Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Project interpret cholangiogram at the SAGES 2024 Education & Innovation Center: skill deficiency in bile duct injury recognition among surgical residents.","authors":"Emily M Hannah, Matthew B Bloom, Steven D Schwaitzberg","doi":"10.1007/s00464-025-12145-x","DOIUrl":"https://doi.org/10.1007/s00464-025-12145-x","url":null,"abstract":"<p><strong>Background: </strong>Bile duct injuries (BDI) remain a rare but dreaded complication of laparoscopic cholecystectomy (LC). Proposed solutions to reduce BDI involve increased use of cholangiograms in patients with ambiguous anatomy. One explanation for the underutilization of intraoperative cholangiograms (IOC) is an unfamiliarity in interpreting cholangiograms, particularly amongst surgical trainees. We aim to gauge the current confidence levels and knowledge state of interpreting cholangiograms of surgeons at all levels of training.</p><p><strong>Methods: </strong>Participants were screened based on their SAGES 2024 Annual Conference attendance and completed the \"Cholangiogram Quiz\" at a station in the SAGES Education & Innovation Center. Data were collected on training background, and confidence in identifying IOC findings. Participants (n = 88, surgical residents, fellows and attendings) completed eighteen multiple choice questions on interpreting a cholangiogram.</p><p><strong>Results: </strong>Overall quiz scores and confidence in interpreting IOC increased with level of training (p < 0.001). Out of normal IOC, aberrant ducts, BDI, common bile duct calculi, and filling defects, PGY1-5 residents were least confident identifying aberrant ducts, followed by BDI. PGY1-3 residents performed worse than attendings on questions on BDI (p < 0.001). Differences in quiz performance by training levels did not reach statistical significance for any other topic tested. Better quiz performance was directly correlated to more frequent use of IOC (p < 0.001). Higher confidence was associated with better quiz performance for all participants (p = 0.006). Confidence interpreting normal IOC and BDI on cholangiogram were directly correlated to quiz performance on these topics (normal IOC: p = 0.005, BDI: p = 0.047).</p><p><strong>Conclusions: </strong>Participants with more advanced training, and who more frequently utilize IOC performed better on our quiz. Compared to other findings seen on IOC, residents failed to identify BDI. Surgical residents would benefit from targeted educational interventions to bolster confidence and improve accuracy in identifying BDI on IOC.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055655","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":"Should we let the sun set or rise on a small bowel obstruction: mortality and readmission rates in operative versus nonoperative management.","authors":"Anna Mary Jose, Jordan Kirsch, Kartik Prabhakaran, Aryan Rafieezadeh, Riddhi Mehta, Ilya Shnaydman, Joshua Klein, Gabriel Froula, Amanda Carlson, Bardiya Zangbar","doi":"10.1007/s00464-025-12059-8","DOIUrl":"https://doi.org/10.1007/s00464-025-12059-8","url":null,"abstract":"<p><strong>Background: </strong>Recurrent small bowel obstruction (SBO) can result in significant morbidity and mortality. In this study, we aimed to compare readmission and its impact on operatively and nonoperatively managed patients admitted with SBO.</p><p><strong>Methods: </strong>We performed a retrospective analysis using the National Readmission Database 2016-2017 and included all patients (≥ 18y) who were non-elective admissions for SBO during the index hospitalization. Patients were dichotomized into two groups: Operative group (OM) and nonoperative group (NOM). Primary outcomes included rates of readmission and mortality upon readmission. Secondary outcomes included complications, which were defined as fistula, abscess, perforation, peritonitis, and sepsis.</p><p><strong>Results: </strong>122,778 patients admitted for SBO were included. Overall, the readmission was 29.8%, with 34.4% readmitted within 30 days. 6.4% were OM, while 93.6% were NOM during index admission. Among OM patients, the readmission rate was significantly lower at 28.6% compared to NOM at 29.9% (p < 0.001). Among the readmitted NOM patients, 88.3% had emergency readmissions, with 10.6% requiring operative intervention. Adjusted analyses revealed that NOM had 32% higher odds of readmission (p < 0.001). Other factors increasing the odds of readmission included female sex, a high Charlson comorbidity index, and an admission diagnosis of cancer. Among readmitted patients, NOM had 50% higher odds of mortality during readmission. Each readmission raised the odds of mortality by 4.0% (p < 0.001). Operative management in the first readmission was associated with younger age, private insurance status, and non-operative management during the index admission.