Asian Journal of Endoscopic Surgery最新文献

{"title":"Congenital Biliary Dilatation With Pre-Existing Diffuse Hepatolithiasis: A Challenging Case","authors":"Tokuro Baba,&nbsp;Masaaki Kuda,&nbsp;Satoshi Ieiri,&nbsp;Mitsuhisa Takatsuki","doi":"10.1111/ases.70377","DOIUrl":"10.1111/ases.70377","url":null,"abstract":"<div>\u0000 \u0000 <p>Although postoperative intrahepatic stones are known to occur after surgery for congenital biliary dilation, preoperative diffuse hepatolithiasis is uncommon. We present a challenging case of a 14-year-old female with a Todani type IVa choledochal cyst complicated by numerous stones. She presented with abdominal pain, obstructive jaundice, and pancreatitis. To stabilize her condition, she was initially treated with endoscopic biliary and pancreatic stenting. Subsequently, laparoscopic radical surgery was performed. Although many stones were removed intraoperatively, complete clearance remained elusive despite repeated lavage and cholangioscopy. Following surgery, the patient recovered from a pelvic abscess and was discharged on postoperative Day 17. MRCP at 3 months showed residual stones, although the patient remained asymptomatic. This case highlights the limitations of laparoscopic surgery for congenital biliary dilation with advanced hepatolithiasis. The indications for open surgery should be carefully evaluated, and treatment strategies should anticipate the possibility of postoperative residual stones.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031746","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 and Robotic Procedures Combined Surgery (LARCS): A Novel Approach to Trainee Participation in Robotic Gastrectomy","authors":"Motohiro Chuman,&nbsp;Hiroki Harada,&nbsp;Kei Hosoda,&nbsp;Masahiro Niihara,&nbsp;Keisuke Manaka,&nbsp;Kota Okuno,&nbsp;Shohei Fujita,&nbsp;Tadashi Higuchi,&nbsp;Koshi Kumagai,&nbsp;Takeshi Naitoh,&nbsp;Yusuke Kumamoto,&nbsp;Keishi Yamashita,&nbsp;Naoki Hiki","doi":"10.1111/ases.70383","DOIUrl":"10.1111/ases.70383","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Robotic gastrectomy (RG) for gastric cancer reduces morbidity and achieves long-term outcomes comparable to laparoscopy. However, RG is typically a solo-surgeon procedure performed by expert console surgeons, limiting trainees' operative experience. To address this issue, we developed Laparoscopic and Robotic procedures Combined Surgery (LARCS), in which the patient-side surgeon (PSS) performs selected surgical maneuvers, including dissection, clipping, and stapling, using laparoscopic instruments under the supervision of the console surgeon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 96 patients who underwent robotic distal or subtotal gastrectomy at Kitasato University Hospital between January 2019 and December 2023. Patients were divided into a conventional RG group (CRG; <i>n</i> = 60) and a LARCS group (<i>n</i> = 36). Propensity scores were estimated based on age, sex, body mass index, American Society of Anesthesiologists status, and clinical T and N categories. Cardinality matching within a 0.2-standard-deviation caliper of the logit of the propensity score yielded 23 matched pairs, with all absolute standardized mean differences for the matching covariates &lt; 0.1. Perioperative outcomes and PSS participation were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, adequate balance was achieved for all matching covariates, with absolute standardized mean differences ranging from 0 to 0.062. Operative time was 406 min in the LARCS group and 373 min in the CRG group (<i>p</i> = 0.110). Estimated blood loss tended to be greater with LARCS (51 vs. 6 mL, <i>p</i> = 0.070). Any postoperative complication occurred in 6 and 5 patients, respectively (<i>p</i> = 1.000), and major complications occurred in 2 and 0 patients, respectively (<i>p</i> = 0.500). Median PSS operative time was 108 min, corresponding to 26.6% of the total operative time in LARCS, versus 0 min in CRG (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LARCS provided patient-side trainees with supervised, instrument-based first-operator participation for approximately one-quarter of the operative time, supporting its feasibility as a complementary approach to trainee participation during robotic gastrectomy. Further prospective studies incorporating objective competency-based assessments are required to determine its educational effectiveness and safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012968","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":"Association Between Preoperative MRI-Based Pelvic Anatomy and Phase-Specific Operative Time