Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Incisional Hernia after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis of Incidence and Risk Factors.","authors":"Maria Fernanda Andrade da Silva, Maria Clara Morais, Gabriele Lech, Matheus Faleiro, João Kasakewitch, Victor Perim, Raquel Nogueira, Diego L Lima","doi":"10.1177/10926429261421860","DOIUrl":"10.1177/10926429261421860","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticoduodenectomy (PD) is a high-risk surgical procedure associated with significant postoperative morbidity. While complications such as pancreatic fistula and delayed gastric emptying are well-studied, the incidence and risk factors of incisional hernia (IH) following PD remain poorly characterized. This systematic review and meta-analysis aimed to evaluate the incidence of IH and identify associated risk factors in patients undergoing PD.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Embase, CENTRAL, and Web of Science databases from inception to December 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting IH incidence after PD were included. The primary outcome was the pooled incidence of IH. Secondary outcomes included risk factors associated with IH. A random-effects model was used for meta-analyses, and heterogeneity was assessed using <i>I</i>² statistics. Risk of bias was evaluated using the ROBINS-I tool.</p><p><strong>Results: </strong>A total of 6 studies comprising 1929 patients met inclusion criteria. The pooled incidence of IH following open PD was 6% (95% CI: 2%-15%), with substantial heterogeneity (<i>I</i>² = 94%). Risk factors significantly associated with IH included BMI ≥ 30 kg/m² (OR range: 1.67-2.6), preoperative hypoalbuminemia (OR 3.4; 95% CI: 1.2-9.4), chronic obstructive pulmonary disease (HR 24.4; 95% CI: 1.6-391.9), elevated preoperative CRP (HR 11.4; 95% CI: 1.2-103.1), postoperative fascial dehiscence (HR 14.1; 95% CI: 1.10-180.4), and wound infection (OR 2.9; 95% CI: 1.8-4.6). Sensitivity analyses confirmed the robustness of incidence estimates.</p><p><strong>Conclusion: </strong>IH is a relatively underrecognized yet significant complication following PD, with a pooled incidence of 6%. Several modifiable and non-modifiable risk factors contribute to its development. These findings underscore the need for targeted preventive strategies in high-risk patients and further research to inform surgical decision-making and postoperative care.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"737-743"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144559","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":"A Simplified Surgical Technique for Thoracoscopic Repair of Congenital Diaphragmatic Hernia.","authors":"Jiepin Wang, Yuting Zhang, Haozhong Xu, Junxiang Wang, Xiuliang Wang, Chi Zhang, Zhen Zheng, Dong Xiao","doi":"10.1177/10926429261449965","DOIUrl":"10.1177/10926429261449965","url":null,"abstract":"<p><strong>Introduction: </strong>The current surgical approaches for treating congenital diaphragmatic hernia (CDH) are challenging. Thoracoscopic transcutaneous closure of CDH is described, of which a retrospective study was conducted to investigate the safety and effectiveness.</p><p><strong>Materials and methods: </strong>In thoracoscopic transcutaneous closure, a thoracoscope and operating forceps are placed through two intercostal ports to expose the defect, followed by stepwise thoracic pressure elevation to facilitate herniated organ reduction. A fascial closure device is introduced through a small skin incision to encircle the diaphragmatic rim in two semicircular passes, and the suture is then tightened extracorporeally to close the defect.</p><p><strong>Results: </strong>Over a 8-year period, 33 TTC repairs were performed for CDH, including 31 Bochdalek and 2 Morgagni cases. Bochdalek repairs were completed in a mean operative time of 53.68 ± 45.81 minutes (range, 10-200 minutes), with a median age of 1 day and median weight of 3.25 kg. Among them, two patients experienced recurrence at 3 months and 7 months postoperatively. During hospitalization, four patients developed pneumothorax, and one patient developed chylothorax. The two Morgagni cases were repaired in 35 and 30 minutes at 5 and 6 months of age. Respiratory support was a median of 59 hours (range, 0-352 hours) in patients who required respiratory assistance, intensive care unit stay was a median of 15 days (range, 1-91 days) in patients admitted to the intensive care unit, and hospital stay was a median of 15 days (range, 2-91 days). All patients had uneventful wound healing without rib-development complications during follow-up.