Asian Journal of Endoscopic Surgery最新文献

{"title":"Exoscope-Assisted Ovarian-Sparing Resection of Contralateral Mature Teratomas in Bilateral Pediatric Ovarian Disease: A Case Series","authors":"Wilson E. de Oliveira,&nbsp;Bianca Rezende Rosa,&nbsp;Gisele Eiras Martins,&nbsp;Gustavo da Silveira Orsi,&nbsp;Letícia Semissato dos Santos,&nbsp;Ana Laura Balduino do Nascimento,&nbsp;Luiz Fernando Lopes,&nbsp;Rodrigo Chaves Ribeiro","doi":"10.1111/ases.70331","DOIUrl":"10.1111/ases.70331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bilateral ovarian tumors in pediatric patients present a surgical challenge requiring complete tumor removal while preserving sufficient ovarian tissue for endocrine function and future fertility. In bilateral disease, preservation is often feasible only on the ovary that retains salvageable parenchyma. Exoscope systems provide high-definition magnified visualization of the operative field. To our knowledge, this is one of the first reports of exoscope-assisted ovarian-sparing surgery in pediatric patients. This study describes the technical feasibility of the technique and the completeness of tumor removal with preservation of ovarian parenchyma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective case series of four patients with bilateral ovarian tumors who underwent exoscope-assisted ovarian-sparing surgery between 2020 and 2024 at a Brazilian pediatric cancer center. Eligible patients had imaging consistent with benign lesions and normal serum tumor markers. Surgical technique combined exoscopic magnification with intraoperative ultrasonography in open procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All patients had mature teratomas confirmed on final pathology. No intraoperative capsular ruptures occurred across the four preservation procedures. Mean follow-up was 31.0 months (range 20–39). Two patients maintained regular spontaneous menses without hormonal supplementation. One patient developed clinical hypogonadism 8 months after surgery and received hormone replacement therapy, after which regular cycles resumed. One patient was not assessable for spontaneous menstrual recovery because continuous combined hormonal contraception was started after surgery at her request. No tumor recurrence occurred during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Exoscope-assisted ovarian-sparing surgery was technically feasible for the contralateral or remaining ovary in adolescents with bilateral mature teratomas. Spontaneous menstrual function was preserved in two of four patients, one required hormone replacement therapy, and one was not assessable. Controlled studies that include objective ovarian reserve markers and extended follow-up are required before the added value of the exoscope can be established.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279183","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":"Clinical Impact of Subcutaneous Fat Area on Incisional Hernia Development Following Laparoscopic Colorectal Cancer Surgery","authors":"Tomokazu Kishiki,&nbsp;Nobuyoshi Aso,&nbsp;Aiko Iioka,&nbsp;Takashi Wakamatsu,&nbsp;Kazuna Honda,&nbsp;Isao Kataoka,&nbsp;Shun Ishii,&nbsp;Satoshi Isobe,&nbsp;Toshiya Shirota,&nbsp;Yoshiki Nakayama,&nbsp;Tomomasa Fukasawa,&nbsp;Atsuki Goto,&nbsp;Yoshihiro Sakamoto,&nbsp;Nobutsugu Abe,&nbsp;Eiji Sunami","doi":"10.1111/ases.70329","DOIUrl":"10.1111/ases.70329","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Incisional hernia is a common complication experienced by patients who have undergone colorectal surgery. Visceral and subcutaneous fats have been implicated as risk factors; however, only a few studies have evaluated the role of abdominal wall musculature. Therefore, we examined the anatomical features of the intra-abdominal cavity and abdominal wall to identify risk factors for incisional hernia following laparoscopic colorectal resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study involved 164 patients who underwent laparoscopic colorectal resection for cancer between January 2019 and December 2024 at our institution. Specimens were extracted via a small midline umbilical incision. Patients with prior midline incisions or stomas were excluded. Preoperative computed tomography at the umbilical level was used to measure visceral and subcutaneous fat area using SYNAPSE VINCENT. Clinical, operative, and postoperative data were collected. The diagnosis was established by physical examination or computed tomography during a median follow-up period of 24 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen patients (9.8%) developed incisional hernia. In all patients, incisional hernia developed within 18 months postoperatively. Univariate analysis identified female sex, body mass index, and visceral and subcutaneous fat area as significant predictors. Multivariate analysis identified subcutaneous fat area as an independent risk factor (<i>p</i> = 0.018; OR = 5.839; 95% CI: 1.331–41.452).