Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Comparison of Efficacy and Safety of Balloon Dilation Versus Gradual Dilation in Patients with Obesity Undergoing Supine Percutaneous Nephrolithotomy.","authors":"Ubeyd Sungur, Taner Kargı, Alican Çatik, Yusuf Arıkan, Alper Bitkin, Ali İhsan Taşçı","doi":"10.1177/10926429251359731","DOIUrl":"https://doi.org/10.1177/10926429251359731","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> We aimed to compare the safety and efficacy of gradual dilatation (GD) and balloon dilatation (BD) in supine percutaneous nephrolithotomy (PNL) in patients with obesity. <b><i>Methods:</i></b> The study was performed on 164 patients with a body mass index (BMI) ≥30 kg/m² who underwent supine PNL in the Galdakao-modified Valdivia position. Sixty patients who underwent tract creation with BD were defined as Group 1, and 104 patients who underwent tract creation with GD were defined as Group 2. Demographic characteristics, preoperative, intraoperative, and postoperative data were compared between the two groups. Then, binary logistic regression analysis was performed to predict stone-free status and complications, and parameters predicting success and safety were investigated. <b><i>Results:</i></b> There was no statistically significant difference between the two groups regarding stone-free status, transfusion rate, and the Clavien-Dindo complication grades. Fluoroscopy time and operation time were significantly lower in Group 1 than in Group 2 (<i>P</i> < .001 and <i>P</i> = .002). When the factors predicting success were analyzed, multiple stones and staghorn stones were associated with lower success in multivariate analysis. Long operation times were found to be significant in predicting the development of complications in multivariate analysis. <b><i>Conclusions:</i></b> BD and GD have similar success and complication rates as dilatation methods in patients with obesity. BD method may provide less X-ray exposure with shorter fluoroscopy and operation time, but both methods can be used safely in supine PNL in patients with obesity.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swallowable Gastric Balloon: As a Noninvasive Option for Weight Loss.","authors":"Mariano Palermo, Federico Davrieux","doi":"10.1177/10926429251359390","DOIUrl":"https://doi.org/10.1177/10926429251359390","url":null,"abstract":"<p><p><b><i>Background:</i></b> Obesity is a multifactorial disease that has had an increase in its prevalence. Its treatment requires a multidisciplinary team to prepare the patient for bariatric surgery. But not all patients are willing to undergo a surgical procedure. Other options to surgery were developed, such as the swallowable gastric balloon, a novel device that allows weight loss (WL) due to a restrictive function without anesthesia, endoscopy, or surgery and is completely ambulatory. <b><i>Methods:</i></b> A descriptive, retrospective, and observational study was presented. A total of 497 obese patients of both sexes, who underwent placement of a swallowable gastric balloon for WL, were included. The study was conducted at a single center between January 2020 and January 2024. <b><i>Results:</i></b> A total of 515 balloons were placed (497 patients). 71% were women. The mean age was 39 years. The mean body mass index was 31.7. The mean WL was 14.3%, with weight maintenance at 12 months in 86% of patients. A 100% success rate was obtained in its implantation. The adverse effects described were nausea and vomiting (22.9%), abdominal pain (33%), reflux (52%), headache (12%), and asthenia (24%). Complications reported included intolerance in 1.1%, hyperinflation in 0.3%, catheter breakage upon removal in 0.3%, and dehydration in 0.5%. No procedure-related mortality was reported. <b><i>Conclusions:</i></b> Swallowable gastric balloon is an excellent option for patients with overweight or grade I and II obesity.