Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Automated surgical phase recognition in pediatric laparoscopic fundoplication using deep learning: a retrospective video-based study.","authors":"Yohei Sanmoto, Luning Li, Yudai Goto, Xin Zhu, Kouji Masumoto","doi":"10.1007/s00464-026-13437-6","DOIUrl":"https://doi.org/10.1007/s00464-026-13437-6","url":null,"abstract":"<p><strong>Background: </strong>Automated surgical phase recognition may support objective workflow analysis and surgical education but has not been sufficiently evaluated in pediatric minimally invasive surgery. This study aimed to develop and evaluate a deep learning-based phase recognition model for pediatric laparoscopic fundoplication.</p><p><strong>Methods: </strong>We retrospectively analyzed 38 laparoscopic fundoplication videos recorded between 2015 and 2025. Videos were annotated at 1-s intervals using a predefined 10-phase workflow. Heterogeneous nonstandard intra-abdominal intervals were excluded before model training and evaluation, resulting in a nine-phase classification framework. A phase recognition model combining a frozen Vision Transformer backbone with a bidirectional gated recurrent unit network was trained using cross-entropy and temporal smoothing losses and evaluated by case-level 5-fold cross-validation with three random seeds per fold. Overall and phase-specific classification performance, misclassification patterns, and correlations and absolute differences between predicted and reference phase durations were assessed.</p><p><strong>Results: </strong>Across the eight surgical phases, mean accuracy, macro-F1 score, and macro-Jaccard index were 0.812 ± 0.030, 0.805 ± 0.030, and 0.682 ± 0.042, respectively. Phase-specific mean recall ranged from 0.674 to 0.902 and was lowest for the shoulder stitch phase (0.674 ± 0.135). Predicted timelines generally reflected the overall operative workflow, with misclassifications occurring predominantly between temporally or procedurally adjacent phases. Predicted and reference phase durations showed moderate to very strong correlations across phases (Spearman's ρ, 0.469-0.937), with the lowest correlation observed for hiatal closure (ρ = 0.469); hiatal closure and wrap formation also had the largest median absolute errors (5.0 min each).</p><p><strong>Conclusions: </strong>Automated phase recognition in pediatric laparoscopic fundoplication videos achieved promising classification performance, although discrimination between visually similar adjacent phases and case-level phase duration estimation require further improvement. These findings establish an initial benchmark for pediatric surgical video analysis and support further investigation of its applications in operative review, surgical education, and structured performance assessment.</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":"149138263","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":"Effect of virtual reality versus dry lab training on technical skills in robotic surgical simulation: a systematic review and meta-analysis.","authors":"Samy Castillo-Flores, Ricardo E Nunez-Rocha, Andres A Abreu, Zachary A Whitham, Gilbert Z Murimwa, Morgan F Pettigrew, Ofelia Negrete-Vasquez, Ganesh Sankaranarayanan, Angela A Guzzetta, Daniel J Scott, Herbert J Zeh, Patricio M Polanco","doi":"10.1007/s00464-026-13459-0","DOIUrl":"https://doi.org/10.1007/s00464-026-13459-0","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality (VR) and dry lab (DL) platforms are widely used for robotic surgery training, yet their comparative effectiveness remains uncertain, particularly for suturing skills.</p><p><strong>Methods: </strong>A systematic review of controlled studies comparing VR with physical robotic simulation was conducted; meta-analysis was restricted to VR versus DL studies. PubMed, Embase, MEDLINE, and the Cochrane Library were searched. The primary outcome was post-training technical performance; task completion time was secondary. Pooled standardized mean differences (SMD) or mean differences (MD) with 95% CI were calculated using random-effects models.</p><p><strong>Results: </strong>Ten studies (333 trainees) were included in the qualitative synthesis, and six (168 participants) in the quantitative analysis. DL training showed significantly higher post-test technical performance (SMD - 0.43; 95% CI - 0.74 to - 0.12). In RCTs (n = 89), the difference was not significant (SMD - 0.15; 95% CI - 0.57 to 0.27). Fixed-time curricula favored DL (SMD - 0.51; 95% CI - 0.96 to - 0.05), whereas proficiency-based progression showed no difference. Task completion time was similar between modalities (MD 0.14; 95% CI - 0.43 to 0.70).