Updates in Surgery最新文献

{"title":"Anticipating surgical complexity in laparoscopic cholecystectomy: a clinical score based on inflammatory markers.","authors":"Erick Moreno Delgado, Edwin Leopoldo Maldonado García, Jorge Luis Vargas Lugo, Carlos Ignacio Martínez Huerta, Estefanía Méndez Herrera, Daniela Martínez de León León, Ricardo Antonio Martínez Rivera Rivera","doi":"10.1007/s13304-025-02511-8","DOIUrl":"10.1007/s13304-025-02511-8","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2223-2232"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A bibliometric analysis of diverticulitis: global trends and future directions.","authors":"Mehmet Berksun Tutan, Duygu Tutan","doi":"10.1007/s13304-026-02548-3","DOIUrl":"10.1007/s13304-026-02548-3","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1879-1888"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the robot bleeds: risk factors and outcomes of intraoperative blood loss in robotic liver resection.","authors":"Silvio Caringi, Antonella Delvecchio, Rebecca Marino, Paolo Magistri, Andrea Belli, Annarita Libia, Graziano Ceccarelli, Francesco Izzo, Marcello Giuseppe Spampinato, Nicola De' Angelis, Patrick Pessaux, Tullio Piardi, Fabrizio Di Benedetto, Francesca Ratti, Riccardo Memeo","doi":"10.1007/s13304-026-02596-9","DOIUrl":"10.1007/s13304-026-02596-9","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2021-2028"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of malignancy and necessity of completion thyroidectomy in patients with indeterminate thyroid nodules (Bethesda III and IV), more than expected in endemic region.","authors":"Aykut Çelik, Tuğba Matlım Özel, Sezer Akbulut, Görkem Yıldız, Fatih Mert Dogukan, Serkan Sarı","doi":"10.1007/s13304-026-02655-1","DOIUrl":"10.1007/s13304-026-02655-1","url":null,"abstract":"<p><p>American Thyroid Association (ATA) argues that the prevalence of malignancy of the indeterminate nodules may vary substantially among regions, and states that it is crucial to know the prevalence of malignancy within each indeterminate cytological category at one's institution. Our aim is to draw attention to the malignancy rates of indeterminate nodules that cannot be underestimated in an endemic region and raise awareness to differences across different populations. Between March-2021 and June-2024, 13,531 fine needle aspirations were performed on thyroid nodules in a single institution. Of these 2121 nodules were classified as indeterminate (Bethesda III-IV) and 242 patients underwent surgery. Demographic characteristics, nodule size, risk of malignancy, tumor types and subtypes were evaluated. The necessity of radioactive iodine (RAI) therapy and consequent completion thyroidectomy was investigated. Of the 242 patients 123 (50.8%) underwent lobectomy and 119 (49.2%) underwent total thyroidectomy. In total, 115 (47.5%) of 242 patients resulted in malignancy (186 patients were Bethesda-III and 82 (44.1%) of them were malignant; 56 were Bethesda-IV and 33 (58.9%) of them were malignant). Incidental carcinoma was detected in a different focus other than the indeterminate nodule in 17 patients. RAI therapy was indicated in 39 patients (33.9%) primarily based on the ATA guideline, and 24 (20.8%) patients who initially underwent lobectomy required completion thyroidectomy. Risk of malignancy in indeterminate thyroid nodules varies endemically. Each region should know their own risk and each patient's treatment should be tailored accordingly. In this way, under-overtreatment and related morbidities will be prevented.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2167-2176"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic ımpact of vascular, lymphatic, and perineural ınvasion in surgically resected, non-adjuvantly treated stage IA non-small-cell lung cancer: a retrospective cohort study.","authors":"İnanç Yazıcı, Mustafa Vedat Doğru, Abdulsamed Alp, Levent Cansever, Muzaffer Metin, Kemal Karapınar, Damla Azaklı Yazıcı, Aysun Ölçmen","doi":"10.1007/s13304-025-02520-7","DOIUrl":"10.1007/s13304-025-02520-7","url":null,"abstract":"<p><p>Surgical treatment can achieve a cure in stage IA non-small-cell lung cancer (NSCLC). Although invasion of vascular, lymphatic, or perineural structures does not alter TNM staging, such features are sometimes considered when recommending adjuvant therapy. This study aimed to evaluate the impact of these invasion types on overall survival (OS) and disease-free