</p><p><strong>Conclusion: </strong>While cost, length of stay, and complications were higher in OM, NOM was associated with a higher readmission rate and mortality upon readmission. Each additional readmission for small bowel obstruction increased the odds of mortality by 4.0%.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041418","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":"Food security and its impact on patient-reported outcome measures (PROMs) in patients seeking evaluation for metabolic and bariatric surgery.","authors":"Samuel Torres-Landa, Nicole L Petcka, Jessica Wu, Elizabeth M Hechenbleikner, Mobola Oyefule, Jamil L Stetler, Sheethal Reddy, Edward Lin, S Davis Scott, Danny Mou","doi":"10.1007/s00464-025-12187-1","DOIUrl":"https://doi.org/10.1007/s00464-025-12187-1","url":null,"abstract":"<p><strong>Background: </strong>Food insecurity (FI) places patients seeking metabolic and bariatric surgery (MBS) evaluation at a disadvantage, as it is associated with worse patient-reported outcome measures (PROMs). However, of the further granularity impact of FI levels on PROMs is needed. We sought to investigate the impact of food insecurity levels on BODY-Q ER (eating-related) behavior, distress, symptoms, and physical function in preoperative MBS patients.</p><p><strong>Methods: </strong>Patients who underwent preoperative assessment for MBS (Feb 2024-2025) and completed the validated 6-item FI questionnaire and BODY-Q ER modules (scale of 0-100; 0 being worse health and 100 being optimal health) were included. Patients were divided into food security levels (high, low, and very low). Median Rasch scores (0-100, higher signifies better health) of BODY-Q ER behavior, distress, symptoms, and physical function were compared between food security levels using the Kruskal-Wallis test (p < 0.05).</p><p><strong>Results: </strong>From the 614 patients, 76% had high food security, 14.7% had low food security, and 9.9% had very low food security. Median Rasch scores from all four BODY-Q surveys (eating-related behavior, eating-related distress, eating-related symptoms, and physical function) were statistically different by food security level (p < 0.001). Higher median Rasch scores were seen in patients with high food security in all BODY-Q surveys compared to low food security and very low food security.</p><p><strong>Conclusions: </strong>Food security levels directly correlate with BODY-Q PROMs scores: lower food security is associated with worse eating-related behavior, distress, symptoms, and physical function. The 6-item FI questionnaire helped identify individuals at highest risk. Presurgical planning should involve goal-directed interventions to optimize these patients and correlate with surgical outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041280","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":"Development of anatomical metrics for objective quantification of critical view of safety.","authors":"Benjamin Mueller, Busisiwe Mlambo, Sue Kulason, Rogerio Nespolo, Rui Guo","doi":"10.1007/s00464-025-12137-x","DOIUrl":"https://doi.org/10.1007/s00464-025-12137-x","url":null,"abstract":"<p><strong>Background: </strong>Debates on the subjective criteria for evaluating Surgical Milestones, such as achieving the critical view of safety (CVS) during cholecystectomy, remain a prominent focus and challenge in the field of surgical data science. In this study, we computed anatomical metrics with machine learning tools and investigated the relationship between these objective anatomical metrics and subjective criteria for CVS achievement.</p><p><strong>Methods: </strong>We implemented and calibrated a zero-shot monocular depth estimation model for endoscopic images from cholecystectomies. These depth measures were integrated with human-annotated segmentation masks of three key anatomical structures relevant to CVS: cystic duct, cystic artery, and gallbladder. Computational geometry techniques were then employed to extract structure-specific depth distributions and compute two anatomical metrics: diagonal length and surface area. We tested for significant differences in these case-wise metrics, grouped by human-annotated CVS status.</p><p><strong>Results: </strong>2256 frames (35 cases) were graded on CVS criteria, of which 343 frames (17 cases) met all three CVS criteria and 384 frames (17 cases) met no CVS criteria. The calibrated depth model achieves 0.063 on absolute relative error and 0.774 on squared relative error in the metric measurement. The diagonal length and surface area of both the cystic duct and cystic artery were significantly larger when all CVS criteria were met. On average, the cystic duct (cystic artery) length was 7.6 mm (13.6 mm) longer when CVS criteria was met.