</p><p><strong>Conclusions: </strong>DL training was associated with higher post-test technical performance overall, but not in the RCT-only analysis; task completion time was similar between modalities. Both approaches may have complementary roles depending on curriculum, task, and trainee characteristics.</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":"149138276","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":"Indocyanine green-guided lymphadenectomy and survival of patients with gastric cancer: a systematic review and meta-analysis of time-to-event data.","authors":"Yuhang Liu, Han Zou, Yixiang Zhai, Yue Xiong, Qijun Lv","doi":"10.1007/s00464-026-13324-0","DOIUrl":"https://doi.org/10.1007/s00464-026-13324-0","url":null,"abstract":"<p><strong>Background: </strong>Indocyanine green fluorescence imaging (ICG-FI) is increasingly used for lymph node mapping in gastric cancer (GC) surgery, but its impact on long-term oncologic outcomes remains unclear. This systematic review and meta-analysis evaluated the long-term survival benefits of ICG-guided lymphadenectomy compared with conventional surgery.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane Library were searched from inception to November 2025, supplemented by clinical trial registries. Studies comparing ICG-guided versus non-ICG-guided lymphadenectomy in GC patients were included. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes included lymph node yield and postoperative complications. Random-effects models were used, and Bayesian analyses estimated the probability of survival benefit.</p><p><strong>Results: </strong>Seven studies comprising 7518 patients were included. ICG significantly improved 3-year OS (HR = 0.635, 95% CI 0.511-0.790, P = 0.000), 3-year DFS (HR = 0.682, 95% CI 0.530-0.877, P = 0.003), and 5-year OS (HR = 0.700, 95% CI 0.507-0.966, P = 0.030), with Bayesian posterior probabilities of 100%, 100%, and 99.1%, respectively. No significant differences were observed for 2-year OS or DFS. ICG significantly increased lymph node yield (WMD = 6.557, 95% C1 3.821-9.294, P = 0.000) without increasing postoperative complications (RR = 0.899, 95% CI 0.647-1.250, P = 0.527).</p><p><strong>Conclusion: </strong>ICG-guided lymphadenectomy is associated with improved long-term survival and increased lymph node dissection without increasing complications. These findings support ICG-FI as a valuable adjunct in gastric cancer surgery. Further high-quality randomized trials are warranted to validate these results in diverse populations and settings.</p><p><strong>Prospero registration number: </strong>CRD420261342420.</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":"149138437","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":"Video-based OSATS and GEARS assessment of pancreatic transection and stump closure predicts clinically relevant pancreatic fistula after robotic distal pancreatectomy.","authors":"Alessia Vallorani, Kristine Kuchta, Laleh Foroutani, Sangrag Ganguli, Sarah B Hays, Colin Johnson, Pietro Mascagni, Syed A Mehdi, Aram Rojas, Mohamed A Adam, Miral S Grandhi, Adnan Alseidi, Melissa E Hogg","doi":"10.1007/s00464-026-13447-4","DOIUrl":"https://doi.org/10.1007/s00464-026-13447-4","url":null,"abstract":"<p><strong>Background: </strong>Clinically relevant postoperative pancreatic fistula (CR-POPF) remains a major source of morbidity after distal pancreatectomy. Existing risk models rely on clinical and anatomical variables and may not capture operative performance. We evaluated whether technical performance during pancreatic transection and stump closure was associated with CR-POPF after robotic distal pancreatectomy (RDP).</p><p><strong>Methods: </strong>We conducted a multicenter retrospective study of consecutive RDPs performed between 2020 and 2024 at two high-volume hepatopancreatobiliary centers. Cases with complete videos of pancreatic transection and 90-day follow-up were included. Two blinded graders assessed performance using modified Objective Structured Assessment of Technical Skills (mOSATS) and Global Evaluative Assessment of Robotic Skills (GEARS). Stapler type, number of firings, application time, available gland texture data, and case difficulty were recorded. Technical skill comparisons were adjusted for case difficulty. The primary outcome was CR-POPF within 90 days.