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Competency in Bariatric-Metabolic Surgery: The Impact of Simulation-Based Training on Surgeons' Experience.","authors":"Ursula Figueroa, Diego Sanhueza, Milenko Grimoldi, Enrique Cruz, Rafael Selman, Eduardo Machuca, Cristián Jarry, Gabriel Escalona, Fernando Crovari, Nicolás Quezada, Sergio Riveros, Mauricio Gabrielli, Martín Inzunza, Julián Varas","doi":"10.1177/10926429251359745","DOIUrl":"https://doi.org/10.1177/10926429251359745","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The learning curve for a laparoscopic Roux-en-Y gastric bypass (LRYGB) requires between 50 and 150 cases to reach competency and over 500 cases to significantly reduce morbidity. Our team has developed and validated a simulation-based training program focused on LRYGB-related skills, but its impact on surgeons' clinical development has not been assessed. <b><i>Objectives:</i></b> This study aims to evaluate the perceptions of participants after a bariatric-metabolic surgery simulation-based training course (BSC), exploring potential effects on their surgical exposure and development. <b><i>Methods:</i></b> A cohort study was conducted among trainees from the 2018-2023 simulation course who were surveyed to evaluate its impact on surgical experience, proficiency, case exposure, confidence, and clinical outcomes. <b><i>Results:</i></b> From 2018 to 2023, 110 trainees completed the BSC, and 27% responded to a follow-up survey. Pre-course, 76% were practicing surgeons and 13% residents; 33% had performed >200 laparoscopic cases and 13% none. At follow-up, 57% reported very advanced experience; 97% affirmed enhancements in technique and outcomes; 90% noted increased confidence and deemed simulation essential. Procedure-specific relevance was rated 63% for exploratory laparoscopy, 66% for bypass, and 70% for sleeve gastrectomy. <b><i>Conclusions:</i></b> Feedback from trainees highlights a simulation course's role in enhancing surgical skills, confidence, and exposure to complex cases. While it is recognized that attaining surgical competency is influenced by multiple factors, this study contributes valuable trainee-centered evidence supporting the positive impact that structured simulation-based training can have in a surgical career.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Landmark Exposure & Anatomical Recognition and Axillo-Breast Lateral Entry: Endoscopic Thyroidectomy.","authors":"Kushagra Gaurav, Akshay Anand, Ranjith Kumaran R, Abhinav Arun Sonkar","doi":"10.1177/10926429251359746","DOIUrl":"https://doi.org/10.1177/10926429251359746","url":null,"abstract":"<p><p><b><i>Background:</i></b> Minimally invasive thyroidectomy has evolved to improve cosmetic outcomes while maintaining surgical safety. The axillo-breast approach is increasingly favored, yet standardized methods to enhance anatomical clarity and nerve preservation are limited. <b><i>Objective:</i></b> To describe the Axillo-Breast Lateral Entry (ABLE) technique for endoscopic hemithyroidectomy and introduce the Critical Landmark Exposure & Anatomical Recognition (CLEAR) concept for safer dissection. <b><i>Materials and Methods:</i></b> A retrospective review was conducted on 40 patients who underwent ABLE endoscopic hemithyroidectomy without intraoperative neuromonitoring between January 2023 and October 2025 at a tertiary centre in Northern India. Standard laparoscopic instruments and energy devices were used. Port placements followed ergonomic principles. The CLEAR view was applied to reliably identify key structures: recurrent laryngeal nerve (RLN), inferior thyroid artery (ITA), and parathyroid glands within a defined anatomical triangle. <b><i>Results:</i></b> All patients had benign nodules with a mean size of 4.4 ± 1.2 cm. The RLN was visually identified in 100% of cases. There were no instances of permanent vocal cord palsy or hypoparathyroidism. All patients were discharged by postoperative day one, with excellent cosmetic outcomes and no major complications. <b><i>Conclusion:</i></b> The ABLE technique is safe, reproducible, and ergonomically favorable, particularly for early-career surgeons. The CLEAR concept provides a consistent anatomical framework for preserving critical structures, especially when intraoperative neuromonitoring is not available. This approach may facilitate wider adoption of endoscopic thyroidectomy in resource-limited settings.