Asian Journal of Endoscopic Surgery最新文献

{"title":"Correction to “Pulmonary gas embolism during robot-assisted partial nephrectomy: Experiences, current trends, and important cautions in Japan”","authors":"","doi":"10.1111/ases.70353","DOIUrl":"10.1111/ases.70353","url":null,"abstract":"<p>\u0000 <span>T. Nishikimi</span>, <span>T. Ohashi</span>, <span>Y. Hosono</span>, et al., “ <span>Pulmonary Gas Embolism During Robot-Assisted Partial Nephrectomy: Experiences, Current Trends, and Important Cautions in Japan</span>,” <i>Asian Journal of Endoscopic Surgery</i> <span>19</span>, no. <span>1</span> (<span>2026</span>): e70278, https://doi.org/10.1111/ases.70278.\u0000 </p><p>In Table 1 on page 4, under the “Intracardiac right-to-left shunt (confirmed)” column, “Yes (TEE)” in the last row (Mori et al.) should be corrected to “No (TEE)” instead.</p><p>We apologize for this error.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13388826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550600","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":"Operative Approach for Robotic Descending Colon Cancer Requiring Bidirectional Mobilization of the Splenic Flexure and Sigmoid–Descending Junction","authors":"Tsutomu Kumamoto,&nbsp;Koki Otsuka,&nbsp;Junichiro Hiro,&nbsp;Koshiro Matsunami,&nbsp;Koichi Matsumoto,&nbsp;Gaku Inaguma,&nbsp;Yusuke Omura,&nbsp;Yosuke Kobayashi,&nbsp;Ichiro Uyama,&nbsp;Koichi Suda","doi":"10.1111/ases.70352","DOIUrl":"10.1111/ases.70352","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Robotic Descending Colectomy Occasionally Requires Splenic Flexure (SF) and Sigmoid–Descending Junction (SDJ) Mobilization. In Multiport Robotic Surgery, This Bidirectional Mobilization Can Be Technically Demanding Because the Operative Field Extends in Two Directions, and Conventional Curved-Line or Stepped-Line Configurations May Limit Operative Envelope or Cause Arm Interference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>For lesions requiring continuous SF–SDJ access, an oblique-line configuration using the da Vinci Xi (DVXi) or the da Vinci SP (DVSP) system is typically required for an adequate operative envelope. This study describes the selection and use of curved-line, stepped-line, and oblique-line DVXi port configurations, with the DVSP system as a complementary option, based on lesion location and required mobilization direction. In the oblique-line configuration, the robotic ports are arranged diagonally from the right side of the round ligament of the liver toward the lower abdominal midline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The Oblique-Line Configuration Is Designed to Align the Camera Axis and Working Instruments With the Anticipated Direction of Mobilization, Whereas the DVSP System Provides Flexible Access Across Proximal and Distal Operative Fields. These Strategies May Help Surgeons Gain Stable Robotic Access Without Additional Port Insertion, Redocking, or Excessive Instrument Angulation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537246","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":"Repair of Membranous Tracheal Defect Using Sutureless Free Pericardial Fat Pad Covering During Endoscopic Resection of Tracheal Mucus Retention Cyst: A Case Report","authors":"Takayuki Kosaka,&nbsp;Seshiru Nakazawa,&nbsp;Akinobu Ida,&nbsp;Rikuo Ushikubo,&nbsp;Takashi Ibe,&nbsp;Ken Shirabe","doi":"10.1111/ases.70350","DOIUrl":"10.1111/ases.70350","url":null,"abstract":"<div>\u0000 \u0000 <p>A man in his 60s was referred to our hospital for evaluation of a cystic nodule on the membranous trachea detected on computed tomography. Bronchoscopy revealed a submucosal nodule. After dissecting the mucosal surface with forceps, biopsy of the cyst wall showed no evidence of malignancy. Surgery was performed because of the potential risk of airway stenosis associated with cyst enlargement. The mediastinal pleura was incised and the nodule was carefully dissected from the membranous part of the trachea. A mucosal defect approximately 5 mm in diameter was identified, corresponding to the area of mucosa that had been peeled off during the preoperative bronchoscopic biopsy. The defect was covered with a free pericardial fat pad in a sutureless manner. Here we report a case in which a membranous trachea defect was successfully repaired using sutureless covering with free pericardial fat pad, which is considered a simple and effective method.