</p><p><strong>Results: </strong>Seventy-four patients were included, and 12 developed CR-POPF. Two stapler firings were more frequent in patients with CR-POPF (25.0% vs. 1.6%, p = 0.004), whereas stapler type and application time were not associated with CR-POPF. Total mOSATS and GEARS scores were lower in the CR-POPF group (22.3 ± 2.3 vs. 24.5 ± 2.5, p = 0.004; 22.5 ± 2.4 vs. 24.9 ± 2.6, p = 0.005). After adjustment for case difficulty, time and motion, instrument handling, tissue exposure, summary mOSATS, depth perception, bimanual skill, efficiency, and robot control remained significantly lower in patients with CR-POPF. Higher total mOSATS and GEARS scores were associated with lower odds of CR-POPF on univariable analysis; adjusted estimates were similar but did not reach statistical significance.</p><p><strong>Conclusion: </strong>Lower technical performance during pancreatic transection was associated with CR-POPF after RDP, independent of measured case difficulty. Structured video-based assessment may complement existing risk models by capturing operative factors not reflected by baseline characteristics.</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":"149138358","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":"Current status of minimally invasive surgery for thoracic esophageal diverticula: systematic review and meta-analysis.","authors":"Alberto Aiolfi, Giacomo Tamburri, Francesco Cammarata, Filippo Bistagnino, Gianluca Bonitta, Aleksandar Simić, Ognjan Skrobic, Christian Alexander Gutschow, Sebastian F Schoppmann, Shahin Ayazi, Moustafa Elshafei, Calin Popa, Davide Bona, Luigi Bonavina","doi":"10.1007/s00464-026-13426-9","DOIUrl":"https://doi.org/10.1007/s00464-026-13426-9","url":null,"abstract":"<p><strong>Introduction: </strong>Thoracic esophageal diverticula, including epiphrenic and parabronchial types, are rare clinical entities representing about 30% of all esophageal diverticula. Thoracic diverticula of the pulsion type have traditionally been associated with motility disorders and treated by stapled diverticulectomy with or without myotomy/fundoplication in patients experiencing disabling symptoms of dysphagia, regurgitation or pulmonary aspiration. Purpose of this study was to review the existing literature and estimate outcomes of minimally invasive surgery.</p><p><strong>Methods: </strong>Systematic review and meta-analysis. PubMed, MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried. The search was last updated on April 20, 2026. Outcomes were staple-line leak, overall complications, in-hospital mortality, and symptoms improvement.</p><p><strong>Results: </strong>Twenty-one observational studies including 390 patients were analyzed. The age of the patients ranged from 23 to 83 years. Dysphagia (86%), regurgitation (73.4%), and respiratory symptoms (31.2%) were common indications for surgery. The size of the diverticula ranged from 2 to 11 cm. Preoperative use of standard or high-resolution esophageal manometry was reported in 18 studies. Achalasia (49.2%) was the most commonly associated motility disorder. Laparoscopic (61.9%), thoracoscopic (30.6%), or combined (6.7%) minimally invasive approaches were described. Adjunctive procedures were esophagomyotomy (87%) and Dor (34.6%) or Toupet (17.7%) fundoplication. The estimated pooled prevalence of staple-line leak was 9.8% (95% CrI 7.1-13.4%; I² = 0.0). Exploratory unadjusted subgroup analyses did not identify statistically supported differences in staple-line leak according to myotomy (RR = 0.67; 95% CrI 0.17-3.52) or surgical approach (RR = 0.72; 95% CrI 0.22-3.39). The estimated pooled prevalence of overall complications, in-hospital mortality, and study-reported symptom resolution/improvement was 21.6% (95% CrI 16.1-28.4%), 1.3% (95% CrI 0.5-2.9%), and 92.1% (95% CrI 87.7-95%), respectively.</p><p><strong>Conclusions: </strong>Current evidence reporting outcome for minimally invasive midesophageal and epiphrenic diverticulectomy is limited by study design and treatment heterogeneity. Future well-designed multicenter studies are required to assess the effect of surgical approach and esophageal myotomy on short-term morbidity, symptomatic outcomes, and recurrence rate.