Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Effectiveness of Enhanced Recovery After Surgery Protocols for Robot Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis.","authors":"Joshua Bruinsma, Nicholas A Clausen, Rostyslav Nikolenko, Hugo C Temperley, Wanyang Qian, Benjamin M Mac Curtain","doi":"10.1177/10926429261468581","DOIUrl":"10.1177/10926429261468581","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocols aim to improve perioperative outcomes through evidence-based, multimodal care pathways. While ERAS is well established in radical cystectomy, its role in robotic-assisted radical prostatectomy (RARP) remains less clearly defined. This systematic review and meta-analysis evaluates the safety and efficacy of ERAS protocols in patients undergoing RARP.</p><p><strong>Methods: </strong>A systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing ERAS or modified ERAS protocols with standard care in patients undergoing RARP were included. Outcomes assessed included length of stay (LOS), return of bowel function, operative time, estimated blood loss, and postoperative complications. A random-effects meta-analysis was performed using Stata 18, with results reported as Hedges' g standardized mean differences and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Seven studies comprising 1314 patients (615 ERAS, 699 standard care) met inclusion criteria. ERAS protocols were associated with a statistically significant reduction in LOS (mean 5.98 versus 7.45 days, Hedges' g -0.68; 95% CI: -1.21 to -0.15). ERAS also showed an earlier return of gastrointestinal function: time to flatus (mean 1.66 versus 2.03 days, Hedges' g -0.60; 95% CI: -0.91 to -0.30) and time to defecation (mean 2.68 versus 3.13 days, Hedges' g -0.43; 95% CI: -0.61 to -0.24). No significant differences were observed in complication rates, operative time, or blood loss.</p><p><strong>Conclusions: </strong>ERAS protocols in RARP are associated with improved short-term postoperative recovery, particularly gastrointestinal function. However, the clinical impact on LOS may be modest in contemporary practice, where early discharge is increasingly routine, particularly with the adoption of single-port surgery. Future studies should focus on identifying high-yield ERAS components and evaluating their role in higher-risk patient populations who may derive greater benefit from structured perioperative optimization.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"786-794"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413549","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":"Artificial Intelligence Applications in General Surgery in the United States of America: A Bibliometric Analysis.","authors":"Clara Avelar Mendes de Vasconcellos, Elisa Guimarães Forchezatto, Gabriela Lyons, Thiago Souza E Silva, Raquel Nogueira, Flavio Malcher, Leandro Totti Cavazzola, Diego Laurentino Lima","doi":"10.1177/10926429261449958","DOIUrl":"10.1177/10926429261449958","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is rapidly transforming surgical practice, with applications spanning preoperative planning, intraoperative guidance, postoperative management, and surgical education. Despite accelerating research activity, the structure, thematic evolution, and funding landscape of AI research in general surgery remain incompletely characterized. This study aimed to systematically evaluate scientific production on AI in general surgery in the United States over the past 5 years using a bibliometric approach.</p><p><strong>Methods: </strong>A bibliometric analysis was conducted following Preliminary Guideline for Reporting Bibliometric Reviews of the Biomedical Literature and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using Web of Science. English-language articles published between 2020 and 2025 with a U.S.-affiliated senior author and focused on AI use in general surgery were included. Publications were analyzed across five primary domains: authorship metrics, thematic endpoints, journal characteristics, country of origin, and funding patterns. Bibliometric indicators included H-index, citation counts, Article Influence Score (AIS), and Bradford's Law classification. Funding distribution across endpoints was evaluated using chi-square or Fisher's exact tests, with effect sizes estimated using Cramér's V and odds ratios. Temporal trends in endpoints and keywords were assessed using Poisson and negative binomial regression models.</p><p><strong>Results: </strong>Fifty-nine studies met inclusion criteria, comprising 20 reviews and 39 original investigations. Scientific production increased consistently from one study in 2019 to 17 in 2023 and 16 in 2024, demonstrating sustained growth. Surgical workflow recognition (<i>n</i> = 19) and clinical decision support (<i>n</i> = 18) were the predominant research domains, representing 63% of the included literature. Temporal analysis demonstrated significant annual growth in reviews (Incidence rate ratios [IRR] 2.09, <i>P</i> = .002) and workflow-focused studies (IRR 1.37, <i>P</i> = .031). Keyword analysis revealed sustained prominence of AI and machine learning, with limited emergence of new thematic directions. Most studies reported no funding (57.6%). Although overall funding distribution did not significantly differ across application categories (<i>P</i> = .846), clinically actionable AI applications were significantly more likely to receive funding compared with other research areas (OR 4.0, 95% CI 1.22-13.13; <i>P</i> = .029).