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Incision-Free Technique for R0 Resection in Cervicothoracic Esophageal Carcinoma: A Novel Approach of the Chai's Supra-Thoracic Apex Technique.","authors":"Wei Zhang, Yayun Sheng, Shouqiang Yu, Chen Zhang, Huiping Chai, Feng Liu, Shaojin Zhu, Wen Du","doi":"10.1089/lap.2025.0075","DOIUrl":"https://doi.org/10.1089/lap.2025.0075","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Esophageal squamous cell carcinoma (ESCC) located at the cervicothoracic junction (CTJ-ESCC), approximately 18-21 cm from the incisors, poses unique surgical difficulties given its proximity to the trachea and recurrent laryngeal nerves. This investigation evaluated a new approach that avoids cervical incisions by combining the EGIARADMT™ curvilinear stapling method with OrVil™-based three-dimensional suspension anastomosis (TriSAS) to achieve R0 resection. <b><i>Methods:</i></b> A retrospective analysis was performed on 11 consecutive cases of CTJ-ESCC treated between February 2019 and March 2024, with follow-up data available until February 2025. <b><i>Results:</i></b> All patients underwent R0 resection without cervical incisions, achieving a proximal margin of 1-4 cm. The median operative time was 350 minutes (range: 275-605) with a blood loss of 100 mL (range: 20-700). Lymphadenectomy resulted in a median of 21 nodes (range: 9-38) being retrieved. The median duration of hospitalization was 49 days (range: 42-67). There were no occurrences of anastomotic leaks, strictures, or recurrent laryngeal nerve injuries. Transient gastric stasis was observed in 18.2% of cases and resolved with conservative management. One postoperative mortality was attributed to pulmonary infection. The median overall and disease-free survival were 25 months. <b><i>Conclusion:</i></b> Integrating EGIARADMT curvilinear stapling with OrVil-TriSAS anastomosis enables cervical incision-free R0 resection for CTJ-ESCC, achieving precise oncologic control with functional preservation. Adjuvant therapy may further improve survival despite clear margins.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Nomogram for Predicting Lymph Node Metastasis in Incidental Gallbladder Cancer before Re-Resection.","authors":"Jingbin Wang, Yuanfang Sun, Yanhao Sun","doi":"10.1089/lap.2025.0081","DOIUrl":"https://doi.org/10.1089/lap.2025.0081","url":null,"abstract":"<p><p><b><i>Background:</i></b> Incidental gallbladder cancer (IGBC) is often diagnosed unexpectedly during or after cholecystectomy performed for presumed benign gallbladder disease. Accurate preoperative prediction of lymph node (LN) metastasis is critical for guiding surgical re-resection strategies but remains challenging. This study aimed to develop and validate a nomogram to predict LN metastasis in IGBC patients prior to re-resection. <b><i>Methods:</i></b> We retrospectively analyzed 745 IGBC patients who underwent re-resection between August 2019 and October 2024. Clinical data, including demographics, comorbidities, laboratory tests, imaging findings, and histopathological features, were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for LN metastasis. A nomogram was constructed based on these factors. The predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA). <b><i>Results:</i></b> Multivariate analysis identified tumor size > 1 cm, advanced T stage, poor differentiation, positive LN status on preoperative computed tomography imaging, and elevated serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 as independent predictors of LN metastasis. The nomogram demonstrated good discriminative ability, with an area under the ROC curve (AUC) of 0.827. Calibration plots showed good agreement between predicted probabilities and observed outcomes. DCA indicated the clinical usefulness of the nomogram. <b><i>Conclusions:</i></b> The nomogram based on preoperative clinical, imaging, and pathological factors provides an effective tool for predicting LN metastasis in IGBC patients before re-resection. It can assist clinicians in risk stratification and optimizing surgical strategies, potentially improving patient outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Resection of Esophageal and Gastroesophageal Junction Submucosal Tumors.","authors":"Mohammad Alomari, Daniel Knewitz, Rocio Castillo Larios, Jamii St Julien, Mathew Thomas, Enrique F Elli, Steven P Bowers","doi":"10.1089/lap.2025.0079","DOIUrl":"10.1089/lap.2025.0079","url":null,"abstract":"<p><p><b><i>Background:</i></b> Submucosal tumors (SMT) of the esophagus and gastroesophageal junction (GEJ) are rare entities, which often present a significant challenge to surgeons. Prior studies have