survival (DFS) in stage IA NSCLC patients who did not receive adjuvant treatment. A total of 402 patients with pathological stage T1N0M0 NSCLC who underwent anatomical lung resection between January 2014 and December 2019 were retrospectively analyzed. Final staging was performed according to the 8th edition of the TNM classification. Pathology reports and follow-up data were reviewed. Demographic features, surgical details, postoperative complications, and tumor invasion patterns were examined in relation to OS and DFS using Jamovi (v2.5.3.0). In multivariable analysis, older age (HR 1.03, 95% CI 1.00-1.06, p = 0.05), male sex (HR 1.81, 95% CI 1.10-2.98, p = 0.01), and postoperative complications (HR 1.64, 95% CI 1.12-2.40, p = 0.01) independently predicted lower OS. While individual invasion types were not significantly associated with OS, their co-occurrence predicted poorer OS (HR 4.06, p = 0.05) and DFS (HR 12.74, p = 0.001). In subgroup analyses, lymphatic invasion was linked to reduced OS in male patients (HR 1.46, p = 0.04), while lymphatic and vascular invasion both negatively affected OS in squamous cell carcinoma (HR 1.72 and 1.98, respectively). When all three invasion types were present, prognosis worsened markedly in stage IA NSCLC. Sex- and histology-based risk assessment may help guide postoperative treatment decisions.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2253-2261"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limited (pancreas-sparing) surgical resections for non-ampullary duodenal neoplasms: indications, surgical techniques and outcomes.","authors":"G Nappo, C Jayamanne, G Donisi, M Pagnanelli, M Gandini, G Capretti, C Ridolfi, F Gavazzi, S Carrara, A Zerbi","doi":"10.1007/s13304-026-02637-3","DOIUrl":"10.1007/s13304-026-02637-3","url":null,"abstract":"<p><p>Non-ampullary duodenal neoplasms (DNs) are rare, heterogeneous lesions for which the optimal surgical strategy remains debated. While pancreatoduodenectomy (PD) is considered the standard for ampullary or locally advanced tumours, limited resection (LR) of the duodenum offers a pancreas-preserving alternative in appropriately selected cases. This study aimed to describe the indications, surgical techniques, and outcomes of LR for non-ampullary DNs. All consecutive patients undergoing LR, including segmental resection (SR), wedge resection (WR), extra-mucosal excision (EME), endoluminal excision (ELE), for non-ampullary DNs at our institution between August 2010 and May 2025 were retrospectively reviewed. Demographic, operative, pathological, and follow-up data were collected from a prospectively maintained database. Disease-specific survival (DSS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method, with subgroup analyses for duodenal adenocarcinoma (DA), gastrointestinal stromal tumors (GIST), and neuroendocrine tumors (NET). Thirty-three patients underwent LR: SR D1 (n = 2, 6.1%), SR D3-D4 (n = 13, 39.4%), WR (n = 13, 39.4%), EME (n = 2, 6.1%), and ELE (n = 3, 9.1%). Median operative time was 219 min (IQR 162-278) and median blood loss was 100 mL (IQR 50-100). Overall morbidity occurred in 45.4% of patients, with severe complications in 18.2% and no 90-day mortality. Final histology included GIST/leiomyoma (45.4%), DA (18.2%), NET (18.2%), and adenoma (18.2%). At a median follow-up of 66.8 months for DA, 75.6 months for GIST, and 61.4 months for NET, 5-year DSS/DFS rates were 80%/66.7% for DA, with only one recurrence in the GIST group and two recurrences in the NET group (one disease-related death). LR of the duodenum is a safe and effective alternative to PD for selected non-ampullary DNs, with low morbidity, no perioperative mortality, and excellent long-term oncological outcomes in appropriately chosen patients. When technically feasible and without ampullary or pancreatic invasion, LR should be considered the preferred approach for localized duodenal GIST, selected D3-D4 DA, and non-ampullary NET requiring surgery.