</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":"149138281","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":"Predictors and therapeutic yield of oesophagogastroduodenoscopy in critically and morbidly ill patients presenting with coffee-ground vomitus.","authors":"Hafizuddin Salleh, Yap Lee Ming, Abdel Latif Khalifa Elnaim, Ismail Sagap","doi":"10.1007/s00464-026-13469-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13469-y","url":null,"abstract":"<p><strong>Background: </strong>Coffee-ground vomitus in critically ill patients causes anxiety among healthcare providers. It commonly prompts endoscopic examination for both diagnostic and therapeutic purposes. Performing upper gastrointestinal endoscopy in this cohort is not without potential complications. The study objective was to assess the outcomes of endoscopy and to identify clinical factors associated with therapeutic endoscopic intervention.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted using data of 245 critically and morbidly ill patients presenting with coffee-ground vomitus who underwent endoscopy between 2015 and 2025 at Malacca Hospital. Variables included demographics, clinical and laboratory parameters, endoscopic timing and findings, and clinical outcomes. The Chi-square test or Fisher's exact test were used for univariate analysis, and variables with p < 0.25 were entered into a multivariable analysis to identify independent predictors of endoscopic intervention.</p><p><strong>Results: </strong>A total of 245 patients were included; 81 (33.1%) underwent therapeutic endoscopic intervention, while 164 (66.9%) underwent diagnostic endoscopy alone. Endoscopic findings were inflammatory in 67 (27.3%), low-risk ulcers in 60 (24.5%), high-risk ulcers in 59 (24.1%), tumors in 8 (3.3%), varices in 3 (1.2%), and 15 (6.1%) patients had normal findings. Age < 60 years, hemoglobin < 10 g/dL, and urea > 6.5 mmol/L were significantly associated with therapeutic intervention. Multivariable analysis identified hemoglobin < 10 g/dL (p = 0.033) and urea > 6.5 mmol/L (p = 0.010) as independent predictors of endoscopic intervention.</p><p><strong>Conclusion: </strong>In critically and morbidly ill patients presenting with coffee-ground vomitus only one-third received therapeutic endoscopic procedure. Hemoglobin < 10 g/dL and blood urea > 6.5 mmol/L were independently associated with therapeutic endoscopic intervention. These findings support further evaluation of a selective, risk-based approach to prioritizing endoscopy; prospective validation is required before such an approach can be recommended for clinical practice.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128627","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":"Learning curve of robotic pancreaticoduodenectomy: a CUSUM and risk-adjusted CUSUM analysis of 120 consecutive cases.","authors":"Giuseppe Quero, Matteo Aulicino, Lodovica Langellotti, Gloria Santoro, Giuseppe Massimiani, Flavia Taglioni, Giuseppe Daloiso, Roberta Menghi, Federica Marzi, Antonio Pio Tortorelli, Claudio Fiorillo, Claudia Ferrantone, Davide De Sio, Mario Lettieri, Rossella Sepe, Vincenzo Tondolo, Sergio Alfieri","doi":"10.1007/s00464-026-13423-y","DOIUrl":"https://doi.org/10.1007/s00464-026-13423-y","url":null,"abstract":"<p><strong>Background: </strong>Robotic pancreaticoduodenectomy (RPD) has progressively gained acceptance in high-volume pancreatic surgery centers. However, the learning curve associated with implementation of an RPD program remains incompletely defined. This study aimed to evaluate the learning curve of RPD using cumulative sum (CUSUM) and risk-adjusted cumulative sum (RA-CUSUM) analyses.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained database including 120 consecutive patients undergoing RPD between January 2023 and April 2026 was performed. CUSUM analysis of operative time and RA-CUSUM analysis of major postoperative morbidity (Clavien-Dindo grade ≥III) were used to assess operative efficiency and postoperative safety, respectively. Outcomes were compared before and after the exploratory RA-CUSUM-derived learning curve transition point.</p><p><strong>Results: </strong>Median operative time was 625 min (IQR 568-706), whereas major postoperative morbidity occurred in 30 patients (25%). CUSUM analysis identified an inflection point at case 49, demonstrating progressive improvement in operative efficiency. Linear regression analysis confirmed a significant reduction in operative time across consecutive procedures (regression coefficient - 1.68 min/case; R² = 0.3884; p < 0.001). RA-CUSUM analysis identified an exploratory change point at case 56, after which a sustained downward trajectory of the risk-adjusted morbidity curve was observed. Following the exploratory change point, operative time significantly decreased from 706 to 574 min (p < 0.001), whereas major morbidity significantly decreased from 39.2 to 12.5% (p < 0.001). Post-pancreatectomy hemorrhage also significantly decreased (7.1% vs 0%, p = 0.04). Exploratory modeling demonstrated a significant progressive reduction in the predicted risk of major postoperative morbidity with increasing cumulative surgical experience (p = 0.0056). Oncological outcomes remained stable throughout the learning process.