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The subcutaneous fat area was independently associated with incisional hernia after laparoscopic colorectal resection. Meticulous fascial closure and tailored surgical strategies are essential in these patients. Furthermore, abdominal wall structure, rather than fat indices alone, should be considered in risk assessment and prevention of incisional hernia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279139","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":"Transcystostomal Bladder Tumor Resection in a Transgender Man After Phalloplasty","authors":"Takatoshi Moriwake,&nbsp;Yusuke Tominaga,&nbsp;Nariaki Ozaki,&nbsp;Yuko Matsumoto,&nbsp;Tomoko Kobayashi,&nbsp;Ichiro Tsuboi,&nbsp;Kasumi Yoshinaga,&nbsp;Tomoaki Yamanoi,&nbsp;Tatsushi Kawada,&nbsp;Takuya Sadahira,&nbsp;Satoshi Katayama,&nbsp;Shingo Nishimura,&nbsp;Kensuke Bekku,&nbsp;Yuzaburo Namba,&nbsp;Motoo Araki","doi":"10.1111/ases.70330","DOIUrl":"10.1111/ases.70330","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Phalloplasty in transgender men is frequently complicated by a neourethral stricture, precluding standard transurethral access for bladder tumor resection. We describe the first reported case of a transcystostomal bladder tumor resection in a transgender man after a radial forearm free flap (RFFF) phalloplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>A 65-year-old transgender man, 23 years after an RFFF phalloplasty, presented with gross hematuria and a 15-mm posterior bladder tumor. A 7.95 Fr flexible ureteroscope reached the bladder but with markedly limited maneuverability. A two-stage transcystostomal approach was used: a 14 Fr suprapubic cystostomy (SPC) was placed 1 month before resection for tract maturation, followed by balloon dilation and insertion of a 24 Fr resectoscope. The modified Valdivia position enabled simultaneous transcystostomal and transurethral access with gravity-assisted irrigation drainage. Complete tumor resection was achieved without complications, and pathology confirmed noninvasive papillary urothelial carcinoma (pTa, low-grade) with negative margins. A single immediate intravesical instillation of pirarubicin was administered. Surveillance cystoscopy via the cystostomy tract at 3 and 6 months revealed no recurrence; the patient continues to void while standing with the cystostomy catheter capped.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The two-stage transcystostomal approach, combining prior SPC placement, balloon tract dilation, and the modified Valdivia position, enabled safe oncological control while preserving phallic anatomy and standing voiding function. This technique offers a reproducible option for bladder tumor resection in patients with functionally inadequate transurethral access after phalloplasty.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70330","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273299","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":"Early Experience of Hinotori Robot System in General Surgery: A Systematic Review","authors":"Clara Avelar Mendes de Vasconcellos,&nbsp;Gabriela Lyons,&nbsp;Matheus Daniel Faleiro,&nbsp;Maria Fernanda Andrade Gomes da Silva,&nbsp;Jack Liu,&nbsp;Kohei Shigeta,&nbsp;Raquel Nogueira,&nbsp;Diego Lima","doi":"10.1111/ases.70324","DOIUrl":"10.1111/ases.70324","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Robotic-assisted surgery has enhanced visualization, precision, and dexterity in general surgery. While the da Vinci system predominates, newer platforms such as the Hinotori Surgical Robot System (Hinotori) have emerged. This systematic review evaluates early clinical experience with Hinotori in general surgery, focusing on procedural characteristics and perioperative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A systematic review was conducted according to PRISMA guidelines. MEDLINE/PubMed, EMBASE, Cochrane Library, and Web of Science were searched through March 2026 using the terms “Hinotori Surgical Robot System,” “General Surgery,” and “Minimally Invasive Surgery.” Risk of bias was assessed using ROBINS-I. Studies reporting general surgical procedures with postoperative outcomes were included; conference abstracts were excluded. Data extracted included study design, procedure type, console time, operative time, blood loss, complications, and length of stay (LOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 475 records screened, 15 studies met inclusion criteria (4 case reports and 11 retrospective cohorts), all conducted in Japan (2023 to 2026), comprising 296 patients. Colorectal surgeries predominated (57.1%), followed by gastric procedures (25%). Console times ranged from 252 to 400 min (gastric), 213 to 325 min (colorectal), 252 min (esophageal), 239 to 350 min (pancreatic), and 292 min (biliary). No intraoperative complications or conversions were reported. Median blood loss ranged from 3 to 164 mL. LOS varied by procedure type (8–41 days). Postoperative complications were infrequent and primarily Clavien-Dindo Grades I–II. Comparative studies with the da Vinci system have demonstrated similar perioperative outcomes, with the main differences related to platform use, particularly longer operative and console times.