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449727","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 Three Minimally Invasive Surgical Approaches for Restorative Proctocolectomy in Ulcerative Colitis: A Retrospective Study","authors":"Koji Okabayashi,&nbsp;Kohei Shigeta,&nbsp;Satoru Matsuda,&nbsp;Yuko Kitagawa","doi":"10.1111/ases.70344","DOIUrl":"10.1111/ases.70344","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Restorative proctocolectomy (RPC) is the most frequently performed procedure for patients with ulcerative colitis (UC) requiring surgical intervention. Although several approaches to laparoscopic RPC for UC have been documented, the optimal minimally invasive surgical (MIS) approach remains to be firmly established. This study aims to compare the postoperative complication rates and surgical outcomes of three MIS approaches for RPC: laparoscopic surgery (Lap), hand-assisted laparoscopic surgery (HALS), and reduced port surgery combined with taTME (RPS + taTME).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 156 patients who underwent two-stage RPC for UC via laparoscopy at Keio University Hospital between February 2002 and February 2022. The influence of patient characteristics on postoperative complications and surgical outcomes was evaluated using Fisher's exact test, analysis of variance (ANOVA), or logistic regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 156 patients, 60 underwent Lap, 46 underwent HALS, and 50 underwent RPS + taTME. Postoperative complication rates were 43.3% for Lap, 50.0% for HALS, and 36.0% for RPS + taTME. There were no significant differences in postoperative complications between the surgical approaches (HALS vs. Lap: odds ratio (OR) 0.54, 95% confidence interval (CI) 0.18–1.69, <i>p</i> = 0.29; RPS + taTME versus Lap: OR 1.57, 95% CI 0.63–3.89, <i>p</i> = 0.33). Operative time was significantly shorter in the HALS group, while estimated blood loss was significantly lower in the RPS + taTME group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights the distinct characteristics of three MIS approaches for laparoscopic RPC. The incidence of postoperative complications did not differ significantly among the techniques. These findings provide valuable insights for colorectal surgeons, facilitating the selection of optimal surgical techniques for the management of UC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438444","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":"Endoscopic Transanal Soave Procedure (ETaS) Using a LAPPROTECTOR for Hirschsprung Disease","authors":"Yusuke Yamane,&nbsp;Shota Shinohara,&nbsp;Nobuhito Ogata,&nbsp;Koshin Funabara,&nbsp;Keisuke Ozeki,&nbsp;Takuro Fujita,&nbsp;Taiichiro Kosaka,&nbsp;Akihiko Soyama,&nbsp;Susumu Eguchi","doi":"10.1111/ases.70345","DOIUrl":"10.1111/ases.70345","url":null,"abstract":"<p>Short-segment Hirschsprung disease is usually managed by a transanal Soave procedure, sometimes with laparoscopic assistance when proximal mobilization is difficult. We describe endoscope-assisted transanal Soave (ETaS) using a Lap Protector–based access platform without laparoscopy. A 6-year-old boy with constipation since infancy underwent surgery after rectal mucosal biopsies at ages 3 and 5 showed positive acetylcholinesterase staining. Mucosectomy was started 5 mm proximal to the dentate line and extended ~2 cm before closure of the distal cuff. A sealed transanal endoscopic workspace was then created with a LAPPROTECTOR and EZ-Access, allowing deep pelvic dissection and proximal mobilization to the sigmoid-descending junction under stable pneumorectum. After confirmation of mesenteric orientation and ganglion cells on frozen-section full-thickness biopsy, coloanal anastomosis was completed. Operative time was 225 min with minimal blood loss, no abdominal ports, and an uneventful postoperative course. This technique may be a useful option in selected pediatric patients.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437494","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":"Robotic Hepatectomy Using the Hugo RAS System: Initial Experience and Technical Considerations","authors":"Katsunori Sakamoto,&nbsp;Hiroto Nishino,&nbsp;Tomoaki Yoh,&nbsp;Hidenobu Kojima,&nbsp;Asahi Sato,&nbsp;Hirofumi Hirao,&nbsp;Takahiro Nishio,&nbsp;Shinya Okumura,&nbsp;Daisuke Ueda,&nbsp;Kei Yamane,&nbsp;Siyuan Yao,&nbsp;Masaaki Hirata,&nbsp;Satoshi Ogiso,&nbsp;Tatsuya Okamoto,&nbsp;Kazuyuki Nagai,&nbsp;Yoichiro Uchida,&nbsp;Takashi Ito,&nbsp;Takamichi Ishii,&nbsp;Shigeo Hisamori,&nbsp;Kazutaka Obama,&nbsp;Etsuro Hatano","doi":"10.1111/ases.70349","DOIUrl":"10.1111/ases.70349","url":null,"abstract":"<div>\u0000 \u0000 <p>Robotic hepatectomy using the Hugo robotic-assisted surgery (RAS) system has recently been introduced; however, clinical experience remains limited. We report our initial experience in five patients, focusing on surgical techniques and short-term outcomes. All procedures were completed robotically without conversion to open or laparoscopic surgery. The median operative time was 175 min (range, 162–209), and the median console time was 100 min (range, 79–139). The median inflow occlusion time was 31 min (range, 14–62). Intraoperative blood loss was minimal, with a median of 0 mL (range, 0–10). No intraoperative or postoperative complications were observed. The median postoperative hospital stay was 7 days (range, 4–11). The series included lesions in both left- and right-sided liver segments, including technically demanding areas such as segment 7. These findings suggest that Hugo RAS minor hepatectomy appears feasible and safe in selected cases, with favorable short-term outcomes.