</p><p><strong>Conclusions: </strong>RPD demonstrates a measurable learning curve characterized by progressive improvement in operative efficiency and postoperative safety. These findings suggest that postoperative safety may provide a more clinically meaningful framework than operative time alone for describing the evolution of the learning curve.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of a standardized three-dose intravenous tranexamic acid protocol in bariatric surgery: a pilot study.","authors":"Paola Llamuca-Castro, Diego Lima, Arturo Estrada, Jason Xia, Yeisson Rivero-Moreno, Raquel Nogueira, Ya Zhou, Tiwalade Adediji, Joseph Vazzana, Diego Camacho, Jenny Choi, Erin Moran-Atkin","doi":"10.1007/s00464-026-13494-x","DOIUrl":"https://doi.org/10.1007/s00464-026-13494-x","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid (TXA) has been increasingly evaluated in bariatric surgery; however, heterogeneity remains in dosing and timing, and the feasibility of implementing a standardized multidose regimen in routine practice is not well established. This pilot study evaluated implementation of a standardized three-dose intravenous TXA protocol in metabolic bariatric surgery.</p><p><strong>Methods: </strong>This prospective, sequential-period pilot study included 1077 patients undergoing sleeve gastrectomy (SG), Roux-en-Y gastric bypass, or revisional surgery during alternating 3-month TXA and non-TXA periods. The primary outcome was feasibility, assessed by recruitment, protocol adherence, and completeness of 30-day outcome ascertainment. Postoperative bleeding, operative time (OT), length of stay (LOS), and thromboembolic events were evaluated exploratorily. Bleeding was assessed using Firth penalized logistic regression under intention-to-treat (ITT) and as-treated frameworks.</p><p><strong>Results: </strong>Of 1,122 patients screened, 1077 were enrolled (96.0%; 95% CI 94.7-97.1%). Overall adherence to period-assigned treatment was 94.5% (95% CI 93.0-95.8%); all patients initiating TXA completed the three-dose regimen, and 30-day outcome ascertainment was 100.0% (95% CI 99.7-100.0%). Clinically significant bleeding occurred in 1.46% of patients assigned to TXA periods vs. 2.84% assigned to non-TXA periods (p = 0.174). In ITT analysis, TXA allocation was not significantly associated with bleeding among SG patients (OR 0.55; 95% CI 0.10-2.53; p = 0.449), whereas anastomotic procedures had higher bleeding odds than SG (OR 5.41; 95% CI 1.86-18.64; p = 0.002). No treatment-by-procedure interaction was identified (p = 0.985). OT and LOS were similar between groups, and no 30-day thromboembolic events occurred.</p><p><strong>Conclusion: </strong>Implementation of a standardized three-dose intravenous TXA protocol was feasible within routine bariatric surgical practice, with high adherence and complete outcome ascertainment. Given the low bleeding event rate observed in this pilot, adequately powered studies are needed to determine whether TXA meaningfully reduces postoperative bleeding and whether its effect differs by procedure type.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128622","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":"Does ICG-NIRF cholangiography replace the critical view of safety in laparoscopic cholecystectomy? A prospective evaluation on biliary visualization dynamics and the impact of inflammation.","authors":"Kohei Mishima, Kazuya Hirukawa, Yuta Abe, Satoru Matsuda","doi":"10.1007/s00464-026-13438-5","DOIUrl":"https://doi.org/10.1007/s00464-026-13438-5","url":null,"abstract":"<p><strong>Background: </strong>While indocyanine green near-infrared fluorescence (ICG-NIRF) cholangiography is increasingly used to facilitate real-time biliary visualization, its ability to substitute for the Critical View of Safety (CVS) as a primary anatomical endpoint remains unclear. This study aimed to characterize the intraoperative dynamics of ICG-NIRF and evaluate the impact of acute cholecystitis (AC) on its reliability.