Asian Journal of Endoscopic Surgery最新文献

{"title":"The financial impact of robotic surgery on hospital gross profits in Japan compared to laparoscopic surgery","authors":"Yoshiharu Sakai,&nbsp;Tsutomu Morishita","doi":"10.1111/ases.13410","DOIUrl":"https://doi.org/10.1111/ases.13410","url":null,"abstract":"<p>Robotic surgery is gaining traction in Japan due to its technological advancements, but its financial viability for hospitals remains uncertain. This study investigates the impact of robotic surgery on hospital gross profits, comparing it to laparoscopic surgery using data from surgeries performed at Red Cross Hospital Osaka. The study spans multiple surgical fields, including gastrointestinal, urology, gynecology, and thoracic surgery. While the number of robotic surgeries has increased, they consistently generate lower gross profits for hospitals compared with laparoscopic surgeries, primarily due to the high costs of robotic instruments and maintenance. Certain procedures, such as hernia repair, proximal gastrectomy, and distal pancreatectomy, result in negative profits when performed robotically. This article highlights the financial challenges hospitals face under Japan's current healthcare reimbursement system, where the fees for robotic and laparoscopic surgeries are largely the same. Policy adjustments may be necessary to ensure the financial sustainability of robotic surgery.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Close Contact Transillumination Light Guides Surgeon to Vaginal Point Aa: Pharus Method for Robot-Assisted Sacrocolpopexy","authors":"Akiko Yoshida Ueno,&nbsp;Takayuki Sato,&nbsp;Michiya Kobayashi,&nbsp;Shinya Wakatsuki,&nbsp;Takaomi Namba,&nbsp;Kazutoshi Hayashi","doi":"10.1111/ases.13412","DOIUrl":"10.1111/ases.13412","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In robot-assisted sacrocolpopexy (RSC) for patients with cystocele, accurate identification of the vaginal point Aa from the serosal side is crucial for surgical mesh placement in the appropriate position. We developed a novel Pharus method for exactly locating the point Aa for RSC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the Pharus method, the tip of a rigid endoscope was placed directly on the vaginal point Aa. In a preliminary experiment, we observed LED lights with different wavelengths of 450–870 nm using the Firefly imaging system to evaluate which wavelengths of light were captured by the Firefly mode. In a clinical study, the Pharus method was employed in four patients with Stage II or more advanced cystocele undergoing RSC. For comparison, a near-infrared fluorescence method by indocyanine green (ICG) tattooing at the point Aa was also performed. The visibility of each method was evaluated under Firefly-mode imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the preliminary experiment, visible LED lights with wavelengths ≤ 720 nm, and near-infrared LED lights with wavelengths ≥ 830 nm were detected by the Firefly mode. In RSC using the Pharus method, the point Aa of each patient was clearly highlighted as a green spot from the serosal side by the endoscopic white light penetrating the vaginal wall with a thickness of 3.3–4.6 mm. Compared with the ICG tattooing method, the Pharus method showed superior visibility in all patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The transillumination light effectively guided the surgeon to the vaginal point Aa, which can be likened to the Latin word “pharus,” meaning lighthouse.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.13412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to “Evaluating the Benefit of Contact-Force Feedback in Robotic Surgery Using the Saroa Surgical System: A Preclinical Study”","authors":"Hinpetch Daungsupawong,&nbsp;Viroj Wiwanitkit","doi":"10.1111/ases.13411","DOIUrl":"10.1111/ases.13411","url":null,"abstract":"","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of participation of endoscopic surgical skill qualification system-qualified surgeons in laparoscopic high anterior resection","authors":"Naruhiko Sawada,&nbsp;Shumpei Mukai,&nbsp;Tomonori Akagi,&nbsp;Ken Okamoto,&nbsp;Fumihiko Fujita,&nbsp;Hirokazu Suwa,&nbsp;Yoshihito Ide,&nbsp;Tomohisa Furuhata,&nbsp;Akiyoshi Kanazawa,&nbsp;Tsukasa Shimamura,&nbsp;Shigehiro Kojima,&nbsp;Shinobu Ohnuma,&nbsp;Tatsuya Kinjo,&nbsp;Nobuki Ichikawa,&nbsp;Shigeki Yamaguchi,&nbsp;Akinobu Taketomi,&nbsp;Takeshi Naitoh,&nbsp;EnSSURE Study Group Collaboratives in the Japan Society of Laparoscopic Colorectal Surgery","doi":"10.1111/ases.13409","DOIUrl":"10.1111/ases.13409","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A technical qualification system was established by the Japanese Society of Endoscopic Surgery in 2004, and its effectiveness in low anterior resection (LAR) has been reported. We herein performed a subgroup analysis of the effectiveness of the participation of technically qualified surgeons in laparoscopy-assisted high anterior resection (HAR), a procedure used for the technical qualification of surgeons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The