reported only single-modality approaches. We report our experience with SMTs using multiple surgical techniques with the intent of margin-negative resection and organ preservation. <b><i>Methods:</i></b> Between 2001 and 2022, a total of 55 patients underwent surgical resection for SMT of the esophagus or GEJ at our institution. We reviewed the electronic medical records to obtain demographic information and details of the operation. We also report peri- and early (<30 days) postoperative outcomes. <b><i>Results:</i></b> Median age at operation was 62 years (22-93), and 54.5% were male. Endoscopic ultrasound was used in 45 (81.8%) patients preoperatively to classify tumors as possibly amenable for enucleation versus requiring mucosal resection. Forty-eight (87.3%) patients underwent minimally invasive procedures. Enucleation was performed in 23 (41.8%) patients, whereas 32 (58.2%) required full-thickness resection (wedge: 18; segmental: 11) or tumor resection with mucosectomy. One patient experienced Clavien-Dindo grade III or greater complications. There were no reoperations or postoperative mortality. Pathology revealed gastrointestinal stromal tumor in 25 (45.5%) patients, leiomyoma in 22 (40%), and other histology in 8 (14.5%). Negative surgical margins were achieved in 100% of the cases. Involvement of the cardia was associated with the need for full-thickness or tumor resection with mucosectomy (68.4% versus 31.5%, <i>P</i> = .0214). Surveillance was conducted in 20 (36.4%) patients with a median follow-up of 656 days (210-3091). One patient had progressive multifocal disease, and another went on to develop metastatic disease. <b><i>Conclusion:</i></b> Minimally invasive approaches are appropriate in most esophageal and GEJ SMTs and are associated with low complication rates and disease recurrence. Involvement of the gastric cardia increases the likelihood of requiring full-thickness resection or tumor resection with mucosectomy rather than enucleation.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"564-569"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Inguinal Hernia Repair for the New Robotic Surgeon-Safety and Early Outcomes in a Large Academic Medical Center.","authors":"Daniel Tagerman, Michelle Nessen, Diego L Lima, Ryan Chin, Nawaf Hindosh, Zachary Solomon, Xavier Pereira, Prashanth Sreeramoju, Flavio Malcher","doi":"10.1089/lap.2025.0051","DOIUrl":"10.1089/lap.2025.0051","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> This work evaluated outcomes of robotic inguinal hernia repair (RIHR) in a single-institution study comparing surgeons with varying robotic experience. <b><i>Methods:</i></b> A retrospective study of all patients with RIHR performed between July 2016 and September 2021 at a single institution was performed. Baseline characteristics and outcomes between surgeons with >5 years of robotic experience (ERS) were compared with those with <5 years (NRS). <b><i>Results:</i></b> A total of 297 cases of RIHR were performed. Mean age was 58.3 years (standard deviation [SD] 15.3) with a strong male predominance (88.2%). Forty-four patients (14.8%) had a previous repair, 87 (29.3%) underwent bilateral repair, and mean body mass index was 27.7 (SD 4.8). Sixty cases were performed by one ERS surgeon, and the remaining 237 cases were performed by eight NRS. ERS had more recurrent hernias (38.3% versus 8.9%, <i>P</i> < .001), previous abdominal surgery (48% versus 25%, <i>P</i> < .001), and more often had bilateral inguinal hernias (42% versus 26%, <i>P</i> = .018). Incarcerated hernias were more commonly repaired by ERS compared with NRS (35% versus 8.9%, <i>P</i> < .001). Mean operative time was higher for ERS (132.8 minutes versus 106.2, <i>P</i> < .001). ERS was associated with more intraoperative complications (10% versus 0%, <i>P</i> < .001) as well as 30-day complications (6.7% versus 1.7%, <i>P</i> = .033); however, these were of minimal clinical significance. While ERS had a higher rate of radiographical recurrence (6.7% versus 3.0%, <i>P</i> < .001) after 30 days, there was no difference in clinical concern for recurrence. <b><i>Conclusions:</i></b> While ERS may approach more complex situations, RIHR is a safe approach for both novice and experienced robotic surgeons.