</p><p><strong>Conclusion: </strong>Thoracoscopic transcutaneous closure is a feasible and effective technique to treat CDH. While possessing the advantages of minimally invasive surgery, it shortens the operative time and learning curve.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"765-770"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845484","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":"Magnetic Sphincter Augmentation after Sleeve Gastrectomy: Reassessing Erosion Rates Beyond Misconceptions.","authors":"Alberto Aiolfi, Davide Bona, Francesco Cammarata, Luigi Bonavina","doi":"10.1177/10926429261452439","DOIUrl":"10.1177/10926429261452439","url":null,"abstract":"","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"758-759"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935097","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 Repair of Esophageal Atresia with Distal Tracheoesophageal Fistula: Is It Safe to Delay Surgery?","authors":"Ignacio Ibarra Rodríguez, José Andrés Molino Gahete, Sergio López Fernández, Marta Martos Rodríguez, Haider Ali Khan, César Wenceslao Ruiz, Karla Estefania, Elena Vilardell, Carmen Ribes, Gabriela Guillén","doi":"10.1177/10926429261450540","DOIUrl":"10.1177/10926429261450540","url":null,"abstract":"<p><strong>Aim of the study: </strong>Thoracoscopic repair of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is an increasingly adopted approach. However, it is a complex minimally invasive technique that should be performed by experienced surgeons under optimal conditions. This study aims to determine whether delaying surgery to ensure these conditions is safe.</p><p><strong>Methods: </strong>We conducted a retrospective observational study (2017 to 2024) analyzing historical cohorts of 41 neonates with EA and distal TEF who underwent thoracoscopic repair. Fifteen (36.5%) were operated on the first day of life (Group A), while 26 (63.5%) underwent delayed surgery (Group B). Baseline characteristics, preoperative and intraoperative morbidity and mortality, and follow-up outcomes were analyzed.</p><p><strong>Results: </strong>There were no significant differences in sex, gestational age, birth weight, or associated anomalies, including anorectal malformation. Group B neonates underwent surgery at 2.38 ± 0.76 days of life. No preoperative respiratory infections or need for emergency surgery were reported, and there were no significant differences in atelectasis (6.6% versus 11%), respiratory distress (40% versus 34%), or intubation requirement (13% versus 19%). Intraoperatively, conversion rates (6.6% versus 7.6%) and desaturation events (20% versus 19%) were comparable. Postoperatively, no differences were found in intubation days (3.3 versus 3.37), infections (6.6% versus 11.5%), atelectasis (13.3% versus 19.2%), or follow-up complications (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>Delaying the repair of EA with distal TEF is safe, allowing thoracoscopic surgery to be performed by experienced surgeons under optimal conditions without increasing morbidity due to the wait.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"760-764"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018575","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":"Avoiding the Umbilical Incision in Obese Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Cohort Study of Wound-Related Outcomes.","authors":"Yasunori Uesato, Susumu Inamine","doi":"10.1177/10926429261445558","DOIUrl":"10.1177/10926429261445558","url":null,"abstract":"<p><strong>Background: </strong>The umbilical port is routinely used for camera insertion and specimen retrieval in laparoscopic cholecystectomy (LC). However, the umbilicus is anatomically vulnerable and may be associated with an increased risk of surgical site infection (SSI) and port-site hernia (PSH), particularly in obese patients. We evaluated the clinical impact of avoiding an umbilical incision in obese patients undergoing LC.