in vNOTES Hysterectomy: A Retrospective Study","authors":"Masahiro Kanamori,&nbsp;Hiroharu Kobayashi,&nbsp;Maiko Ikebata,&nbsp;Aimi Oda,&nbsp;Yumi Shimizu,&nbsp;Misa Kobayashi,&nbsp;Yoshihiro Takaki,&nbsp;Hiroshi Adachi","doi":"10.1111/ases.70382","DOIUrl":"10.1111/ases.70382","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Predicting surgical difficulty in vNOTES hysterectomy remains challenging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 49 patients who underwent vNOTES hysterectomy between April 2023 and April 2026. Cases with pelvic organ prolapse and cases with incomplete data were excluded, resulting in 42 evaluable patients. At our institution, patients suspected preoperatively of cul-de-sac obliteration were not considered candidates for vNOTES hysterectomy. The procedure was divided into three phases: transvaginal access, laparoscopic, and closure. Pelvic anatomical parameters (PCL, H line, M line, and H/PCL ratio) and clinical variables were evaluated using preoperative resting MRI and perioperative surgical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The H line showed significant negative correlations with operative time in both the transvaginal phase (<i>ρ</i> = −0.345, <i>p</i> = 0.025) and laparoscopic phase (<i>ρ</i> = −0.413, <i>p</i> = 0.007), whereas no significant correlation was observed in the closure phase. In multivariate analysis, the H line showed a consistent negative association with operative time, although statistical significance was not reached.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pelvic anatomy, particularly the H line, is associated with operative difficulty in vNOTES hysterectomy. Resting MRI provides a practical and generalizable assessment method. These findings may aid preoperative evaluation and improve surgical planning and patient selection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012976","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":"Comparison of Surgical Outcomes Between Laparoscopic Sleeve Gastrectomy (LSG) Versus Laparoscopic Sleeve Gastrectomy With Proximal Jejunal Bypass (LSG With PJB) in Patients With Severe Obesity (BMI ≥ 50 kg/m2)","authors":"Sathienrapong Chantawibul,&nbsp;Kwanchanok Losuwarat,&nbsp;Ratchamon Pinyoteppratarn,&nbsp;Pakapon Tudsri,&nbsp;Wasin Chakuttrikul,&nbsp;Kunnapat Lertlerphant,&nbsp;Kuanchanok Duanyai,&nbsp;Natcha Nitiwatthana,&nbsp;Ekawit Srimaneerak","doi":"10.1111/ases.70381","DOIUrl":"10.1111/ases.70381","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The optimal bariatric procedure for patients with severe obesity (BMI ≥ 50 kg/m²) remains debated. This study compares standard laparoscopic sleeve gastrectomy (LSG) with an emerging metabolic intervention, LSG with proximal jejunal bypass (LSG + PJB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retroprospective study (January 2022–December 2024) included 48 patients with severe obesity, divided into LSG (<i>n</i> = 25) and LSG + PJB (<i>n</i> = 23) groups. Outcomes evaluated included percent excess weight loss (%EWL), percent total weight loss (%TWL), HbA1C, complete diabetes mellitus (DM) remission, operative time, length of stay (LOS), and complications. The study protocol was approved by the Institutional Review Board of Rajavithi Hospital (Approval No. 68184).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 12 months, both groups achieved significant weight reduction. LSG + PJB showed higher mean %EWL (52.05% vs. 42.27%) and %TWL (28.74% vs. 24.71%) than LSG, though statistically insignificant. However, LSG + PJB demonstrated significantly superior metabolic outcomes, including a higher complete DM remission rate (100% vs. 66.7%, <i>p</i> = 0.047) and greater reductions in HbA1C (<i>p</i> = 0.001), fasting blood sugar (<i>p</i> = 0.005), and C-peptide (<i>p</i> = 0.026). While operative time was longer for LSG + PJB (183.3 vs. 113 min), LOS and major complications were comparable. Notably, the LSG group experienced higher rates of constipation (16%, <i>p</i> = 0.045) and GERD (12%, <i>p</i> = 0.086).