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"531-537"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracoscopic Stapling Ligation of H-Type Tracheo-Esophageal Fistula: A Viable and Safe Technique.","authors":"Omar Nasher, Anna Morandi, Steven S Rothenberg","doi":"10.1089/lap.2024.0391","DOIUrl":"10.1089/lap.2024.0391","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> H-type tracheo-esophageal fistula (TEF) is rare. Different techniques of fistula ligation are practiced around the world. The aim of this study is to report our experience of thoracoscopic stapling ligation and division of the TEF. <b><i>Methods:</i></b> Retrospective review of patients who underwent thoracoscopic ligation of H-type TEF from April 2016 to January 2024. The diagnosis was made with a preoperative esophagram and confirmed with intraoperative rigid bronchoscopy. The procedure was standardized and in all cases, a 5 mm laparoscopic stapler was used to ligate and divide the TEF. Demographics, operative details, and complications were collected and analyzed. <b><i>Results:</i></b> A total of 12 patients were included (7 males) during the 8-year study period. The median age at surgery was 2.5 months (IQR: 1-3), and the median gestational age at birth was 38 weeks (IQR: 35-39). The median weight was 4.8 kg (IQR: 3-5). One case was a redo surgery of a failed ligation by a different surgeon, and another had two previous endoscopic ablation attempts. The median operative time was 55 minutes (IQR: 45-79), and there were no conversions to thoracotomy. None of the patients experienced recurrence of the TEF, esophageal leak or stenosis, or recurrent laryngeal nerve injury. <b><i>Conclusion:</i></b> The thoracoscopy approach to H-type TEF is feasible and allows a clear visualization of the fistula and the surrounding anatomical structures. The use of a 5 mm laparoscopic stapler represents a superior, reproducible, and safe method of ligating the fistula with no reported complications in this series.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"574-577"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hidden Challenge: Hepatic Artery Variations and Their Impact on Laparoscopic Gastric Cancer Surgery Outcomes.","authors":"Selim Tamam, Mehmet Şah Benk, Serdar Çulcu, İsmail Can Tercan, Fırat Tekeş, Gökhan Gökten, Ezgi Altınsoy, Cengiz Ceylan, Ali Ekrem Ünal, Salim Demirci","doi":"10.1089/lap.2025.0061","DOIUrl":"10.1089/lap.2025.0061","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Few studies have evaluated the relationship between vascular anatomical variations and laparoscopic gastrectomy outcomes in patients with gastric cancer. In this study, we aimed to evaluate the effects of preoperatively detected hepatic artery variations on surgical outcomes in patients with gastric cancer undergoing laparoscopic radical gastrectomy. <b><i>Materials and Methods:</i></b> A retrospective analysis was conducted on the radiological, intraoperative, postoperative, and clinical data of 186 patients who underwent laparoscopic gastrectomy for gastric cancer. Patients were divided into two groups: those with variations and those without. The distinction between the two groups was determined by preoperative radiological imaging. The impact of these variations on perioperative and postoperative complications, as well as surgical outcomes, was subsequently evaluated. <b><i>Results:</i></b> Arterial variations were identified in 69 patients (37.1%). The most prevalent arterial variation was the aberrant left hepatic artery, observed in 25 patients (13.4%). In the cohort exhibiting arterial variations, operation time (<i>P</i> < .001; 203 minutes [195-220] versus 191 minutes [180-202]), intraoperative blood loss (<i>P</i> < .001; 100 mL [70-150] versus 50 mL [40-80]), and the total number of dissected lymph nodes (<i>P</i> = .006; 24 [20-34] versus 21 [17-29]) were found to be significantly higher, with statistically significant differences observed between the groups. <b><i>Conclusions:</i></b> A comprehensive evaluation of radiological imaging in patients prior to laparoscopic gastric cancer surgery, employing a multidisciplinary approach and preoperative identification of potential variations, has the potential to prevent complications and enhance surgical outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"550-556"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}