Surgical Endoscopy And Other Interventional Techniques最新文献

{"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}

{"title":"Dual-time-point ICGA for perfusion-guided transaxillary single-port endoscopic gynecomastia surgery: a prospective exploratory comparative cohort study.","authors":"Chao Wang, He Jiang, Xiaoyue Zhang, Xin Miao, Feng Zhao, Xiaowen Liu, Xiangguo Dang","doi":"10.1007/s00464-026-13451-8","DOIUrl":"https://doi.org/10.1007/s00464-026-13451-8","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated a standardized dual-time-point indocyanine green fluorescence angiography (ICGA) protocol in transaxillary single-port endoscopic surgery for gynecomastia, focusing on early perfusion-related outcomes, perioperative recovery, and patient-reported outcomes.</p><p><strong>Methods: </strong>This prospective exploratory comparative cohort study included 88 men undergoing transaxillary single-port endoscopic subcutaneous glandular excision. Forty-three patients received ICGA and 45 did not. In the ICGA group, perfusion was assessed after deep dissection from the pectoralis major fascia and again after skin closure before compression dressing. Perfusion grading guided intraoperative adjustment and postoperative risk-stratified management. The primary outcome was a perfusion-related composite endpoint within 14 postoperative days. Secondary outcomes included perioperative variables, early complications, nipple sensation change, and 6-month BODY-Q scores. An exploratory observation point analysis assessed the association between second ICGA relative perfusion value (RPV) and postoperative day 14 local tissue changes.</p><p><strong>Results: </strong>The primary endpoint occurred in 3 of 43 patients (7.0%) in the ICGA group and 12 of 45 patients (26.7%) in the non-ICGA group, corresponding to an absolute risk difference of - 19.7 percentage points (95% confidence interval, - 34.8 to - 3.9) and an odds ratio of 0.21 (95% confidence interval, 0.05 to 0.79; P = 0.022). Perioperative recovery variables did not differ significantly. At 6 months, adjusted satisfaction with chest and nipples was higher in the ICGA group, whereas scar appraisal and psychological function showed no clear between-group differences. Lower second ICGA RPV was associated with postoperative day 14 local residual risk tissue changes, with 26.0% identified as an exploratory warning threshold.</p><p><strong>Conclusions: </strong>A standardized dual-time-point ICGA protocol was feasible and was associated with fewer early perfusion-related tissue changes without evident perioperative burden. The 26% RPV value remains an exploratory warning signal requiring external validation.</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":"149147981","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":"Efficacy of endoscopic submucosal dissection for superficial neoplastic lesions in the ileocecal valve region: a large multi-center comparative study.","authors":"Kasenee Tiankanon, Joo Ha Hwang, Mohamed O Othman, David L Diehl, Rinrada Worapongpaiboon, Edward John Despott, Yasutoshi Shiratori, Manol Jovani, Anand Kumar, Yutaka Tomizawa, Shaimaa Elkholy, Mohammad Bilal, Makoto Nishimura, Sayaka Nagao, Abel Joseph, Shai Friedland, Mai Ahmed Khalaf, Molham Abdulsamad, Georgios Kalopitas, Elisabet Maristany Bosch, Syed Matthew Kodilinye, Daryl Ramai, Abdulrahman Qatomah, Kevan Josloff, Mohammed El-Sherbiny, Karim Essam, Hany Haggag, Abeer Abdellatef, Kerolis Yousef, Mohamed Abdel Zaher, Hiroyuki Aihara, Saowanee Ngamruengphong","doi":"10.1007/s00464-026-13258-7","DOIUrl":"https://doi.org/10.1007/s00464-026-13258-7","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic submucosal dissection (ESD) of ileocecal valve (ICV) polyps potentially offers higher en bloc resection and lower recurrent rates than endoscopic mucosal resection. However, evidence regarding safety and efficacy of ICV polyp ESD compared to non-ICV polyps remain limited. We aim to assess the safety and efficacy of ICV polyps ESD versus polyps in the right colon.</p><p><strong>Methods: </strong>A multi-center, retrospective cohort study was conducted at 11 referral centers. Polyps in the proximal right-sided colon treated by ESD were included and categorized into ICV and non-ICV group. The primary outcomes were en bloc, R0, curative resection rate. The secondary outcomes were procedural time, adverse event, and local recurrence rates.</p><p><strong>Results: </strong>A total of 414 patients (age 65.6 ± 11.3 years, 51.7% male) were enrolled (76 ICV and 338 non-ICV). The overall mean polyp size was 37 ± 19 mm. The mean ICV circumferential involvement was 35 ± 23%, with 3(3.9%) lesions with ileal extension. Complete resection rate was comparable between groups (100% vs 99.7%; p = 0.86). ICV group showed lower en bloc (82% vs 93%, p = 0.004), R0 (74% vs 86%, p = 0.001), curative resection rate (74% vs 86%, p = 0.021), and higher post-procedural bleeding rate (9.2% vs 2.7%; p = 0.003). Local recurrence rates were similar (8% vs 6%; p = 0.75), with 90% of recurrences treated endoscopically.