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425378","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":"Standardizing Upper Abdominal Fascial Terminology: A Transdisciplinary Expert Consensus From the Japanese Society for Endoscopic Surgery","authors":"Jun Watanabe,&nbsp;Hisashi Shinohara,&nbsp;Kazutaka Obama,&nbsp;Takahiro Kinoshita,&nbsp;Yuichi Nagakawa,&nbsp;Kohei Nakata,&nbsp;Tsunenori Kondo,&nbsp;Jun Miki,&nbsp;Hiroyuki Egi,&nbsp;Yoshiharu Sakai,&nbsp;Yuko Kitagawa","doi":"10.1111/ases.70348","DOIUrl":"10.1111/ases.70348","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Terminology describing fascial structures in the upper abdomen remains inconsistent across surgical specialties. Eponymous structures such as the fasciae of Toldt, Gerota, Fredet, and Treitz are widely used, but their definitions vary among disciplines. To address this issue, the Japanese Society for Endoscopic Surgery established a transdisciplinary surgical working group to standardize intraoperative fascial nomenclature in the upper abdomen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A transdisciplinary surgical expert panel comprising surgeons from upper gastrointestinal, colorectal, hepatopancreatobiliary, and urological specialties held structured consensus meetings between February and September 2023. Surgeons from each field presented intraoperative anatomical structures with inconsistent terminology. Through iterative discussions based on intraoperative findings and surgical anatomy, consensus statements were developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four consensus statements were established. First, the renal fascia (Gerota fascia) was recognized as a representative relatively dense condensation fascia that can be consistently identified intraoperatively. Second, structures traditionally referred to as the fasciae of Toldt, Fredet, and Treitz were interpreted as regional or topographic expressions of fusion fascia, rather than independent anatomical membranes. Fusion fascia was understood as a loose, multilayered fusion-related connective tissue zone within the broad operative anatomical spectrum of fascia. Third, because fusion fascia is multilayered, defining a single fixed surgical interface was considered inappropriate. Fourth, membrane-like structures exposed on the visceral side after dissection of the fusion fascia were collectively designated as proper visceral fasciae.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This surgeon-led consensus provides an operative nomenclature framework for fascial structures recognized intraoperatively in upper abdominal endoscopic surgery. The three core terms may serve as a basic conceptual skeleton for describing upper abdominal fascial anatomy and facilitate cross-specialty communication.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425371","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":"Is the Interparietal Subtype of Groin Hernia Really Uncommon? A Single-Center Retrospective Cohort Study","authors":"Saseem Poudel,&nbsp;Tamaki Kawagoe,&nbsp;Yosuke Kitayama,&nbsp;Junkichi Koinuma,&nbsp;Sosuke Sumikawa,&nbsp;Kuniaki Sasaki,&nbsp;Hidehiko Kitagami,&nbsp;Takaya Kusumi,&nbsp;Satoshi Hirano","doi":"10.1111/ases.70347","DOIUrl":"10.1111/ases.70347","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Interparietal inguinal hernia is an anatomically atypical subtype of groin hernia in which the hernia sac extends between layers of the abdominal wall rather than along the inguinal canal. Its true prevalence and optimal surgical management remain poorly defined in the era of routine cross-sectional imaging and laparoscopic repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center retrospective study of patients undergoing surgical repair for groin hernia between April 2023 and March 2025. Preoperative diagnosis was based on computed tomography (CT) imaging, and interparietal hernia was confirmed intraoperatively. Patient characteristics, imaging findings, operative details, and short-term outcomes were analyzed. Incidence was assessed at both the patient and lesion levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 208 patients with 256 hernia lesions were included. Interparietal hernia was identified in 12 patients (5.8%) and 12 lesions (4.7%). Most patients were elderly women with low body mass index and presented with subtle or atypical groin symptoms. All cases suspected on preoperative CT were confirmed intraoperatively. A characteristic imaging feature was a hernia sac originating from the internal inguinal ring and extending cranially between abdominal wall layers. All interparietal hernias were successfully managed laparoscopically using the totally extraperitoneal approach, with no conversions, major complications, or need for bowel resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Interparietal inguinal hernia may be more frequently identified in contemporary practice than previously reported, likely reflecting improved detection with CT imaging. Recognition of characteristic imaging findings is essential for accurate diagnosis and surgical planning. Laparoscopic repair, particularly the totally extraperitoneal approach, is a safe and effective treatment for this uncommon hernia subtype.