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 75 patients with a body mass index (BMI) ≥ 32 who underwent LC between April 2019 and November 2025. Patients were divided into an umbilical incision group (<i>n</i> = 46) and a nonumbilical incision group (<i>n</i> = 29). The primary endpoint was overall postoperative complications (Clavien-Dindo grade ≥ II) within 6 months. Absolute risk differences and corrected odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>Postoperative complications occurred in six patients (12.8%) in the umbilical incision group and in none (0%) in the nonumbilical incision group (<i>P</i> = .076). Although the difference did not reach statistical significance, all observed complications occurred in the umbilical incision group. The absolute risk difference was 13.0% (95% CI 3.3%-22.8%). After Haldane-Anscombe correction, the estimated OR for complications associated with the umbilical incision approach was 9.47 (95% CI 0.51-174.76). All complications were wound-related (four SSIs and two PSHs). Operative time, blood loss, and postoperative hospital stay were significantly lower in the nonumbilical incision group. All outcome measures consistently favored the nonumbilical approach.</p><p><strong>Conclusions: </strong>Although statistical significance was not reached, all wound-related complications occurred exclusively in the umbilical incision group. Avoiding an umbilical incision in obese patients undergoing LC may represent a clinically reasonable strategy associated with a potential reduction in wound-related morbidity. Larger prospective studies are warranted.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"714-719"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822401","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":"Feasibility of Small Bowel Length Shortening with Sleeve Gastrectomy for Metabolic and Nutritional Complications After RYGB.","authors":"Chih-Kun Huang, Herson Sadian, Ming-Che Hsin, Long-Bin Jeng, Po-Chih Chang, Ting-Wei Chang","doi":"10.1177/10926429261442508","DOIUrl":"10.1177/10926429261442508","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic and nutritional complications-including intractable dumping syndrome (DS), gastroesophageal reflux disease (GERD), anemia, and weight recurrence-may develop long after Roux-en-Y gastric bypass (RYGB). Current revisional options, such as reversal or distalization, can be technically demanding and may worsen malabsorption. Restoring gastric continuity and pyloric function may offer physiological benefits. This study evaluated the feasibility and early outcomes of small bowel length optimization and shortening with sleeve gastrectomy (BOS-SG) as a revisional strategy after RYGB.</p><p><strong>Methods and procedures: </strong>This retrospective analysis included 8 consecutive female patients who underwent BOS-SG, with or without hiatal hernia repair, between 2018 and 2023 at a tertiary center. Indications were refractory DS, GERD, anemia unresponsive to medical therapy, and weight recurrence. A standardized multidisciplinary and endoscopic evaluation was performed preoperatively. Perioperative parameters and postoperative clinical outcomes were reviewed.</p><p><strong>Results: </strong>All procedures were completed laparoscopically without conversion. The mean operative time was 168 minutes, and the mean hospital stay was 5 days. Compared with pre-revision status, patients achieved a mean weight loss of 6.7 kg, corresponding to 7.9% total weight loss and 39.9% excess weight loss. DS resolved in all patients. GERD improved in 60% of symptomatic patients, and 60% of those with anemia normalized hemoglobin. Two patients (25%) required reoperation, 1 for recurrent hiatal hernia, and 1 for an anastomotic leak, both managed laparoscopically with good recovery.</p><p><strong>Conclusion: </strong>BOS-SG appears feasible and may provide physiological advantages through restoration of gastric continuity and pyloric function in selected patients with post-RYGB metabolic or nutritional complications. Larger prospective studies are needed to validate these early findings.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"751-757"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634778","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":"Clear Surgical Margins in Robotic Versus Laparoscopic Total Mesorectal Excision: An ACS-NSQIP Analysis.","authors":"Rodrigo Moisés de Almeida Leite, Rocco Ricciardi, Silvio Siqueira, Luiz Eduardo Ceccon Calil de Assumpção, Luiz Felipe Berthier Jacomino, Sergio Eduardo Alonso Araujo","doi":"10.1177/10926429261433467","DOIUrl":"10.1177/10926429261433467","url":null,"abstract":"<p><strong>Introduction: </strong>Whether the robotic approach in total mesorectal excision (TME) is associated with increased clear radial and distal margins, compared to the laparoscopic approach, is yet to be determined.