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early evidence supports the feasibility and safety of the Hinotori system across multiple general surgical procedures, with outcomes comparable to the da Vinci platform. Larger comparative studies with longer follow-up and cost-effectiveness analyses are needed to define its clinical role.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Registration</h3>\u0000 \u0000 <p>A review protocol for this systematic review was registered in PROSPERO (CRD420250637267).</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273387","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 the Hinotori and da Vinci Platforms in Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Study","authors":"Masanari Nishida,&nbsp;Akinori Wada,&nbsp;Tetsuya Yoshida,&nbsp;Kubota Shigehisa,&nbsp;Masayuki Nagasawa,&nbsp;Kenichi Kobayashi,&nbsp;Kazuaki Yamanaka,&nbsp;Kazuyoshi Johnin,&nbsp;Susumu Kageyama","doi":"10.1111/ases.70326","DOIUrl":"10.1111/ases.70326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Comparative evidence between robotic platforms for robot-assisted radical prostatectomy (RARP) remains limited, particularly regarding oncological quality beyond perioperative outcomes. This study compared outcomes between the hinotori and da Vinci systems, focusing on positive surgical margin (PSM) distribution in a real-world cohort with varying surgeon experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed 437 patients who underwent RARP at our institution between 2013 and 2025. After propensity score matching, 130 patients in the da Vinci group and 65 in the hinotori group were analyzed. Perioperative outcomes, PSM rates and anatomical distribution, urinary continence recovery, and biochemical recurrence (BCR)-free survival were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The matched cohort involved 17 surgeons, including 12 hinotori surgeons, with expert surgeons performing 38% of hinotori procedures. Operative, console, and setup-related times were longer, and estimated blood loss was greater in the hinotori group. No transfusions were required. Complication rates and hospital stay were comparable. No differences were observed in overall or stage-specific PSM rates. PSMs most frequently involved the apex and posterolateral regions in both groups, with no difference in anatomical PSM distribution. The 12-month urinary continence recovery rates were 87% in the hinotori group and 85% in the da Vinci group. In the 2-year time-aligned analysis, BCR-free survival rates in the hinotori and da Vinci groups were 94% and 89% at 1 year and 89% and 85% at 2 years, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hinotori-assisted RARP showed longer operative and setup-related times but no apparent deterioration in perioperative safety, PSM outcomes including anatomical distribution, continence recovery, or early BCR-free survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253841","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":"Preoperative Botulinum Toxin A Within an Endoscopic Retromuscular Strategy for Ventral Hernia Repair: A Preliminary Prospective Study in Japanese Patients","authors":"Kentaro Shinohara,&nbsp;Takuya Saito,&nbsp;Kohei Yasui,&nbsp;Sho Ueda,&nbsp;Tatsuki Matsumura,&nbsp;Takaaki Osawa,&nbsp;Masataka Ando,&nbsp;Yasuyuki Fukami,&nbsp;Kenitiro Kaneko,&nbsp;Tsuyoshi Sano","doi":"10.1111/ases.70323","DOIUrl":"10.1111/ases.70323","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We have developed a stapler repair technique as an endoscopic retromuscular strategy for ventral hernia repair. Because transversus abdominis release before stapled fascial closure is technically difficult in this technique, preoperative reduction of fascial tension may be valuable even in moderate-sized hernias. Botulinum toxin A may address this limitation, but its necessity and appropriate dosing in Asian patients remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, single-center study included 10 patients with midline ventral hernias ≥ 5 cm in width. Ultrasound-guided botulinum toxin A was injected into the bilateral lateral abdominal wall muscles using a weight-adjusted dose of 200 units of Botox Vista for patients weighing ≥ 50 kg and 100 units for those weighing &lt; 50 kg. Surgery was scheduled 4 weeks later, and endoscopic retromuscular repair using the stapler repair technique was