</p><p><strong>Conclusion: </strong>AI research in U.S. general surgery is growing but remains concentrated in workflow and decision-support domains. Funding favors clinically actionable applications, highlighting the need for broader, equity-focused AI development.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"795-810"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857466","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":"Safety and Feasibility of Sleeve Gastrectomy Conversion to Roux-en-Y Gastric Bypass Versus Single Anastomosis Duodeno-Ileal Bypass: An MBSAQIP Analysis.","authors":"Yeisson Rivero-Moreno, Arturo Estrada, Valentina Viscarret, Erin Moran-Atkin, Jenny Choi, Diego Camacho","doi":"10.1177/10926429261458534","DOIUrl":"10.1177/10926429261458534","url":null,"abstract":"<p><strong>Background: </strong>Sleeve gastrectomy (SG) has become the most common bariatric procedure worldwide. Unfortunately, a significant number of patients require conversion to Roux-en-Y gastric bypass (RYGB) or single-anastomosis duodeno-ileal bypass (SADI) because of recurrent weight gain. This study aimed to determine the rates of complications and mortality associated with conversion from SG to RYGB (SG-RYGB) compared with conversion from SG to SADI (SG-SADI).</p><p><strong>Methods: </strong>This retrospective analysis used data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database from 2020 to 2022. Patients undergoing SG-RYGB or SG-SADI were included. Thirty-day operative outcomes, intraoperative and postoperative events, and mortality were analyzed.</p><p><strong>Results: </strong>A total of 28,758 patients were included. Of these, 27,412 (95.3%) underwent SG-RYGB and 1346 (4.6%) underwent SG-SADI. The mean preoperative body mass index was 39.7 kg/m² for SG-RYGB and 45.3 kg/m² for SG-SADI (<i>P</i> < .001). SG-RYGB was associated with a higher frequency of intraoperative/postoperative complications within the first 30 days (5.9% versus 3.4%, <i>P</i> < .001), including transfusion (1.3% versus 0.4%, <i>P</i> = .004), readmission (7.3% versus 4.6%, <i>P</i> < .001), and emergency department visits (12.5% versus 8.5%, <i>P</i> < .001). Although SG-SADI was associated with a higher rate of anastomotic leak (0.4% versus 1.1%, <i>P</i> < .001), there was no difference in reoperation rates (2.8% versus 2.5%) or deaths (0.02% versus 0%). Overall, SG-SADI-S was associated with a lower risk of intraoperative/postoperative complications, with an adjusted odds ratio of 0.741 (95% confidence interval: 0.543-0.901, <i>P</i> = .041).</p><p><strong>Conclusions: </strong>Both revisional procedures are safe. Although SG-RYGB was associated with a higher frequency of intraoperative/postoperative complications within the first 30 days, SG-SADI had a higher rate of anastomotic leaks, with no difference in reoperation rates or deaths.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"834-839"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206696","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":"Comparison of Transabdominal Preperitoneal and Totally Extraperitoneal Repair in Laparoscopic Inguinal Hernia: A Randomized, Clinical Trial on Postoperative Complications, Pain, and Functional Recovery.","authors":"Amin Khayreddine Ghouali, Fouad Benamara, Loubna Bouhmama, Khadija Larabi, Elhassen Ahmed Lachachi, Smain Nabil Mesli, Chakib Mohammed Abi-Ayad","doi":"10.1177/10926429261450400","DOIUrl":"10.1177/10926429261450400","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic repair is recommended for inguinal hernia because it is associated with reduced postoperative pain and faster recovery compared with open repair. However, the choice between transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques remains controversial.</p><p><strong>Methods: </strong>A prospective randomized, clinical trial was conducted between November 2021 and June 2025. Adult male patients with unilateral uncomplicated inguinal hernias were included. Patients were randomized in a 1:1 ratio to undergo TAPP or TEP repair. The primary endpoint was 30-day postoperative complications graded according to the Clavien-Dindo classification. Secondary endpoints included chronic pain, functional recovery, and recurrence.</p><p><strong>Results: </strong>A total of 144 patients were included and randomized, with 72 patients in each group. Briefly, 30-day postoperative complications were significantly more frequent after TAPP than TEP (19.4% versus 6.9%, <i>P</i> = .024). Most complications were minor (Grades I-II), and three Grade IIIa events required percutaneous aspiration. Chronic pain at 3 months was observed in 5.6% of patients after TAPP and 1.4% after TEP (<i>P</i> = .181). Time to return to normal activity did not differ significantly between groups. After a median follow-up of 26 months, the recurrence rate was 2.8% in both groups.</p><p><strong>Conclusion: </strong>TEP was associated with significantly lower short-term postoperative complications and shorter hospital stays, while long-term outcomes were comparable between techniques.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"811-818"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857476","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":"Esophagogastric Dysfunction and Recurrent Symptoms in Neurologically Impaired Children with an Intact Nissen Fundoplication.","authors":"Carlos García-Hernández, Carlos Aguilar-Gutiérrez, Diego Leonardo Herrera-Ojeda, Lourdes Carvajal-Figueroa","doi":"10.1177/10926429261460678","DOIUrl":"10.1177/10926429261460678","url":null,"abstract":"<p><strong>Background: </strong>Neurologically impaired children frequently experience recurrent gastroesophageal reflux symptoms after laparoscopic Nissen fundoplication, even when the fundoplication remains anatomically intact. Esophagogastric dysfunction may contribute to these recurrences but is often underrecognized.