</p><p><strong>Conclusion: </strong>ESD of ICV polyps in expert hands is safe with high rate of complete resection. Despite a lower en bloc resection and higher post-ESD bleeding rate compared to non-ICV polyps, ESD remains an alternative option for large ICV polyps.</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":"149149127","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":"Deep learning-based semantic segmentation of abdominal wall layers during direct optical trocar insertion: toward AI-assisted surgical access.","authors":"Mohammad Javad Farzadmanesh, Ali Jaliliyan, Parisa Tavana, Abdolreza Pazouki","doi":"10.1007/s00464-026-13404-1","DOIUrl":"https://doi.org/10.1007/s00464-026-13404-1","url":null,"abstract":"<p><strong>Background: </strong>The initial entry phase of minimally invasive surgery-direct optical trocar insertion (DOTI)-remains high risk due to potential spatial disorientation. To our knowledge, this pilot study investigates a deep learning-based semantic segmentation framework for identifying critical abdominal wall layers during DOTI.</p><p><strong>Methods: </strong>From 10 DOTI procedures, 951 frames were extracted and pixel-wise annotated into three anatomical classes-rectus muscle, rectus sheath, and peritoneum-plus background. A DeepLabV3+ architecture with ResNet-50 backbone was trained using five-fold cross-validation. Performance was assessed by mean Intersection over Union (mIoU), mean Dice coefficient (mDice), precision, recall, and F1-score.</p><p><strong>Results: </strong>The model achieved a mean IoU of 0.794 (95% CI 0.785-0.802) and a mean Dice of 0.883 (95% CI 0.878-0.889). Class-specific Dice scores were 0.923 for rectus muscle, 0.903 for rectus sheath, and 0.824 for peritoneum. Confusion matrix analysis showed minimal direct confusion between anatomical tissue classes (0.0-0.3%), with most errors confined to tissue-background boundaries.</p><p><strong>Conclusion: </strong>This pilot single-center study demonstrates the technical feasibility of deep learning-based semantic segmentation for extra-abdominal tissue-layer identification during optical trocar insertion. Although the model showed consistent performance across five-fold cross-validation, the small patient cohort limits generalizability, and larger multi-center and prospective studies are required before clinical translation. The proposed framework provides a preliminary basis for future investigation of AI-assisted surgical guidance.</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":"149149595","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":"Diagnostic accuracy of ureteroscopic biopsy for upper tract urothelial carcinoma: implications for kidney-sparing therapy selection.","authors":"Jungwon Park, Jungkeun Song, Younsoo Chung, Hyung Joon Kim, Hakmin Lee, Jong Jin Oh, Sangchul Lee, Seong Jin Jeong, Sung Kyu Hong, Seok-Soo Byun, Sang Hun Song","doi":"10.1007/s00464-026-13249-8","DOIUrl":"https://doi.org/10.1007/s00464-026-13249-8","url":null,"abstract":"<p><strong>Background: </strong>Radical nephroureterectomy (RNU) remains the gold standard for high-risk upper tract urothelial carcinoma (UTUC). However, renal preservation is increasingly emphasized for patients with low-grade disease or impaired renal function.</p><p><strong>Objective: </strong>To evaluate the diagnostic performance of URS biopsy compared to final pathologic findings after radical nephroureterectomy and to assess the clinical implications for treatment selection.</p><p><strong>Materials & methods: </strong>We retrospectively analyzed 913 patients who underwent radical nephroureterectomy for UTUC at a single tertiary center. Among these, 164 patients underwent preoperative URS with biopsy, and 125 had both URS grade and final pathologic grade available for concordance analysis. Diagnostic performance metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's kappa coefficient were calculated. Risk factors for undergrading were identified using multivariable logistic regression.</p><p><strong>Results: </strong>The overall concordance between URS biopsy and final pathology was 82.4% (103/125). However, marked discordance was observed in low-grade URS biopsies, with an undergrading rate of 58.6% (17/29 cases upgraded to high-grade on final pathology). The PPV for low-grade URS biopsy was only 41.4%, whereas the PPV for high-grade URS biopsy was excellent at 94.8%. Cohen's kappa was 0.423, indicating moderate agreement. Risk factors for undergrading included age <65 years (OR 2.66, p = 0.004), renal pelvis location (OR 2.59, p = 0.037), and multifocal disease (OR 2.12, p = 0.044). Patients undergoing URS biopsy had higher bladder recurrence rates (29.8% vs. 22.3% vs. 20.5%, p = 0.020) despite not being an independent predictor at multivariate analysis (p = 0.289).