the preferred approach. CT-based changes in defect width and muscle length, surgical outcomes, and treatment-related adverse events were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight patients underwent endoscopic repair, one open repair, and one intraperitoneal onlay mesh plus repair. Median defect width decreased from 5.7 to 4.5 cm (<i>p</i> = 0.004), and lateral abdominal wall muscles significantly elongated bilaterally. No treatment-related adverse events occurred. Primary fascial closure was achieved in all patients, with no recurrence during a median follow-up of 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Weight-adjusted preoperative botulinum toxin A was safe and produced favorable CT-based morphological changes. These changes may reduce fascial tension before stapled closure and help expand the applicability of the stapler repair technique to selected patients with moderate-sized ventral hernias.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260036","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":"Risk Factors for Prolonged Operative Time in Hand-Sewn Laparoscopic IPAA for Ulcerative Colitis","authors":"Ryuichi Kuwahara,&nbsp;Motoi Uchino,&nbsp;Yusuke Tomoo,&nbsp;Kentaro Nagano,&nbsp;Kurando Kusunoki,&nbsp;Yuki Horio,&nbsp;Kei Kimura,&nbsp;Kozo Kataoka,&nbsp;Masataka Ikeda,&nbsp;Hiroki Ikeuchi","doi":"10.1111/ases.70328","DOIUrl":"10.1111/ases.70328","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Laparoscopic-assisted total proctocolectomy and ileal pouch–anal anastomosis (Lap-IPAA) is a standard surgical procedure for patients with ulcerative colitis (UC), but its operative time can be prolonged due to technical complexity and disease-specific factors. This study aimed to identify risk factors associated with prolonged operative time in hand-sewn Lap-IPAA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective single-center study included 156 patients with UC who underwent hand-sewn Lap-IPAA between January 2018 and June 2024. Patients receiving stapled IPAA or open surgery were excluded. Clinical, laboratory, surgical, and perioperative data were collected from electronic records. Prolonged operative time was defined as ≥ 370 min (75th percentile). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 156 patients, 40 (25.6%) were classified into the prolonged operative time group. Male sex (80.0% vs. 51.7%, <i>p</i> = 0.002) and higher BMI (21.7 vs. 18.6 kg/m², <i>p</i> &lt; 0.001) were significantly more common in the prolonged group. Multivariate analysis confirmed male sex (OR, 5.153; 95% CI, 1.927–13.779; <i>p</i> &lt; 0.001) and BMI (OR, 1.323; 95% CI, 1.146–1.526; <i>p</i> &lt; 0.001) as independent risk factors. Other variables, including UC severity, albumin, CRP, and preoperative immunosuppressive therapies, were not significantly associated with operative time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Male sex and elevated BMI were independently associated with prolonged operative time in hand-sewn Lap-IPAA for UC. These findings highlight the importance of preoperative planning and support the centralization of complex UC surgeries to experienced centers, particularly for high-risk patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253866","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":"Central Pancreatectomy with Duct-to-Mucosa Pancreaticogastrostomy Using a Knotless Continuous Suturing Technique: Initial Experience with a Totally Laparoscopic Approach","authors":"Mampei Kawashima,&nbsp;Akira Matsushita,&nbsp;Akira Hamaguchi,&nbsp;Yu Kato,&nbsp;Takashi Ono,&nbsp;Toshiyuki Irie,&nbsp;Ryo Ga,&nbsp;Yuto Aoki,&nbsp;Yukio Oshiro,&nbsp;Yoshiharu Nakamura","doi":"10.1111/ases.70325","DOIUrl":"10.1111/ases.70325","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Central pancreatectomy (CP) preserves pancreatic parenchyma but remains technically demanding in minimally invasive surgery because two pancreatic transection surfaces increase the risk of postoperative pancreatic fistula and hemorrhage. This study aimed to evaluate the feasibility of totally laparoscopic central pancreatectomy (LCP) using a standardized risk-oriented surgical design, including a knotless continuous duct-to-mucosa pancreaticogastrostomy technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective two-institution study evaluated the feasibility of totally laparoscopic central pancreatectomy (LCP). A standardized risk-oriented surgical design was adopted, consisting of stapler-based pancreatic transection and duct-to-mucosa pancreaticogastrostomy for distal reconstruction. Open CP performed using the same reconstructive concept served as a reference cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six patients underwent CP, including three treated with totally laparoscopic CP. All laparoscopic procedures were completed without conversion. One patient developed clinically relevant postoperative pancreatic fistula (ISGPS grade B). No postpancreatectomy hemorrhage, reintervention, or mortality occurred. The median operative time and estimated blood loss in the laparoscopic group were 287 min and 10 mL, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Totally laparoscopic central pancreatectomy appeared technically feasible in selected patients when performed within a standardized, risk-oriented surgical framework.