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both procedures effectively achieve weight loss in patients with severe obesity. Nevertheless, LSG + PJB yields significantly superior glycemic control and DM remission with a comparable safety profile, making it a highly effective surgical alternative, particularly for patients with comorbid Type 2 diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978280","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":"Impact of Upper Mediastinal Anatomy and Anastomotic Position on Anastomotic Leakage After Transcervical–Hiatal Subtotal Esophagectomy With Posterior Mediastinal Reconstruction","authors":"Akihiro Kuroda,&nbsp;Sho Yajima,&nbsp;Raito Asaoka,&nbsp;Kotaro Sugawara,&nbsp;Kazuya Higashizono,&nbsp;Asami Okamoto,&nbsp;Shuichiro Oya,&nbsp;Yoshiyuki Miwa,&nbsp;Koichi Yagi,&nbsp;Yoshifumi Baba","doi":"10.1111/ases.70378","DOIUrl":"10.1111/ases.70378","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Anastomotic leakage (AL) after esophagectomy increases morbidity and mortality. Although mediastinal anatomy has been implicated in AL, no prior study has evaluated this issue in transcervical–hiatal subtotal esophagectomy (closed mediastinum). We investigated whether the scaled upper mediastinal anteroposterior diameter (sAPD) and anastomotic height (AH) influence AL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We retrospectively studied 224 patients who underwent transcervical–hiatal subtotal esophagectomy with mediastinoscopy-assisted mediastinal lymphadenectomy and posterior mediastinal reconstruction using a subtotal gastric conduit; the pleura was preserved (closed mediastinum). sAPD was measured on preoperative CT and AH on the first postoperative CT obtained 3–6 months postoperatively. Associations with AL were assessed by logistic regression, and receiver operating characteristic (ROC)-derived cutoffs defined four sAPD × AH risk groups. Two comparison cohorts (transthoracic, <i>n</i> = 91; narrow gastric conduit, <i>n</i> = 20) were also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AL occurred in 31/224 (13.8%). Narrower sAPD and higher AH were independently associated with AL (odds ratio [OR] 0.86, <i>p</i> = 0.002; OR 1.15, <i>p</i> = 0.049); risk was highest in the narrow-sAPD/high-AH group (35.9%; OR 12.32). Airway-gastric fistula occurred in five patients (2.2%), all with a narrow sAPD. AH alone was associated with AL in the transthoracic cohort; AL was 5.0% in the narrow gastric conduit cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>sAPD and AH are practical, imaging-based predictors of AL after transcervical–hiatal subtotal esophagectomy. The association between narrow sAPD and airway-gastric fistula supports conduit–space mismatch as a mechanism. Combined assessment stratifies risk and may guide conduit design and anastomotic level.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971807","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":"Association of the IWATE Difficulty Score With Conversion to Open Surgery and Perioperative Outcomes After Laparoscopic Liver Resection","authors":"Lai Thien Vo,&nbsp;Kim Hoai Nguyen,&nbsp;Ho Tran,&nbsp;Binh Xuan Dau,&nbsp;Thanh Phuoc Cong Nguyen,&nbsp;Phuoc Thanh Bui,&nbsp;Phat Thuan Tran","doi":"10.1111/ases.70380","DOIUrl":"10.1111/ases.70380","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study evaluated the association of the IWATE difficulty score with conversion to open surgery and perioperative outcomes after laparoscopic liver resection and explored the association between cirrhosis and conversion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort included 84 consecutive patients who underwent planned laparoscopic liver resection in Vietnam between January 2024 and March 2026. Patients were classified into low/intermediate and advanced/expert IWATE groups. The primary outcome was conversion to open surgery. Secondary outcomes included operative time, intraoperative blood loss, perioperative blood transfusion, 90-day postoperative complications, and postoperative length of hospital stay. Discrimination for conversion was assessed using receiver operating characteristic analysis. Exploratory logistic regression analyses evaluated the associations of IWATE difficulty and cirrhosis with conversion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-three patients had low/intermediate and 31 had advanced/expert difficulty. Conversion occurred in 4 of 53 patients (7.5%) and 12 of 31 patients (38.7%), respectively (<i>p</i> = 0.001). Advanced/expert difficulty remained associated with conversion after adjustment for overall cirrhosis status (adjusted odds ratio, 6.30; 95% confidence interval, 1.54–25.79; <i>p</i> = 0.010). Overall cirrhosis was also associated with conversion (adjusted odds ratio, 13.29; 95% confidence interval, 3.32–53.19; <i>p</i> &lt; 0.001). A sensitivity analysis restricted to cirrhosis documented before surgery showed similar exploratory associations, although confidence intervals were wide. The advanced/expert group had longer operative time, greater intraoperative blood loss, more 90-day postoperative complications, and longer postoperative hospital stay. The area under the receiver operating characteristic curve was 0.834 (95% confidence interval, 0.717–0.951); an exploratory cutoff of ≥ 8 provided 68.8% sensitivity and 85.3% specificity. Of the 16 conversions, 11 were bleeding-related and five were non-bleeding-related.