</p><p><strong>Methods: </strong>We analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant user files for all elective rectal cancer cases performed with minimally invasive surgical techniques (robotic and laparoscopic). Natural orifice, single incisional, and transanal approaches were excluded from the analysis. We calculated relative risks (RR) through Poisson regression models after adjusting for age, body mass index, American Society of Anesthesiologists scores, pathologic T and N status, locations of tumor (low, middle, or high in rectum), neoadjuvant therapy, and surgical specialty.</p><p><strong>Outcomes: </strong>Our primary outcome was the result of both radial and distal clear surgical margins upon pathologic analysis. Secondary outcomes included distance of clear distal margins and number of harvested lymph nodes.</p><p><strong>Results: </strong>Our cohort consisted of 1321 robotic cases and 2039 laparoscopic cases. There were no significant differences in demographics or tumor staging across groups, except a higher proportion of low rectal cancer in the robotic cohort. The robotic approach was associated with improved radial and distal clear margins in pathological analysis (adjusted RR: 1.06, 95% CI: [1.03-1.10], <i>P</i> < .001). There was a nonsignificant trend toward longer clear distal margin in the robotic cohort. No difference was observed in lymph node harvesting.</p><p><strong>Limitations: </strong>As a retrospective and nonrandomized study, residual bias and confounding variables are likely to exist. Relevant information such as mesorectal fascia involvement in clinical preoperative staging could also limit the findings.</p><p><strong>Conclusions: </strong>Robotic TME is associated with a higher likelihood of clear surgical margins when compared to laparoscopy.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"727-730"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822772","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":"Surgical Options for Refractory Anastomotic Ulcer after Roux-en-Y Gastric Bypass: A Narrative Review of the Literature.","authors":"Patrick Noel, Christophe Cazeres, Rami Edward Lutfi, David Nocca, Thierry Manos, Marcelo Loureiro, Mariano Palermo, Moises Jacobs, Jaime Ponce","doi":"10.1177/10926429261440860","DOIUrl":"10.1177/10926429261440860","url":null,"abstract":"<p><strong>Background: </strong>Marginal ulcer (MU) is a well-recognized complication following Roux-en-Y gastric bypass (RYGB), with a reported prevalence of 0.6%-16%. While most ulcers respond to medical therapy with proton pump inhibitors and risk factor modification, a subset of patients develop refractory ulcers requiring surgical intervention. Despite this clinical challenge, there remains no consensus on the optimal surgical approach for refractory MU.</p><p><strong>Methods: </strong>We performed a narrative review of the literature using PubMed, MEDLINE, and Google Scholar databases from January 2000 to December 2024. Search terms included <i>marginal ulcer, anastomotic ulcer, gastric bypass, refractory ulcer, surgical treatment, vagotomy,</i> and <i>revisional surgery.</i> We focused on studies reporting surgical outcomes for refractory MU after RYGB.</p><p><strong>Results: </strong>Current surgical options include (1) gastrojejunostomy revision with or without pouch reduction, (2) truncal vagotomy (laparoscopic or thoracoscopic), (3) subtotal or total gastrectomy with esophagojejunostomy, (4) gastric remnant resection, and (5) RYGB reversal with or without conversion to sleeve gastrectomy. Reported success rates vary from 36% to 100% depending on technique and follow-up duration. Recurrence rates remain concerning, ranging from 15% to 57% at 1 year. Risk factors for recurrence include persistent smoking (HR: 5.03), immunosuppression (HR: 4.60), and Nonsteroidal anti-inflammatory drug (NSAID) use (HR: 3.11). Emerging endoscopic approaches, including suturing and stent deployment, show promise as step-up therapy before surgical revision.</p><p><strong>Conclusions: </strong>The management of refractory MU after RYGB remains challenging with no single optimal surgical approach. Treatment should be individualized based on ulcer characteristics, the presence of associated complications (gastrogastric fistula and stricture), and patient risk factors. A stepwise algorithm incorporating endoscopic therapy, gastrojejunostomy revision, and salvage procedures is proposed.