure. This study aimed to assess the feasibility and efficacy of a novel robotic dual-function gripper capable of performing both tissue traction and defect approximation in an in vivo model.</p><p><strong>Methods: </strong>A dual-function robotic gripper was developed to facilitate submucosal dissection and post-ESD closure. Comparative experiments were conducted using robot-assisted ESD (RESD) and conventional ESD (CESD) on 24 gastric lesions created in six live pigs. In the RESD group, mucosal defects were closed using the robotic gripper in combination with through-the-scope (TTS) clips, whereas closure in the CESD group was performed using standard TTS clips alone. Primary outcomes included total procedure time, dissection speed, blind dissection rate, and success rate of defect closure. Endoscopic and histological evaluations were conducted on postoperative day 14.</p><p><strong>Results: </strong>All lesions were resected without adverse events. Specimen sizes were comparable between groups (928.1 ± 74.5 mm² vs. 937.2 ± 54.8 mm², p = 0.53). However, the RESD group demonstrated significantly shorter procedure times (10.2 ± 1.7 min vs. 15.8 ± 2.1 min, p < 0.05) and faster dissection speeds (157.6 ± 33.3 mm²/min vs. 91.4 ± 23.7 mm²/min, p < 0.05). Complete defect closure was achieved in all RESD cases, compared to 66.6% in the CESD group. The RESD group also exhibited fewer clip requirements and superior wound healing, as evidenced by narrower zones of epithelial absence and significantly reduced neovascular and fibroblast infiltration.</p><p><strong>Conclusion: </strong>The robotic dual-function gripper significantly enhanced technical performance and mucosal healing in gastric ESD within a porcine model, suggesting its potential as an effective adjunct for gastric therapeutic endoscopy.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087452","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":"Exploring the potential utility of modified difficulty scores based on the IWATE criteria for assessing the surgical difficulty of laparoscopic repeat liver resection.","authors":"Hidetoshi Gon, Shohei Komatsu, Tatsuki Kusuhara, Daisuke Takimoto, Kenji Fukushima, Takeshi Urade, Toshihiko Yoshida, Kentaro Tai, Keisuke Arai, Hiroaki Yanagimoto, Masahiro Kido, Takumi Fukumoto","doi":"10.1007/s00464-025-12225-y","DOIUrl":"https://doi.org/10.1007/s00464-025-12225-y","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic repeat liver resection (LRLR) is more challenging than initial laparoscopic liver resection in some cases because of intra-abdominal adhesions and liver deformation caused by previous operations. However, there are insufficient reports on difficulty scoring systems for LRLR. In this study, we aimed to explore whether the IWATE criteria and its modified scoring system could effectively predict surgical outcomes in patients undergoing LRLR.</p><p><strong>Methods: </strong>Patients who underwent LRLR at the Kobe University Hospital between 2014 and 2024 were enrolled. We assessed the correlation between difficulty scores based on the IWATE criteria and LRLR surgical outcomes. The correlation between the modified difficulty scores and LRLR surgical outcomes were also evaluated. The modified difficulty scores were calculated by adding 2 points for ipsilateral recurrence and 1 point for a previous history of open liver resection to the original difficulty scores of the IWATE criteria.</p><p><strong>Results: </strong>Eighty-four patients who underwent LRLR were enrolled. The median value of the IWATE criteria and modified difficulty score was 4 and 6, respectively. The median operation time and blood loss were 287 min and 10 mL, respectively. Nineteen (23%) patients experienced postoperative complications, wherein four (5%) had Clavien-Dindo grade ≥ IIIa complications. The IWATE criteria difficulty score correlated with operation time (r = 0.52, 95% confidential interval CI 0.35-0.66, P < 0.001) and blood loss (r = 0.26, 95% CI 0.05-0.45, P = 0.018), while the modified difficulty score correlated with operation time (r = 0.53, 95% CI 0.36-0.67, P < 0.001), blood loss (r = 0.31, 95% CI 0.11-0.49, P = 0.004), and overall postoperative complications (odds ratio 1.34 [interquartile range 1.23, 1.47], P = 0.019).</p><p><strong>Conclusions: </strong>The IWATE criteria and modified difficulty score may be useful for assessing LRLR surgical difficulty. Additionally, the modified difficulty score may more precisely predict the risk of postoperative complications.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087455","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-assisted versus laparoscopic versus open liver resection: comparison of postoperative outcomes according to the IWATE difficulty score.","authors":"Schaima Abdelhadi, Mohamad El-Ahmar, Sepehr Abbasi Dezfouli, Katharina Vedder, Maike Hermann, Vanessa Orth, Mahmoud Halawa, Meik Moennichs, Christoph Reissfelder, Flavius Sandra-Petrescu","doi":"10.1007/s00464-025-12231-0","DOIUrl":"https://doi.org/10.1007/s00464-025-12231-0","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive liver surgery (MILS) has become increasingly established, yet the relative benefits of laparoscopic (LLR) and robotic-assisted liver resection (RLR) compared with open liver resection (OLR) across different levels of surgical difficulty remain debated. This study aimed to compare perioperative outcomes of RLR, LLR, and OLR stratified by the IWATE difficulty score.