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher IWATE difficulty was associated with conversion to open surgery and worse perioperative outcomes. Cirrhosis showed an exploratory association with conversion after adjustment for IWATE difficulty, but these findings require confirmation in larger cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963875","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":"Effect of Prior Hilar Manipulation During Previous Hepatectomy on Surgical Outcomes of Laparoscopic Repeat Hepatectomy","authors":"Keisuke Arai,&nbsp;Hidetoshi Gon,&nbsp;Shohei Komatsu,&nbsp;Kenji Fukushima,&nbsp;Takeshi Urade,&nbsp;Toshihiko Yoshida,&nbsp;Yoshihide Nanno,&nbsp;Hiroaki Yanagimoto,&nbsp;Masahiro Kido,&nbsp;Takumi Fukumoto","doi":"10.1111/ases.70379","DOIUrl":"https://doi.org/10.1111/ases.70379","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Laparoscopic repeat hepatectomy (LRH) is an effective treatment for recurrent liver tumors. However, repeat resection can be complicated by dense adhesions around the hepatic hilum and hepatoduodenal ligament, particularly following prior hilar manipulation (PHM) during initial hepatectomy. Nevertheless, the specific impact of PHM on the safety and efficacy of subsequent LRH remains unclear. Therefore, the aim of this study was to investigate the impact of initial hepatectomy with hilar manipulation on the surgical outcomes of LRH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 121 patients who underwent repeat hepatectomy at our institution between 2010 and 2024. The patients were categorized into three groups: LRH with PHM (<i>n</i> = 35), LRH without PHM (<i>n</i> = 59), and open repeat hepatectomy (ORH) with PHM (<i>n</i> = 27). To minimize selection bias, surgical outcomes were compared using two separate propensity score-matching analyses: (1) LRH with vs. without PHM and (2) LRH with PHM vs. ORH with PHM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the first matched cohort (24 patients in each group), there were no significant differences in surgical outcomes in the LRH with and without PHM groups, including the success rate of hepatoduodenal ligament isolation. In the second matched cohort (17 patients in each group), blood loss was significantly less in the LRH with PHM group than in the ORH with PHM group (50 vs. 440 mL; <i>p</i> &lt; 0.001). Other surgical outcomes, including the success rate of hepatoduodenal ligament isolation, did not significantly differ between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Laparoscopic repeat hepatectomy appeared feasible in selected patients after prior hilar manipulation, with matched analysis demonstrating a significant reduction in blood loss compared to the open approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148943545","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":"Robot-Assisted Versus Laparoscopic Surgery for Rectal Cancer: A Propensity Score-Matched Single-Institution Study","authors":"Hiroaki Shuto,&nbsp;Takashi Okuyama,&nbsp;Shunya Miyazaki,&nbsp;Haruo Hosoya,&nbsp;Shinichiro Koshizuka,&nbsp;Natsumi Naito,&nbsp;Gambo Hirotaka,&nbsp;Kazuyuki Saito,&nbsp;Emiko Takeshita,&nbsp;Hidehiro Tajima,&nbsp;Takatoshi Nakamura,&nbsp;Hideyuki Yoshitomi","doi":"10.1111/ases.70375","DOIUrl":"10.1111/ases.70375","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Robot-assisted surgery (RS) is increasingly used for rectal cancer, but its clinical benefits over laparoscopic surgery (LS) remain uncertain. We compared perioperative and oncological outcomes between RS and LS after propensity score matching (PSM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective study included 553 consecutive patients with clinical Stage I–III rectal adenocarcinoma who underwent RS or LS. PSM was performed using age, sex, body mass index, tumor location, neoadjuvant therapy, clinical T stage, clinical N stage, anastomosis status, and lateral pelvic lymph node dissection as covariates. The primary endpoint was 3-year relapse-free survival (RFS), and perioperative outcomes were secondary endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PSM yielded 214 matched pairs. Operative time was significantly longer in the RS group than in the LS group (254 vs. 231 min; <i>p</i> &lt; 0.001), whereas intraoperative blood loss was significantly lower (10 vs. 20 mL; <i>p</i> &lt; 0.001). Conversion to open surgery was less frequent in the RS group (0.5% vs. 3.7%; <i>p</i> = 0.04). Three-year RFS rates were comparable between the RS and LS groups (82.2% vs. 81.1%; <i>p</i> = 0.68), although the crude overall recurrence proportion was significantly lower in the RS group than in the LS group (15.0% vs. 22.9%; <i>p</i> = 0.048).