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253847","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":"A Comparative Analysis of the Hinotori and da Vinci Robotic Systems in Total Hysterectomy for Benign Uterine Gynecological Diseases Using Propensity Score Matching","authors":"Yutaka Torii,&nbsp;Chiaki Oshima,&nbsp;Ryoma Aoki,&nbsp;Akira Yasue,&nbsp;Kazuhiko Tsukada,&nbsp;Haruki Nishizawa","doi":"10.1111/ases.70327","DOIUrl":"10.1111/ases.70327","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The hinotori surgical robot system, the first Japanese-made robotic-assisted surgical system to receive Japanese regulatory approval in 2020, is now being applied clinically in gynecology. This study aimed to comprehensively compare the hinotori and the da Vinci Xi Surgical System with respect to safety and surgical outcomes in robot-assisted total hysterectomy for benign uterine gynecological diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study used 1:1 propensity score matching (PSM) to review patients who underwent robot-assisted total hysterectomy for benign uterine gynecological diseases at our hospital from August 2020 to June 2025. The hinotori was used in 40 patients, while the da Vinci was used for 187 patients. The primary endpoint was the incidence of complications of Grades I–V according to the Clavien–Dindo (CD) classification system within 30 days postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After PSM, 40 patients from each group were included in the analysis. Patient characteristics were well balanced between the groups. Complication rates for CD Grades I–V were 7.5% in the hinotori group and 10.0% in the da Vinci group, with no significant difference (<i>p</i> = 0.602). Meanwhile, operative time (144 vs. 118 min, <i>p</i> &lt; 0.001) and console time (113 vs. 76 min, <i>p</i> &lt; 0.001) were significantly longer in the hinotori group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In robot-assisted total hysterectomy for benign uterine gynecological diseases, the hinotori and da Vinci were comparable in terms of complication incidence. However, longer operative and console times were observed with hinotori, possibly reflecting early adoption effects or platform-specific factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70327","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253900","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":"Standardization and Learning Curve of Robotic Left Hepatectomy Employing Glissonean Approach","authors":"Akira Umemura,&nbsp;Hiroyuki Nitta,&nbsp;Koji Kikuchi,&nbsp;Daiki Takeda,&nbsp;Taro Ando,&nbsp;Toma Kawashima,&nbsp;Satoshi Amano,&nbsp;Taku Kimura,&nbsp;Akira Sasaki","doi":"10.1111/ases.70321","DOIUrl":"10.1111/ases.70321","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Robotic liver resection (RLR) is widely performed as an alternative to laparoscopic liver resection. Many different surgical robot systems (SRSs) have been developed; however, there are relatively few standardized RLR procedures that can be applied to the use of different SRSs. We present a standardized robotic left hepatectomy (RLH) procedure for different SRSs and the learning curve derived via cumulative sum analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>We performed 14 cases of RLH using our standardized procedure. We mobilized the left lobe, and the round ligament was drawn to the caudal side. The omental bursa is opened, and the Arantius duct is carefully transected. The left Glissonean pedicle was encircled and transected using a linear stapler after confirming the demarcation line. Parenchymal transection is gently performed using the clamp–crush technique (intermittent Pringle's maneuver). The root of the left hepatic vein was visualized at the end of the parenchymal transection, and this vein was transected using a linear stapler.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In our series, there were no intraoperative transfusions or conversions. One case of bile leakage required endoscopic treatment, and the patient survived. The learning curve plateaued at seven cases of RLH. Our standardized RLH procedure, which includes the Glissonean approach and the clamp–crush method, can be applied to all SRSs without any specific energy devices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206641","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}