</p><p><strong>Conclusion: </strong>URS biopsy demonstrates high undergrading rates (58.6%) and low PPV (41.4%) for low-grade tumors, making it unreliable for selecting patients for kidney-sparing ablative therapies. High-grade URS biopsies reliably predict high-grade disease. Alternative risk stratification strategies are needed to safely identify candidates for nephron-sparing approaches.</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":"149147963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of semaglutide initiated six months after laparoscopic sleeve gastrectomy on long-term weight loss and metabolic outcomes: single-center preliminary study.","authors":"Pamela Jeske, Julia Roleder, Kinga Zastawna, Łukasz Krokowicz, Krzysztof Szmyt","doi":"10.1007/s00464-026-13505-x","DOIUrl":"https://doi.org/10.1007/s00464-026-13505-x","url":null,"abstract":"<p><strong>Background: </strong>Although laparoscopic sleeve gastrectomy (LSG) is an effective treatment for severe obesity, some patients experience suboptimal weight loss or an early weight-loss plateau during postoperative follow-up. Semaglutide has emerged as an effective pharmacological option for obesity management; however, evidence regarding its use after bariatric surgery remains limited. This study evaluated the impact of adjunctive semaglutide therapy initiated six months after LSG on long-term weight loss and metabolic outcomes.</p><p><strong>Materials and methods: </strong>This retrospective single-center study included 88 patients who underwent primary LSG. Patients were divided into two groups: 45 patients underwent standard postoperative follow-up after LSG, whereas 43 patients received adjunctive semaglutide therapy initiated six months after surgery because of suboptimal weight loss or weight-loss plateau. Anthropometric and metabolic parameters, including body weight, body mass index (BMI), percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin (HbA1c), lipid profile, and blood pressure, were evaluated at baseline and at 6, 12, and 24 months after surgery.</p><p><strong>Results: </strong>No significant differences were observed between the groups six months after surgery, immediately before semaglutide initiation. At 12 months, patients receiving semaglutide achieved significantly lower BMI, lower body weight, and greater %TWL and %EWL. These benefits persisted at 24 months, with significantly greater weight loss and a more favorable metabolic profile, including higher HDL cholesterol and lower total cholesterol and triglyceride concentrations.</p><p><strong>Conclusions: </strong>Adjunctive semaglutide therapy initiated six months after laparoscopic sleeve gastrectomy was associated with significantly greater long-term weight loss and improved cardiometabolic outcomes compared with surgery alone. These findings suggest that postoperative semaglutide may represent an effective and safe strategy for patients experiencing suboptimal weight loss following sleeve gastrectomy.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138392","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 artificial intelligence anatomical model for landmark recognition in endolaparoscopic totally extraperitoneal inguinal hernia repair.","authors":"YuFu Jarrell Lai, Rou Yi Soong, Le'En Maegan Sim, Cedric Lester Amodia, Richie Chu Go, Sharvesh Subhash, Jing Tian, Eng-Tat Ang, Sean Lee, Davide Lomanto","doi":"10.1007/s00464-026-13359-3","DOIUrl":"https://doi.org/10.1007/s00464-026-13359-3","url":null,"abstract":"<p><strong>Background: </strong>Totally extraperitoneal (TEP) inguinal hernia repair demands precise recognition of posterior groin anatomy, yet the learning curve remains steep. We developed and evaluated an artificial intelligence (AI) model to identify key landmarks of the myopectineal orifice during TEP repair to support training and intraoperative guidance.</p><p><strong>Methods: </strong>Thirty high-definition videos of unilateral elective TEP inguinal hernia repair were reviewed. From these, 1,946 image frames were extracted and annotated for six critical landmarks: pubic bone, inferior epigastric vessels, testicular vessels, vas deferens, triangle of pain, and triangle of doom. After cleaning, 1,420 frames remained (training/validation/evaluation split 70/15/15). Training images underwent augmentation (flips, rotations, colour adjustments) and oversampling to address class imbalance, yielding 14,961 training images from an initial 994. A YOLO11-M-seg object detection model was trained for 100 epochs and assessed using COCO metrics (precision, recall, mAP50, mAP50-95).