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425328","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 Transabdominal Preperitoneal Approach Using Self-Fixating Mesh for Spigelian Hernia Repair: A Case Series Study of Four Patients","authors":"Ryosuke Kawamoto,&nbsp;Teppei Kamada,&nbsp;Hiroshi Sugano,&nbsp;Ippei Hironaka,&nbsp;Hideki Kanai,&nbsp;Tetsuya Kobayashi,&nbsp;Yoshiaki Tanabe,&nbsp;Ken Eto","doi":"10.1111/ases.70346","DOIUrl":"10.1111/ases.70346","url":null,"abstract":"<div>\u0000 \u0000 <p>Spigelian hernia is a rare abdominal wall hernia with a high risk of incarceration. Laparoscopic repair is common, but the optimal approach remains controversial. We evaluated the feasibility and outcomes of laparoscopic transabdominal preperitoneal repair of Spigelian hernia using self-fixating mesh. Patients who underwent this repair between 2019 and 2023 were reviewed. All were treated using a standardized approach with self-fixating mesh without additional fixation. Patient demographics, operative findings, and outcomes were analyzed. Four patients underwent transabdominal preperitoneal repair. All patients had favorable outcomes with no recurrence during follow-up. Laparoscopic transabdominal preperitoneal repair using self-fixating mesh is a feasible technique for Spigelian hernia repair.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399583","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":"Early Diffusion and Regional Variation in Robot-Assisted Laparoscopic Resection for Malignant Colon Tumors in Japan: An Analysis of National Database Open Data From Fiscal Years 2022 and 2023","authors":"Tomomi Omura,&nbsp;Takahiro Kamihara,&nbsp;Takuya Omura","doi":"10.1111/ases.70343","DOIUrl":"10.1111/ases.70343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Robot-assisted laparoscopic resection for malignant colon tumors was newly reimbursed in Japan in April 2022, but early national billing-based uptake and geographic variation after reimbursement have not been described using public aggregate claims data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the ninth and tenth National Database Open Data releases for fiscal years 2022 and 2023. Using inpatient K-surgery tables by treating-institution prefecture, we calculated the robot-assisted proportion as robot-assisted malignant colon tumor resection billing counts divided by the sum of conventional and robot-assisted laparoscopic malignant colon tumor resection billing counts. National proportions were calculated from suppression-free total columns. Prefecture-level summaries were reported among displayed prefectures, with a bounded small-cell sensitivity assessment for masked robot-assisted cells.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>National robot-assisted billing counts increased from 1652 to 6141, and the total-based national proportion rose from 3.38% to 11.42%. The number of prefectures with displayed robot-assisted numerator cells increased from 36 to 43. The displayed-prefecture median increased from 1.72% to 8.63%. In a bounded small-cell sensitivity analysis constrained to the hidden national-total difference, the possible fiscal year 2022 median was 0.90%–1.83%, and the fiscal year 2023 median was 8.45%. Among 33 prefectures with displayed data in both years, the median proportion rose from 1.89% to 9.65%, with a median within-prefecture change of +6.76 percentage points; 30 prefectures increased, one decreased, and two were unchanged. Under a direction-of-change sensitivity classification incorporating masked transitions, 43 prefectures were classifiable as increased, one decreased, two were unchanged, and one remained indeterminate. Fiscal year 2023 variation remained substantial among displayed prefectures, with values ranging from 0.00% to 27.79%, and paired ranks were moderately stable (Spearman <i>ρ</i> = 0.77).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Robot-assisted billing among laparoscopic malignant colon tumor resection codes increased rapidly from the first to the second reimbursement year, but inter-prefectural variation remained.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382958","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}