</p><p><strong>Methods: </strong>In this prospective study of 96 consecutive patients (48 AC; 48 non-AC), biliary visualization was assessed at three milestones: T1 (dissection onset), T2 (CVS declaration), and T3 (pre-clipping). Patients received ICG (1.25 mg) at induction. Dissection followed the Tokyo Guidelines 2018 (TG18) framework using standardized subserosal-inner layer technique to achieve the CVS. The primary endpoint was the simultaneous visualization of the common bile duct (CBD), common hepatic duct (CHD), and cystic duct (CyD). Factors affecting visualization were analyzed using generalized estimating equations and multivariable regression.</p><p><strong>Results: </strong>CVS was achieved in 93.8% of cases, whereas simultaneous three-duct NIRF visualization was achieved in only 16.7% at T1, showing significant temporal improvement by T3 (46.9%; OR 4.61, p < 0.001). Multivariable analysis identified AC as the sole independent predictor of both CBD (OR 4.48, p = 0.016) and CHD (OR 3.80, p = 0.003) non-visualization at T3, with identification failure rates increasing stepwise with TG18 severity (p = 0.001).</p><p><strong>Conclusion: </strong>ICG-NIRF signals follow a dissection-dependent trajectory that is consistently attenuated by inflammation. Because the CVS provides anatomical certainty far beyond that of fluorescence alone, ICG-NIRF complements but does not replace the standardized dissection framework. In cases of severe AC, surgeons must prioritize meticulous surgical maneuvers over potentially unreliable fluorescence signals.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128541","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":"Role of extended venous thromboembolism prophylaxis in patients with colorectal neoplasia who underwent minimally invasive colorectal surgery within an enhanced recovery after surgery protocol.","authors":"Nouf AlMarzooqi, Laurence Robert, Liane S Feldman, Sender Liberman, Lawrence Lee","doi":"10.1007/s00464-026-13445-6","DOIUrl":"https://doi.org/10.1007/s00464-026-13445-6","url":null,"abstract":"<p><strong>Background: </strong>Patients with colorectal cancer are at increased risk of venous thromboembolism (VTE) due to malignancy-associated hypercoagulability and the physiologic stress of surgery. Current guidelines recommend extended-duration thromboprophylaxis for up to 28 days following major abdominal or pelvic cancer surgery. However, its effectiveness in patients managed by Enhanced Recovery After Surgery (ERAS) pathways is uncertain. This study evaluated the effectiveness of extended thromboprophylaxis after minimally invasive colorectal resection managed within a mature ERAS program in reducing clinically significant VTE.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including all adult patients undergoing elective minimally invasive colorectal resection for neoplasia at a high-volume Canadian academic centre between 01/2016 and 12/2024. Patients undergoing open surgery, emergency procedures, or receiving therapeutic anticoagulation were excluded. All patients received standard in-hospital thromboprophylaxis. Extended thromboprophylaxis with dalteparin 5000 U for 28 days post-discharge was provided at the physician's discretion before 03/2018 and was subsequently included in the ERAS protocol. The primary outcome was symptomatic post-discharge VTE within 30 days of surgery. Secondary outcomes included bleeding complications, length of stay, emergency department visits, and readmissions.</p><p><strong>Results: </strong>A total of 1043 included in the primary analysis after excluding inpatient VTE events (n=351 patients did not receive extended prophylaxis, n=692 received extended prophylaxis). The incidence of post-discharge VTE was 0.5% (6/1043). There was a higher incidence of VTEs in the -eDVTp group compared to the +eDVTp group [5/351(1.4%) vs. 1/692 (0.1%), p=0.010]. Post-discharge VTE was significantly higher in patients who did not receive extended prophylaxis compared with those who did (1.4% vs. 0.1%, p = 0.010). There were no significant differences in overall or clinically significant bleeding between groups.</p><p><strong>Conclusions: </strong>In patients undergoing minimally invasive colorectal resection within a mature ERAS pathway, the incidence of symptomatic post-discharge VTE is very low. Although extended thromboprophylaxis was associated with a statistically significant reduction in VTE events, the absolute risk reduction was small.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128587","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}