</p><p><strong>Methods: </strong>All consecutive patients undergoing elective liver resection between April 2018 and December 2024 at a high-volume hepatobiliary center were retrospectively analyzed from a prospectively maintained database. Patients were stratified into low/intermediate (IWATE 0-6) and advanced/expert (IWATE 7-12) groups. Multivariable regression and interaction term analyses were performed to adjust for confounders and assess the modifying effect of surgical difficulty.</p><p><strong>Results: </strong>A total of 686 patients were included: 425 (62%) underwent LLR, 101 (15%) RLR, and 160 (23%) OLR. Of these, 400 (58%) were advanced/expert resections. Minimally invasive approaches were associated with significantly reduced blood loss, morbidity, and length of stay compared with OLR across all IWATE levels. In advanced/expert resections, RLR provided the greatest benefit, with lower major complications (8% vs. 17% LLR vs. 23% OLR) and shorter length of stay (median 6 vs. 9 days OLR). Multivariable analyses confirmed these findings, with both LLR (OR 0.24, 95% CI 0.10-0.55) and RLR (OR 0.24, 95% CI 0.06-1.00) independently associated with reduced major complications compared to OLR. Interaction analyses demonstrated that the comparative advantage of RLR was most pronounced in advanced/expert resections, while LLR showed particular efficiency in low/intermediate cases.</p><p><strong>Conclusion: </strong>Both LLR and RLR are safe and effective across all levels of surgical difficulty. RLR, however, offers distinct advantages in technically demanding advanced and expert cases. These findings reinforce the role of MILS as the preferred standard and highlight the importance of tailoring the surgical approach to case complexity.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081573","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":"Defining benchmarks for postoperative mobilization based on the recommendations of the Enhanced Recovery After Surgery (ERAS) program for liver surgery: a prospective study.","authors":"Pia F Koch, Simon Moosburner, Nathanael Raschzok, Robert Oehring, Philipp Brunnbauer, Alexandra Zühlke, Marlen Breitkreutz, Phillip Pfeffer, Karl H Hillebrandt, Wenzel Schöning, Johann Pratschke, Igor M Sauer, Jens Neudecker, Felix Krenzien","doi":"10.1007/s00464-025-12194-2","DOIUrl":"https://doi.org/10.1007/s00464-025-12194-2","url":null,"abstract":"<p><strong>Background: </strong>Early mobilization is a core component of the Enhanced Recovery After Surgery (ERAS) protocol, aiming to accelerate recovery and reduce postoperative complications. In the context of liver surgery, early mobilization is supposed to be associated with improved outcomes, yet the specific influence of timepoint and duration of mobilization remains unexplored. This study seeks to evaluate benchmarks of early mobilization within a structured ERAS program according to the ERAS guidelines to establish evidence-based recommendations for its timing and duration.</p><p><strong>Methods: </strong>A prospective observational study was conducted on 1,076 patients undergoing liver surgery within an ERAS protocol that strictly followed the official ERAS Society recommendations. Mobilization data were collected from postoperative day (POD) 0 through POD 3 for specific liver resections, such as hepatectomy, limited liver resections, and comparisons between open (OR) and minimally invasive liver surgery (MILS). Two patient groups were defined based on the presence or absence of a textbook outcome (TO): Patients who achieved a TO were defined as no complications, no prolonged hospital stay, no readmissions, and no mortality (n = 261) vs. Patients who did not (n = 715; control group).</p><p><strong>Results: </strong>Patients without complications, across all types of liver resections, were mobilized on POD 1, POD 2, and POD 3 for a median of 2 h (IQR 1-4), 4 h (2-6), and 5 h (4-7), respectively. This duration was significantly longer than in patients who experienced any type of postoperative complications (p < 0.001). A MILS right hepatectomy was associated with significantly shorter mobilization times on POD1 to POD3-2 h (1-3), 3 h (2-4), and 4 h (3-6), respectively-compared to a MILS segmentectomy, which showed mobilization times of 2 h (2-4), 4 h (3-6), and 6 h (4-7). In general, mobilization was 2 h longer in patients that underwent MILS in comparison to OR (p < 0.001). Shorter surgeries starting earlier in the day facilitated early mobilization on POD 0 (p < 0.001).</p><p><strong>Conclusion: </strong>Our findings highlight the importance of postoperative mobilization and define cut-offs for the type of liver resection from easy to complex. However, applying a uniform cutoff for all types of liver resections appears more than questionable, given the procedure-specific differences in postoperative mobilization.