</p><p><strong>Results: </strong>The final dataset comprised 15,387 images. The model achieved precision 0.805, recall 0.704, mAP50 0.774, and mAP50-95 0.500. Landmark performance excelled for triangle of pain (AP50 0.847; AP50-95 0.502) and testicular vessels (AP50 0.853; AP50-95 0.560), with strong results for the other landmarks. Inference speed reached 60 FPS, supporting real-time application.</p><p><strong>Discussion: </strong>High accuracies for distinct landmarks like triangle of pain and testicular vessels reflect robust feature learning despite challenges like occlusion and lighting variability. Augmentation simulated intraoperative conditions (angle changes, smoke, blood), enhancing generalisability. Real-time speed exceeds video capture rates, enabling AR overlays for navigation.</p><p><strong>Conclusion: </strong>This AI model shows promise for real-time TEP landmark recognition, potentially accelerating training and reducing complications in endo-laparoscopic hernia repair.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138333","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":"Do structural ICU requirements reflect critical care demand in elective metabolic and bariatric surgery? A retrospective cohort study.","authors":"Michał Robert Janik, Grzegorz Dobkowski, Krzysztof Jędras, Przemysław Sroczyński, Grzegorz Kade","doi":"10.1007/s00464-026-13412-1","DOIUrl":"https://doi.org/10.1007/s00464-026-13412-1","url":null,"abstract":"<p><strong>Background: </strong>Metabolic and bariatric surgery (MBS) is increasingly delivered in lower-acuity settings, yet on-site intensive care unit (ICU) capability remains a structural requirement for the highest center-designation tier. Direct data on critical-care utilization after elective MBS without an on-site ICU are limited. We describe 30-day outcomes at such a center, using contemporaneous elective laparoscopic cholecystectomy (LC) in the same environment as a reference.</p><p><strong>Methods: </strong>Retrospective cohort study of consecutive adults undergoing elective MBS (sleeve gastrectomy or Roux-en-Y gastric bypass) or LC (2022-2025) at a single center without an on-site ICU but with a pre-defined escalation and transfer protocol. The primary outcome was the 30-day complication rate (Clavien-Dindo); ICU utilization was grade ≥IV. Outcomes are reported descriptively with 95% confidence intervals (CIs); regression and propensity-score-matched analyses are exploratory (Supplementary Material).</p><p><strong>Results: </strong>Of 1,065 patients (MBS n=351, LC n=714), 30-day complication rates were 4.27% (95% CI 2.39-6.94%) versus 3.64% (95% CI 2.37-5.27%). No MBS patient was admitted to intensive care (0/351), compatible with a true rate up to 1.05% (upper 95% CI); two LC patients required ICU admission (0.28%), both for retained-stone acute pancreatitis. All five MBS reoperations were for postoperative hemorrhage; none developed organ dysfunction or met ICU-transfer criteria, and none died. Because events were rare, this study cannot exclude clinically meaningful ICU demand, and absence of a detected difference does not establish equivalence.</p><p><strong>Conclusions: </strong>In this single-center experience, elective MBS without an on-site ICU under a structured escalation protocol showed no observed ICU admissions over 30 days, though the confidence interval remains compatible with infrequent critical-care need. These hypothesis-generating findings demonstrate feasibility in one environment and should not be generalized to accreditation policy; prospective multicenter data are required.</p><p><strong>Study registration: </strong>Research Registry (UIN: researchregistry11829); retrospectively registered; https://www.researchregistry.com.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138293","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":"Computer vision augmented indocyanine green near-infrared fluorescence (ICG-NIRF) signal-to-background ratio (SBR) for identification of extrahepatic biliary structures in laparoscopic cholecystectomy.","authors":"Philip J Seger, Shinil Shah, Akhil Gorugantu, Nan Xi, Brendan T Fox, Rishikesh Bhyri, Kaity Tung, Rita Glazer, Brian Quaranto, Junsong Yuan, Erik Wilson, Gene Yang, Steven D Schwaitzberg, Peter C W Kim","doi":"10.1007/s00464-026-13442-9","DOIUrl":"https://doi.org/10.1007/s00464-026-13442-9","url":null,"abstract":"<p><strong>Introduction: </strong>Indocyanine green near-infrared fluorescence (ICG-NIRF) improves visualization of extrahepatic biliary ducts (EHBD) compared to white light imaging (WLI) in laparoscopic cholecystectomy (LC). However, the optimal EHBD signal is limited by background hepatic fluorescence disturbance, complicating interpretation of critical structures despite ICG pharmacologic approaches. We describe the feasibility of multi-modal computer vision (CV) models to improve the discrimination of the EHBD ICG signal to liver background ratio (SBR), facilitating intra-operative visualization of critical structures.