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RS and LS achieved comparable mid-term oncological outcomes in patients with Stage I–III rectal adenocarcinoma. RS was associated with a lower conversion rate and reduced intraoperative blood loss, suggesting selective perioperative advantages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888109","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":"Type IV Paraesophageal Hernia With Mallory–Weiss Bleeding in an Infant: Endoscopic Hemostasis and Laparoscopic Repair","authors":"Masahiro Fukuhara,&nbsp;Hiroaki Matsumoto,&nbsp;Yasuyuki Uchida","doi":"10.1111/ases.70376","DOIUrl":"10.1111/ases.70376","url":null,"abstract":"<div>\u0000 \u0000 <p>Hiatal hernia is rare in healthy infants, and acute gastrointestinal bleeding is an uncommon symptom of it. A 9-month-old boy with an unremarkable medical history presented with persistent vomiting, coffee-ground emesis, and severe anemia. Computed tomography revealed herniation of the stomach and transverse colon into the right thoracic cavity, resulting in a diagnosis of type IV paraesophageal hernia. Due to concomitant viral bronchitis, elective repair was scheduled after the anemia was treated. However, while waiting for surgery, the patient vomited repeatedly and his anemia progressed. Emergency endoscopy was performed, revealing an actively bleeding Mallory–Weiss tear. Hemostasis was achieved with endoscopic coagulation, followed by laparoscopic paraesophageal hernia repair with hiatal closure and Toupet fundoplication. The postoperative course was uneventful, and no recurrence was observed. In infants with persistent vomiting and unexplained anemia, hiatal hernia should be considered and staged endoscopic and laparoscopic treatment may be effective in cases with acute bleeding.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882122","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":"Determinants of Pneumoperitoneum Duration During Laparoscopic Living-Donor Nephrectomy","authors":"Shunta Hori,&nbsp;Mitsuru Tomizawa,&nbsp;Kuniaki Inoue,&nbsp;Akira Tachibana,&nbsp;Yuki Oda,&nbsp;Kenta Onishi,&nbsp;Yosuke Morizawa,&nbsp;Daisuke Gotoh,&nbsp;Yasushi Nakai,&nbsp;Makito Miyake,&nbsp;Tatsuo Yoneda","doi":"10.1111/ases.70374","DOIUrl":"10.1111/ases.70374","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pure laparoscopic donor nephrectomy (LDN) and hand-assisted LDN (HALDN) are widely performed in living donor kidney transplantation. However, the relative contribution of donor-related factors to operative complexity remains incompletely understood, particularly in Japan, where surgical practices differ from those in Western countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 152 donors who underwent LDN or HALDN between 2006 and 2024. Perioperative outcomes and pneumoperitoneal duration were evaluated. A random forest machine-learning model combined with SHapley Additive exPlanations analysis was used to identify the predictors associated with pneumoperitoneum duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall perioperative complication rate was low, and no mortality was observed. The pneumoperitoneum duration was significantly longer in the HALDN group than in the LDN group. SHapley Additive exPlanations analysis identified the surgical approach, body mass index, donor kidney volume adjusted for body surface area, visceral adipose tissue, and donor age as the strongest predictors of pneumoperitoneum duration. Obesity-related factors exerted a greater influence than anatomical complexity. Postoperative renal function in the donor and recipient graft survival was not significantly associated with the duration of pneumoperitoneum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both LDN and HALDN are safe procedures with minimal perioperative risks. Machine learning analysis demonstrated that, among donor-related factors, obesity-related parameters and kidney size were the principal determinants of operative complexity, exceeding the impact of anatomical factors. These findings may facilitate individualized surgical planning and contribute to the development of Japan-specific standards for donor nephrectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833454","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}