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081602","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":"Evaluation of external validity of the distal pancreatectomy fistula risk score (D-FRS) in a high-volume center.","authors":"Francesca Fermi, Nicolò Pecorelli, Giovanni Guarneri, Alessia Vallorani, Diego Palumbo, Francesco Prato, Francesco De Cobelli, Marco Schiavo Lena, Stefano Partelli, Massimo Falconi","doi":"10.1007/s00464-025-12160-y","DOIUrl":"https://doi.org/10.1007/s00464-025-12160-y","url":null,"abstract":"<p><strong>Background: </strong>To reduce the risk of Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) following distal pancreatectomy (DP), preoperative and intraoperative Distal Pancreatectomy Fistula Risk Scores (D-FRS) were developed. While these models have demonstrated strong internal discrimination, external validation is needed. Therefore, this study aims to evaluate the discrimination and calibration of both risk models in an external cohort of patients undergoing DP.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients undergoing DP in a high-volume center (2020-2024). Preoperatively, all patients underwent a triple-phase CT scan measuring the pancreatic duct diameter (MPD, mm), neck thickness (mm), and late-early (L/E) phase attenuation ratio (L/E < 1 = soft texture). Preoperative D-FRS was calculated as the predicted probability based on MPD and neck thickness. Intraoperative D-FRS was calculated using MPD, neck thickness, body mass index (BMI, kg/m²), intraoperative time, and L/E ratio. CR-POPF was defined according to ISGPS criteria. Models' discrimination and calibration were assessed using the Area Under Curve (AUC) and calibration plot (ideal intercept = 0; slope = 1).</p><p><strong>Results: </strong>A total of 521 patients were included, 58% of whom underwent laparoscopic DP. CR-POPF occurred in 128 (25%) patients. CR-POPF was significantly associated with a higher BMI (p = 0.019) but not with pancreatic duct diameter, thickness, operative time, or L/E ratio. Both preoperative and intraoperative D-FRS models demonstrated poor discrimination, with an AUC of 0.51 (95% CI: 0.45-0.56) and 0.52 (95% CI: 0.46-0.58), respectively. The preoperative D-FRS exhibited poor calibration, with an intercept of 0.342 and a slope of -0.052, while the intraoperative D-FRS showed an intercept of 0.892 and a slope of -0.008.</p><p><strong>Conclusion: </strong>Both preoperative and intraoperative D-FRS had poor discrimination and calibration ability and tended to overestimate the risk of fistula. In our clinical context, D-FRS cannot be applied without further adjustment and recalibration.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081646","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":"Longitudinal retrospective review of three-tiered low molecular weight heparin dosing protocol to prevent thromboembolism in low-risk patients undergoing laparoscopic sleeve gastrectomy.","authors":"Mohamed Dahman, Craig Ratermann, Lein Ghuniem","doi":"10.1007/s00464-025-12188-0","DOIUrl":"https://doi.org/10.1007/s00464-025-12188-0","url":null,"abstract":"<p><strong>Background: </strong>According to the most recent consensus guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS), almost all bariatric surgery patients are at least a moderate to high risk for the development of postoperative venous thromboembolism (VTE). The most recent update also concludes that there continues to be a lack of high-quality data on safety, efficacy, dosing, and duration of treatment for pharmacologic thromboprophylaxis in the perioperative period up to discharge. Observational data has reported VTE rate between 1.9 and 5.4% in patients undergoing bariatric surgery, and rates as low as 0.5% in less invasive surgery including laparoscopic sleeve gastrectomy (LSG). In a retrospective study of over 175,000 LSGs performed from 2015 to 2016, 0.6% were complicated by postoperative bleed. This retrospective analysis reviews results from a consistent low molecular weight heparin (LMWH) protocol over a 12-year period for safety and efficacy.</p><p><strong>Objective: </strong>To address the lack of long-term data associated with a consistent LMWH protocol providing long-term safety and efficacy data in bariatric surgery.</p><p><strong>Setting: </strong>The study was conducted at a Community Hospital, United States.</p><p><strong>Methods: </strong>Protocol of enoxaparin 30 mg, 40 mg, or 60 mg every 12 h for patients with a weight of < 300 lbs., 300-400 lbs., or > 400 lbs., respectively, and is initiated at least 2 h before surgery.</p><p><strong>Results: </strong>Of 1936 patients, 4 patients (0.21%) developed VTE while 3 patients (0.15%) had bleeding complications.</p><p><strong>Conclusion: </strong>The thromboprophylaxis regimen utilized in this study demonstrated enoxaparin to be safe and efficacious, with incidences of thromboembolism and bleeding both below reported averages from the national quality databases.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076223","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}