</p><p><strong>Methods: </strong>A multi-institutional LC database was curated (n = 928). A retrospective analysis of ICG-NIRF LC cases (n = 156) was performed to identify images of hepatobiliary anatomy in both WLI and ICG-NIRF. The multi-modal images were annotated for EHBD, liver, and instruments. A YOLOv11-based model selectively attenuated background liver ICG-NIRF, to improved EHBD visualization. A novel WLI-ICG fusion image generated after SAM3 segmentation displayed ICG-NIRF enhanced EHBD superimposed on WLI liver parenchyma, improving critical structure identification while eliminating background noise. The visual impact of the models was quantified via intensity of EHBD (signal) to liver (background) ratio.</p><p><strong>Results: </strong>The baseline EHBD to liver SBR in ICG-NIRF was 1.21 ± 0.69. Attenuating background liver fluorescence alone improved SBR (4.46 ± 3.06) (p < 0.0001). The WLI-ICG fusion model displaying ICG enhanced EHBD on native liver parenchyma improved SBR (3.07 ± 1.09) (p < 0.0001) while improving usability. The multi-modal detection models demonstrated superior performance versus previous models trained on WLI alone, precision: 0.911, recall: 0.866, F1 score: 0.887, mAP: 0.842.</p><p><strong>Conclusion: </strong>Our study demonstrates the methodologic feasibility of CV models to selectively enhance the EHBD to liver SBR via generation of a novel, practical WLI-ICG fusion image. Multi-modal CV identification and augmentation of EHBD provides higher quality, more objective assessment of critical structures and a potentially more universal solution to the utility and usability of ICG-NIRF compared to previous pharmacologic approaches.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138295","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":"Primary defect closure in minimally invasive direct inguinal hernia repair: a propensity-weighted analysis.","authors":"Claudia Theis, Victor Andrade Nunes, Bernardo Fontel Pompeu, Xinyan Zheng, Sergio Mazzola Poli de Figueiredo","doi":"10.1007/s00464-026-13478-x","DOIUrl":"https://doi.org/10.1007/s00464-026-13478-x","url":null,"abstract":"<p><strong>Background: </strong>The benefit of defect closure during minimally invasive repair of direct inguinal hernias remains uncertain. Prior studies have reported conflicting findings and often lacked adequate control for confounding.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients undergoing elective, unilateral, laparoscopic or robotic repair of direct inguinal hernias with complete 30-day follow-up in the Abdominal Core Health Quality Collaborative registry. Inverse probability of treatment weighting adjusted for age, BMI, ASA class, smoking, anticoagulation, diabetes, hypertension, immunosuppressant use, prior pelvic operation, recurrent hernia, direct hernia size, and prior mesh. The primary outcome was 30-day surgical site occurrence (SSO). Secondary outcomes included 30-day readmission, reoperation, and recurrence. A prespecified robotic subgroup analysis was performed.</p><p><strong>Results: </strong>A total of 4,209 patients were included. Closure was associated with lower SSO rate (3.6% vs 6.2%, p = 0.034) but higher 30-day cardiac readmissions (2.2% vs 0.3%, p < 0.001), driven by 3 versus 1 events, while other causes were infrequent and similar between groups. In the robotic subgroup (n = 2,171), the wound benefit lost statistical significance (SSO 3.9% vs 5.1%, p = 0.330), whereas cardiac readmissions remained elevated (2.1% vs 0.3%, p = 0.001). Closure clustered with distinct operative practices, including more frequent use of self-fixating mesh (60% vs 38%, p < 0.001), TAP blocks under direct visualization (46% vs 9.9%, p < 0.001), and shorter operative times (62% vs 51% completed in < 60 min, p = 0.001).</p><p><strong>Conclusion: </strong>Direct defect closure was associated with a reduction in early wound complications and higher 30-day cardiac readmissions. Given the very small absolute number of cardiac readmissions (3 vs 1) that are likely unrelated to defect closure, these findings support selective use of direct defect closure, particularly in patients with larger medial defects or higher wound complication risk. Randomized trials with standardized operative protocols are still needed to confirm our findings.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138405","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}