EnSSURE study enrolled 3188 patients who underwent laparoscopic rectal resection for rectal cancer between January 2014 and December 2016 at 56 Japanese hospitals. The outcomes of HAR were compared between groups with and without the participation of technically qualified surgeons. The background of the two groups were equalized by propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the group with the participation of qualified surgeons, the operative time was significantly shorter (<i>p</i> = .0427), more lymph nodes were dissected (<i>p</i> = .0207), and the conversion rate to open surgery was lower (<i>p</i> = .0016); however, no significant difference was observed in blood loss (<i>p</i> = .0616), the R0 resection rate (<i>p</i> = 1.00), intraoperative complication rate (<i>p</i> = .160), postoperative complication rate (<i>p</i> = 1.00), or reoperation rate (<i>p</i> = .6999) between the two groups. Furthermore, no significant difference was noted in long-term outcomes (recurrence-free survival (<i>p</i> = .275) or overall survival (<i>p</i> = .941)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In HAR, the technical benefits of the participation of qualified surgeons was limited to a shorter operative time and lower conversion rate. Nevertheless, the qualification is unique in that it predicts the usefulness of reducing complications in more technically challenging procedures when its effectiveness in LAR is considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Curves and Surgical Outcomes of Laparoscopic Sleeve Gastrectomy Performed by an Attending Surgeon and Trainee Surgeons","authors":"Takamasa Takahashi,&nbsp;Atsuyuki Maeda,&nbsp;Yuichi Takayama,&nbsp;Hiroki Aoyama,&nbsp;Daigoro Takahashi,&nbsp;Takahiro Hosoi,&nbsp;Atsushi Fujiya","doi":"10.1111/ases.13414","DOIUrl":"10.1111/ases.13414","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Laparoscopic sleeve gastrectomy (LSG) is a commonly performed procedure for bariatric and metabolic surgery. However, few reports exist concerning the learning curves and surgical outcomes of LSG among trainee surgeons. This study aimed to investigate the learning curves and surgical outcomes of LSG for one attending surgeon and trainee surgeons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, 90 patients who underwent LSG were retrospectively evaluated. Surgical learning curves for the attending and the trainees were assessed via cumulative sum (CUSUM) analysis. After the attending reached the learning phase, the trainees performed LSG under the guidance of the attending. Surgical and postoperative outcomes were compared retrospectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The CUSUM plot of the attending peaked in the 16th case, began to decrease and reached a plateau in the 49th case. Therefore, we defined the attending in Phase I up to 16 LSGs (<i>n</i> = 16; learning phase), in phase II between 27 and 48 LSGs (<i>n</i> = 22; acquisition phase), and in Phase III from 49 or more LSGs (<i>n</i> = 29; plateau phase). The CUSUM of the trainees' operative time declined from the beginning. The median operative time was significantly shorter in the trainees than in the attending in Phase I (184 [146–266] vs. 161 [111–255], <i>p</i> &lt; 0.01). %EWL was significantly better in the patients of the trainees than in those of the attending (92.4 ± 35.7 vs. 71.0 ± 28.7, <i>p</i> &lt; 0.01). These results indicate that trainees could perform LSG in a stable manner.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Under the guidance of experienced surgeons, LSG can be safely performed by trainees without prolonged surgical time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic surgery for pelvic developmental cyst in adults: A report of four cases","authors":"Masaki Imai,&nbsp;Takeru Matsuda,&nbsp;Ryuichiro Sawada,&nbsp;Hiroshi Hasegawa,&nbsp;Kimihiro Yamashita,&nbsp;Hitoshi Harada,&nbsp;Naoki Urakawa,&nbsp;Hironobu Goto,&nbsp;Shingo Kanaji,&nbsp;Yoshihiro Kakeji","doi":"10.1111/ases.13405","DOIUrl":"10.1111/ases.13405","url":null,"abstract":"<p>Developmental cyst is occasionally seen in children but are less common in adults. Complete removal of developmental cyst is necessary because there are risk of infection, squamous cell carcinoma, and recurrence due to incomplete resection. The best approach for resection of developmental cyst is still controversial. Although transsacral approach, open abdominal approach, or a combination of both have been often employed to date, reports of laparoscopic surgery have been appearing in recent years. We performed laparoscopic surgery for four patients with this disease: (i) 29-year-old woman with epidermoid cyst; (ii) 21-year-old woman with dermoid cyst; (iii) 55-year-old woman with epidermoid cyst; and (iv) 77-year-old woman with epidermoid cyst. No perioperative complications occurred and no recurrence has developed so far in any patients. Laparoscopic surgery can be considered as one of the optimal treatment options for developmental cyst.