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1935-1943"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HUGO™ system robotic eTEP technique for ventral hernia repair. A step-by-step medial bottom-up approach.","authors":"Valentina Ferri, Riccardo Caruso, Daniele Cerbo, Emilio Vicente","doi":"10.1007/s13304-025-02135-y","DOIUrl":"10.1007/s13304-025-02135-y","url":null,"abstract":"<p><p>This study describes an innovative robotic extended totally extraperitoneal (eTEP) technique for ventral hernia repair via a medial bottom-up approach using the new HUGO^™ system. The surgical steps and a novel setup guide for this approach are detailed. A 78-year-old male with an incisional umbilical hernia and concomitant rectus diastasis was treated using the HUGO™ system. The system's modular design enabled a customized surgical approach. Robotic eTEP repair was performed via a medial bottom-up approach, and robotic trocars were placed in the hypogastric region. Single docking was sufficient. The procedure lasted 180 min, with no intraoperative complications. The patient's postoperative recovery was uneventful, and a normal diet was resumed on the first postoperative day. The postoperative hospital stay was 7 days. Satisfactory outcomes without complications were observed during follow-up. This study introduced a novel robotic eTEP approach for abdominal wall hernia repair using the HUGO^™ system, highlighting the medial bottom-up technique and an innovative docking configuration. The medial bottom-up robotic eTEP approach using the HUGO^™ system is a feasible and promising technique for abdominal wall hernia repair. To evaluate long-term outcomes and broader applicability among surgeons experienced in robotic and retromuscular hernia repair, further studies are warranted.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2245-2252"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Built on the shoulders of giants: sixty years of organ transplantation in Italy.","authors":"Ugo Boggi","doi":"10.1007/s13304-026-02792-7","DOIUrl":"10.1007/s13304-026-02792-7","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1857-1861"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the safety and feasibility of subcutaneous areolar tunnel single-port thoracoscopic radical resection for lung cancer: a retrospective cohort study.","authors":"Kai Yang, Keyong Li, Chao Guo, Changhao Que, Zhuang Zuo, Jin Wang, Qi Wang, Dacheng Jin, Yunjiu Gou, Chengfeng Wang","doi":"10.1007/s13304-025-02514-5","DOIUrl":"10.1007/s13304-025-02514-5","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2271-2279"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Italian landscape of robotic-assisted kidney transplantation: results from a national survey.","authors":"C Guidetti, S Serni, U Boggi, A Solinas, F Tanese, A Lauterio, A Volpe, B Catellani, G P Guerrini, T M Manzia, D Lorenzin, A Puzziello, M Romano, M Spada, A Antonelli, G Carcano, N Bossini, M Iaria, M Vivarelli, M Rossi, P Rigotti, L Furian, R I Troisi, S Di Sandro, F Di Benedetto","doi":"10.1007/s13304-026-02561-6","DOIUrl":"10.1007/s13304-026-02561-6","url":null,"abstract":"<p><p>Robotic-assisted kidney transplantation (RAKT) is an emerging minimally invasive alternative to open surgery that offers potential benefits in selected recipients. Despite increasing international interest, its implementation across transplant centers remains variable. This study aims to describe the current status, challenges, and perspectives on RAKT in Italy through a nationwide survey. A web-based questionnaire was distributed to all active kidney transplant centers in Italy. The survey collected data on institutional experience, surgical techniques, intraoperative technologies, perceived barriers, and future directions. Responses were anonymized and analyzed descriptively. Twenty-one out of 39 centers responded (54%). Nine centers were actively performing RAKT at the time of the survey. The median number of RAKT cases per center was 5 (range 1-85), with Da Vinci Xi being the most used platform. Intraoperative tools such as indocyanine green fluorescence and robotic Doppler were variably adopted to verify graft perfusion. Reported operative times ranged from 143 to 410 min (median 215 min), with low conversion rates. Main barriers to adoption included limited access to the robotic platform and lack of structured training. All centers supported the creation of a national registry and expressed interest in collaborative studies. This survey provides the first national overview of RAKT in Italy, highlighting both technical feasibility and structural challenges. The findings support the need for coordinated training efforts, shared data, and policy-level initiatives to foster equitable access to robotic transplant surgery.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1929-1934"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}