</p><p><strong>Conclusion: </strong>In this study, we presented a pipeline that generates anatomical measures from monocular endoscopic images utilizing a depth estimation model, anatomical segmentation masks, and computational geometry. The diagonal length and surface area of the cystic duct and cystic artery were found to be significantly larger in cases where all CVS criteria are met; this lends support to the use of these anatomical metrics as objective grounds for assessing CVS achievement.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055621","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 feasibility and safety of laparoscopic limited resection for duodenal gastrointestinal stromal tumor: a propensity score-matched analysis.","authors":"Yunwei Sun, Jingwen Li, Dan Wu, Yugui Tian, Rui Wang, Tianrui Kuang, Lingwei Meng, He Cai, Xin Wang, Yunqiang Cai, Yongbing Li, Jin Zhou, Bing Peng, Zhong Wu","doi":"10.1007/s00464-025-12088-3","DOIUrl":"https://doi.org/10.1007/s00464-025-12088-3","url":null,"abstract":"<p><strong>Background: </strong>Duodenal gastrointestinal stromal tumors (GISTs) are rare and pose unique surgical challenges due to their anatomic complexity. However, the feasibility and safety of laparoscopic surgery for duodenal GISTs have not been fully evaluated. This study aimed to compare laparoscopic limited resection (LLR) with open limited resection (OLR) for primary localized duodenal GISTs.</p><p><strong>Methods: </strong>A retrospective analysis of patients undergoing duodenal GIST resection from January 2015 to April 2025 was conducted. Propensity score matching (PSM) was performed to minimize confounder factors. Outcomes including operative metrics, postoperative recovery, complications, and recurrence were assessed between LLR and OLR. Statistical analyses compared cohorts pre- and post-matching.</p><p><strong>Results: </strong>A total of 82 patients undergoing limited resection for duodenal GISTs were enrolled, of whom 51 received OLR and 31 received LLR. After 1:1 PSM (n = 58), the two groups were balanced based on age, gender, tumor size, tumor location, and neoadjuvant therapy. The statistical significance of primary outcomes remained consistent between pre- and post-matched cohorts. After PSM, LLR showed reduced intraoperative blood loss (20 vs 50 ml, p = 0.004) and faster oral intake resumption (2 vs 6 days, p = 0.014), with comparable operative time (155 vs 125 min, p = 0.297) and complication rates (24.1% vs 41.4%, p = 0.162). No significant differences were observed between the two groups in the long-term survival outcomes confined by a median follow-up of 28 months.</p><p><strong>Conclusion: </strong>LLR for duodenal GISTs is a feasible and safe treatment. Compared with OLR, LLR has the advantages of less intraoperative blood loss and shorter time to oral intake, without compromising surgical and oncologic outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041391","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":"Gastrojejunostomy revision combined with biliopancreatic limb lengthening provides superior weight loss and metabolic outcomes compared to gastrojejunostomy revision alone in Roux-en-Y gastric bypass patients with weight recurrence.","authors":"Leo I Amodu, Lauren Johnson, Kallie E Wynens, Omkar S Pawar, Nicholas Catanzaro, Sakib Adnan, Leena Khaitan, Mujjahid Abbas","doi":"10.1007/s00464-025-12186-2","DOIUrl":"https://doi.org/10.1007/s00464-025-12186-2","url":null,"abstract":"<p><strong>Introduction: </strong>The Roux-en-Y gastric bypass (RNYGB) is an effective bariatric surgical procedure for weight loss. Some patients experience weight recurrence or fail to lose weight after a RNYGB. No consensus exists on a recommended revisional procedure for RNYGB patients with weight recurrence.</p><p><strong>Methods: </strong>We carried out a retrospective review of records from 2010 to 2024, examining patients who had a prior RNYGB, requiring revision for weight recurrence. We compared patients who had revision of the gastrojejunal (GJ) anastomosis alone, to patients who had revision of the gastrojejunal anastomosis and lengthening of the biliopancreatic (BP) limb (GJ + BPLL). We compared demographics, weight outcomes, as well as postoperative complications.</p><p><strong>Results: </strong>Fifty-one RNYGB patients had a revision primarily for weight recurrence. Twenty-three patients had a GJ revision alone, while 28 patients had a GJ + BPLL. At 24 months post-revision, the GJ + BPLL group had a significantly lower median weight (lbs.) (GJ vs. GJ + BPLL; 288 vs. 186, p = 0.003), as well as BMI (GJ vs. GJ + BPLL; 45.1 vs. 31.91, p = 0.024). Post-revision HbA1c levels were also significantly lower in the GJ + BPLL group (GJ vs. GJ + BPLL; 5.4 vs. 5, p = 0.035). The GJ + BPLL group had a higher rate of multiple vitamin deficiencies. There was no difference between the groups beyond 36 months.