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"731-736"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624243","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":"Laparoscopic Intraperitoneal Onlay Mesh Repair for Non-Midline Incisional Hernias: A Single-Center Clinical Study.","authors":"Xiangcheng Wang, Shenlan Li, Changjin Cui, Bo Li","doi":"10.1177/10926429261433140","DOIUrl":"10.1177/10926429261433140","url":null,"abstract":"<p><strong>Purpose: </strong>Non-midline incisional hernias are technically challenging abdominal wall defects, and evidence of laparoscopic intraperitoneal onlay mesh (IPOM) in this setting is limited. This study evaluated the safety and efficacy of laparoscopic IPOM for non-midline incisional hernias and assessed the impact of different defect closure techniques on perioperative outcomes.</p><p><strong>Methods: </strong>This single-center retrospective study included patients who underwent laparoscopic IPOM repair for non-midline incisional hernias between September 2019 and June 2025. Demographics, body mass index, comorbidities, hernia classification, defect size and area, closure technique, operative time, blood loss, postoperative length of stay, 24-hour pain scores, complications, and recurrence were recorded. Comparisons among the closure groups were performed using the Kruskal-Wallis test.</p><p><strong>Results: </strong>A total of 43 patients were included. The mean defect area was 57.15 ± 53.12 cm², operative time was 133.51 ± 40.68 minutes, intraoperative blood loss was 20.65 ± 11.42 mL, and postoperative hospital stay was 5.79 ± 2.45 days. Overall complication rate was 7.0%, including 1 case each of chronic pain, seroma, and ileus, and recurrence occurred in 1 patient. Barbed suture, hernia needle, and combined closure techniques were used in 10, 16, and 17 patients, respectively. The combined group had larger defects and longer operative times, whereas blood loss, hospital stay, and 24-hour pain scores were comparable among the groups.</p><p><strong>Conclusions: </strong>Laparoscopic IPOM is a safe and effective option for non-midline incisional hernias, achieving low complication and recurrence rates. A combined closure technique is suitable for larger defects, increasing operative time without worsening early perioperative outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"744-750"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505330","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":"Reduced-Port Laparoscopic Cholecystectomy Using a Port-Free Organ Retractor: A Comparative Study with Conventional Four-Port Technique.","authors":"Nao Yoshida, Yukiyasu Okamura, Shu Inagaki, Masataka Shindate, Shunsuke Yamagishi, Takaharu Kawai, Hayato Abe, Yusuke Mitsuka, Yasuhiro Okumura, Osamu Aramaki, Kosuke Narumiya","doi":"10.1177/10926429261440385","DOIUrl":"10.1177/10926429261440385","url":null,"abstract":"<p><strong>Background: </strong>Reduced-port surgery can eliminate the need for a skilled surgical assistant and enable solo surgery with a nonsurgeon camera assistant, potentially addressing surgeon shortages. However, single-incision laparoscopic cholecystectomy has limitations, including instrument collision and prolonged operative time. This study evaluated free jaw (FJ) clip-assisted reduced-port laparoscopic cholecystectomy (RPLC) as a solo-surgery technique.</p><p><strong>Methods: </strong>Between January 2022 and December 2025, 14 patients underwent FJ clip-assisted RPLC (three-incision, <i>n</i> = 6; two-incision, <i>n</i> = 8) performed by a single surgeon with a camera assistant who did not manipulate instruments, and 25 patients underwent four-port conventional laparoscopic cholecystectomy (CLC). The primary outcomes were operative time and the learning curve. The secondary outcomes included blood loss, complications, and postoperative hospital stay. The learning curve was evaluated using cumulative sum (CUSUM) analysis.</p><p><strong>Results: </strong>The CUSUM analysis demonstrated a turning point at case 6, indicating completion of the learning curve. The median operative times were comparable between the RPLC and CLC groups (85.5 versus 90.0 minutes, <i>P</i> = .121). Estimated blood loss was significantly lower in the RPLC group (1 versus 5 mL, <i>P</i> = .013). No complications related to intercostal puncture or FJ clip-induced gallbladder damage were observed. No postoperative complications (Clavien-Dindo ≥II) were observed in either group.</p><p><strong>Conclusions: </strong>FJ clip-assisted RPLC is a feasible solo-surgery technique with a short learning curve. This technique achieved safety comparable to CLC with minimal additional cost, potentially addressing surgeon shortages while maintaining surgical quality.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"720-726"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629104","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}