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent laryngeal nerve lymph node dissection with subcomplete sealing using advanced bipolar energy device in minimally invasive esophagectomy","authors":"Masato Hayashi,&nbsp;Takeshi Fujita,&nbsp;Hisayuki Matsushita","doi":"10.1111/ases.13406","DOIUrl":"10.1111/ases.13406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Recurrent laryngeal nerve (RLN) palsy is a complication that must be avoided during esophagectomy. While RLN injury is thought to be caused by thermal spread from electric devices, electric devices are useful to avoid bleeding. When dissecting lymph nodes around RLNs, to seal small vessels, we use subcomplete technique with advanced bipolar. We describe our surgical technique, termed the subcomplete sealing technique, in RLN lymph node dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>The first step is to perform blunt dissection with forceps on both sides of the esophageal branch near the right RLN. A distance of at least 2 mm from the RLN was preferred. Sealing with advanced bipolar often causes tissue shrinkage, pulling the RLN near the device. To prevent this, sealing should be stopped before reaching completion. Although the sealing was not complete, it was sufficient to seal the small vessels. After subcomplete sealing, the sealed tissues were dissected using laparoscopic scissors. The lymph nodes around left RLN are dissected in the same manner.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>A total of 76 patients received esophagectomy with the subcomplete technique. Grade IIIa RLN palsy occurred in three cases (3.95%). Over Grade IIIb RLN palsies did not occur. This subcomplete sealing technique can assist surgeons in performing RLN lymph node dissection without bleeding and increasing the rate of RLN palsy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of fluorescent cholangiography to complex biliary variants of the confluence of the cystic duct and the infraportal type of the left lateral bile duct during single-incision laparoscopic cholecystectomy: A case report","authors":"Shinji Nishino,&nbsp;Tsuyoshi Igami,&nbsp;Yukihiro Yokoyama,&nbsp;Takashi Mizuno,&nbsp;Junpei Yamaguchi,&nbsp;Shunsuke Onoe,&nbsp;Masaki Sunagawa,&nbsp;Nobuyuki Watanabe,&nbsp;Taisuke Baba,&nbsp;Shoji Kawakatsu,&nbsp;Tomoki Ebata","doi":"10.1111/ases.13404","DOIUrl":"10.1111/ases.13404","url":null,"abstract":"<p>A 21-year-old man was diagnosed with segmental adenomyomatosis of the gallbladder based on ultrasonography and computed tomography images. Computed tomography with drip infusion cholangiography revealed that the cystic duct joined the infraportal type of the left lateral bile duct (IPLLBD), which runs caudal to the umbilical portion, and that the left medial bile duct joined the right hepatic duct without forming the left hepatic duct. We planned a single-incision laparoscopic cholecystectomy with fluorescent cholangiography. The fluorescent cholangiography visualized the anatomic variant of the biliary system, and the cystic duct was divided safely. Fluorescent cholangiography is a suitable procedure to depict complex biliary anatomic variations in this patient. IPLLBD without the formation of the left hepatic duct is potentially hazardous during cholecystectomy.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.13404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system: Esophagus","authors":"Yuko Kitagawa,&nbsp;Haruhiro Inoue,&nbsp;Harushi Udagawa,&nbsp;Ichiro Uyama,&nbsp;Harushi Osugi,&nbsp;Hirofumi Kawakubo,&nbsp;Hiroya Takeuchi,&nbsp;Makoto Hashizume,&nbsp;Junya Aoyama,&nbsp;En Amada,&nbsp;Hiroki Ishida,&nbsp;Yoshiyuki Saito,&nbsp;Masashi Takeuchi,&nbsp;Yuki Hirata","doi":"10.1111/ases.13367","DOIUrl":"10.1111/ases.13367","url":null,"abstract":"","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biliopancreatic limb obstruction after one-anastomosis gastric bypass; a very rare and fatal event: A case report and literature review","authors":"Rahmatullah Athar,&nbsp;Alireza Khalaj,&nbsp;Parvin Shapori","doi":"10.1111/ases.13402","DOIUrl":"10.1111/ases.13402","url":null,"abstract":"<p>The biliopancreatic limb (BPL) obstruction occurrence after one-anastomosis gastric bypass (OAGB) has not been well described in the literature. A 65-year-old female with a history of OAGB surgery presented with acute weight loss and abdominal pain. Imaging studies revealed a bezoar in the duodenal diverticulum obstructing the small bowel. An urgent laparoscopic intervention was performed to remove the bezoar and alleviate the obstruction. The patient experienced postoperative complications, including gastrostomy drainage and subsequent biliobezoar migration. additional surgeries were required to address these complications. This is a rare condition, and it is usually seen in patients with predisposing factors like DM, previous surgery, and duodenal diverticulum. CT scan study is the useful diagnostic modality, and laparoscopic intervention is the choice treatment; this case highlights the importance of recognizing and managing bezoars as a potential complication following bariatric surgery.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}