</p><p><strong>Conclusion: </strong>In patients with weight recidivism after a primary RNYGB, GJ + BPLL can achieve greater reduction in weight and BMI with comparable complication rates compared to GJ revision alone, with a clear advantage in HbA1c reduction. While the weight loss outcomes appear to equalize between groups after 36 months, no patients with GJ + BPLL returned to their pre-revision weight. Larger studies are needed to evaluate differences in durability of GJ + BPLL, as well as other long-term outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041272","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":"Prevention of delayed bleeding after endoscopic mucosal resection of colorectal tumors by secure clipping.","authors":"Kiyoaki Homma, Shinsuke Nawa, Shunichi Okubo, Makoto Kobayashi, Tadashi Honma, Kiyokazu Homma, Nanako Homma","doi":"10.1007/s00464-025-12199-x","DOIUrl":"https://doi.org/10.1007/s00464-025-12199-x","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of delayed bleeding after endoscopic mucosal resection (EMR) of colorectal tumors has been reported to be approximately 1.1-1.7%. Some studies have shown that clipping after EMR does not significantly reduce delayed bleeding. Delayed bleeding after colorectal EMR with clips often occurred due to gaps in the clips or the detachment of mucosal areas that were heavily affected by coagulation.</p><p><strong>Methods: </strong>To prevent this complication, the perfect closure (PC) technique, with conditions such as secure clipping closely together without any gaps, including not only the ulcer but also the coagulated mucosa as the suture range, and avoiding \"clip-on-clip\" placement as far as possible, is considered important against delayed bleeding after colorectal EMRs. In this study, in order to verify the usefulness of the PC technique, we conducted a prospective study of patients who underwent PC after colorectal EMR was performed in two clinics and three hospitals.</p><p><strong>Results: </strong>1744 lesions (1133 patients) were evaluated. No post-procedural bleeding occurred in any patient. The average number of clips used for one lesion was 4.71 ± 2.04, and the average tumor diameter was 8.0 ± 3.78 (5-26) mm. The rate of post-procedural bleeding was 0%. In addition, the analysis of the results using a Monte Carlo simulation showed medical and economic advantages compared to previous studies in which clip closure was performed after colonic EMR.</p><p><strong>Conclusion: </strong>PC has the potential to be an excellent method for preventing postoperative bleeding after colorectal EMRs.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041346","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":"Missed opportunities for laparoscopic common bile duct exploration (LCBDE): we can do better.","authors":"Tawni M Johnston, Casey R Lamb, Alice Jo, Christina L Sierra Rodriguez, David Joshua Mancini, Pablo Martinez-Camblor, Byron Fernando Santos","doi":"10.1007/s00464-025-12159-5","DOIUrl":"https://doi.org/10.1007/s00464-025-12159-5","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic common bile duct exploration (LCBDE) is a safe and effective alternative to endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy (LC), but with a shorter length of stay (LOS). Nevertheless, LCBDE remains highly underutilized. Since 2021, our institution has conducted simulation-based LCBDE training for surgeons and residents. We sought to determine our current LCBDE utilization rate and potential utilization rate by identifying \"missed opportunities\" for LCBDE.</p><p><strong>Methods: </strong>We reviewed LCBDE or ERCP plus LC cases from 2023 to 2024 at a single institution. We excluded LC for hepatobiliary cancer and ERCP for non-gallstone disease. Contraindications to LCBDE were severe cholangitis, severe pancreatitis, malignancy concern, or significant comorbidities. We defined \"missed opportunities\" as cases eligible for LCBDE wherein ERCP was chosen instead. Median LOS (days) was compared between groups.</p><p><strong>Results: </strong>A total of 87 patients underwent LC plus LCBDE or ERCP. LCBDE was performed in 38% (n = 33, LOS = 2). ERCP with appropriate justification was performed in 25% (n = 22, LOS = 4.5) due to severe acute cholangitis (15%, n = 13), concern for malignancy (6%, n = 5), surgeon judgment (3%, n = 3), severe pancreatitis (1%, n = 1), severe comorbidities (1%, n = 1), patient preference (1%, n = 1), and diagnostic uncertainty (2%, n = 2). \"Missed opportunities\" represented the remaining 37% (n = 32, LOS = 3) due to: surgeon consulted after ERCP (18%, n = 16), patient transferred for ERCP only (5%, n = 4), surgeon not LCBDE trained (2%, n = 2), unavailable operating room (1%, n = 1), and unclear reasons (10%, n = 9).</p><p><strong>Conclusions: </strong>Our potential LCBDE utilization rate was 75%. Most ERCP cases represented \"missed opportunities\" for LCBDE despite our robust LCBDE adoption. \"Missed opportunities\" had a significantly longer median LOS than LCBDE (3 vs. 2 days, p = 0.048). Efforts to optimize LCBDE utilization could significantly reduce LOS. The highest yield quality improvement opportunity may be to optimize ERCP/LC referral patterns. The 10% of unclear \"missed opportunities\" cases require additional investigation.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041396","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 versus laparoscopic approaches to neonatal annular pancreas: a comparative analysis of surgical outcomes and innovation trade-offs.","authors":"Yuanzhu Gan, Zebing Zheng, Huijuan Wang, Yu Liao, Zeping Li, Chengyan Tang, Daiwei Zhu, Xingrong Xia, Lu Huang, Qing Du, Wankang Zhou, Yuan Gong, Xilin Liao, Yuanmei Liu, Zhu Jin","doi":"10.1007/s00464-025-12197-z","DOIUrl":"10.1007/s00464-025-12197-z","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and to efficacy of robotic-assisted duodenoduodenostomy (RAD) and laparoscopic-assisted duodenoduodenostomy (LAD) for neonatal annular pancreas and analyze its associated learning curve.</p><p><strong>Methods: </strong>A retrospective analysis of 59 neonates undergoing minimally invasive DS (2019-2024) was performed. Patients were stratified into robotic (RAD, n = 25) and laparoscopic (LAD, n = 34) cohorts. Perioperative outcomes (operative time, anastomosis time, blood loss, drainage duration, complications) were compared. Learning curves for console docking and intracorporeal manipulation were assessed using cumulative sum (CUSUM) analysis.</p><p><strong>Results: </strong>RAD demonstrated significantly shorter anastomosis time (35.6 ± 2.4 min vs. 47.0 ± 4.1 min, P < 0.05), reduced blood loss (median 4.0 ml vs. 6.0 ml, P < 0.05), and earlier drain removal (median 4.0 vs. 5.0 days, P < 0.05) compared to LAD. operative time was longer for RAD (179.3 ± 21.1 min vs. 156.9 ± 23.1 min, P < 0.05), attributed to docking time (22.2 ± 5.9 min) and the learning curve. Complication rates were comparable (16.0% vs. 26.5%, P = 0.537), with no anastomotic leaks, strictures or reoperations in either group. CUSUM analysis identified proficiency thresholds: docking time plateaued at case 13, and intracorporeal manipulation stabilized after 10 cases. Preliminary analysis within the first 20 cases suggests a 20-case threshold may be critical procedural mastery.</p><p><strong>Conclusion: </strong>RAD is a safe and effective approach for neonatal annular pancreas, demonstrating superior precision to laparoscopy. While requiring a longer initial operative time, RAD provides significant advantages in anastomotic efficiency and hemostasis once the learning curve is overcome.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041342","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":"Impact of clinical decisions on patient outcomes after neoadjuvant therapy in locally advanced resectable esophageal squamous cell carcinoma.","authors":"Yizhou Huang, Maohui Chen, Liyuan Zhou, Bingqiang Cai, Yongcong Zhang, Chuanquan Lin, Shuliang Zhang, Taidui Zeng, Chun Chen, Bin Zheng","doi":"10.1007/s00464-025-12166-6","DOIUrl":"https://doi.org/10.1007/s00464-025-12166-6","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant therapy (NAT) is the standard treatment for locally advanced esophageal cancer. Nevertheless, the response to NAT varies significantly among patients. This study is aimed at comparing the influence of different clinical decisions on disease-free survival (DFS) and overall survival (OS) in patients evaluated as stable disease (SD) or clinical response (CR/PR) after NAT.</p><p><strong>Methods: </strong>This retrospective, multicenter cohort study included patients with locally advanced and resectable ESCC who underwent NAT from January 2016 to January 2022. After NAT, patients were classified into CR/PR and SD groups. Each group was further divided into surgical and non-surgical subgroups. Kaplan-Meier survival analysis was used to compare OS and DFS between groups, and Cox regression was used to identify independent prognostic factors.</p><p><strong>Results: </strong>A total of 518 patients were included, with 286 classified as CR/PR and 232 as SD. In the SD group, 170 patients (73.3%) underwent surgery, while 62 (26.7%) refused. In the CR/PR group, 246 patients (86.0%) underwent surgery, and 40 (14.0%) refused. Survival analysis revealed that surgery significantly improved OS and DFS in the SD group, and multivariate analysis identified surgery as an independent prognostic factor for both OS and DFS. In the CR/PR group, surgery significantly improved DFS and was an independent factor for DFS, but it did not significantly impact long-term OS.</p><p><strong>Conclusions: </strong>In patients with clinically stable disease, surgery significantly improves both DFS and OS. In patients with clinical response, surgery improves DFS but has no significant impact on long-term OS.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041307","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}