</p><p><strong>Aim: </strong>To analyze the causes of recurrent gastroesophageal reflux symptoms in neurologically impaired children with an intact Nissen fundoplication attributable to esophagogastric dysfunction and to describe their management and outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive study of neurologically impaired children who underwent laparoscopic Nissen fundoplication between 2010 and 2025 and subsequently developed recurrent gastroesophageal reflux-related symptoms. All patients were evaluated with contrast upper gastrointestinal studies and upper gastrointestinal endoscopy; gastric emptying scintigraphy was performed when gastric atony was suspected. Demographic data, neurological diagnosis, Gross Motor Function Classification System level, nutritional status, symptoms, time to recurrence, imaging findings, treatment, and follow-up were recorded.</p><p><strong>Results: </strong>A total of 124 children were included (96 with cerebral palsy, 18 with traumatic brain injury, and 10 with brain tumors). At 36-month follow-up, 82 patients achieved complete symptom remission. Forty-two children, all with cerebral palsy, developed recurrent symptoms between 10 and 48 months after surgery. Recurrence was due to paraesophageal hernia in 15 patients, all of whom underwent successful laparoscopic redo fundoplication. The remaining 27 children had an anatomically intact fundoplication: 10 presented bile reflux with duodenitis and improved with medical management, and 17 had gastric, pyloric, or duodenal dysfunction requiring laparoscopic pyloroplasty, esophagogastric disconnection, or gastrojejunostomy, with subsequent resolution of symptoms.</p><p><strong>Conclusions: </strong>In neurologically impaired children, esophagogastric dysfunction unrelated to wrap failure is a frequent and surgically treatable cause of recurrent symptoms after Nissen fundoplication.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"844-848"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229032","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 Inguinal Hernia Repair in Pediatric Female Patients Using Cautery and Endoloops: Description of Technique and Outcomes.","authors":"Hayle Noh, Hanan Alansari, Daniel Briatico, Serena Wei, J Mark Walton, Michael H Livingston","doi":"10.1177/10926429261460676","DOIUrl":"10.1177/10926429261460676","url":null,"abstract":"<p><strong>Purpose: </strong>Multiple techniques have been described for laparoscopic inguinal hernia repair in children. The purpose of this study was to describe our experience using cautery and Endoloops in pediatric female patients.</p><p><strong>Methods: </strong>We conducted a retrospective review of pediatric female patients who underwent laparoscopic inguinal hernia repair using cautery and Endoloops at our center. This technique involves establishing laparoscopic access through the umbilicus, everting and cauterizing the hernia sac with a Maryland dissector, and placing two PDS Endoloops at the level of the internal ring. Outcomes included operative time and complications.</p><p><strong>Results: </strong>We identified 50 female patients (mean age 5.6 years, range 2 months to 17 years) who underwent laparoscopic inguinal hernia repair using cautery and Endoloops from January 2015 to March 2024. The indication for surgery in most patients was a clinical hernia (<i>n</i> = 43/50). One of these was incarcerated and another was a recurrent hernia. Seven other patients underwent ligation of an incidental patent processus vaginalis during laparoscopic appendectomy (<i>n</i> = 4), laparoscopic ovarian detorsion (<i>n</i> = 2), or diagnostic laparoscopy for possible Meckel's diverticulum (<i>n</i> = 1). Median operative time was 30 minutes for unilateral inguinal hernias (<i>n</i> = 26/43) and 33 minutes for bilateral (<i>n</i> = 17/43). None experienced conversion to open procedure, surgical site infection, or recurrence.</p><p><strong>Conclusion: </strong>We conclude that laparoscopic inguinal hernia repair using cautery and Endoloops is safe and effective in pediatric female patients. This technique does not require specialized skills, training, or equipment. We have used this approach for primary repair of clinical hernia, incarcerated hernia, recurrent hernia, and incidental patent processus vaginalis.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"849-853"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260382","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":"Brain Neuromodulation via Endoscopic Gastric Implant Improves Glycemic Control in Insulin-Dependent Type-2 Diabetes: First-in-Human Feasibility and Autonomic Response Study.","authors":"Valerio Cigaina, Alfredo Saggioro, Paolo Fabris, Luigi Bonavina","doi":"10.1177/10926429261468981","DOIUrl":"10.1177/10926429261468981","url":null,"abstract":"<p><strong>Background: </strong>A miniaturized, self-powered Brain NeuroModulator (BNM) device, endoscopically implanted under neuroleptanalgesia in the submucosal layer of the proximal lesser gastric curvature, has the potential to consistently increase parasympathetic tone as measured by heart rate variability (HRV).</p><p><strong>Objective: </strong>Since type-2 diabetes mellitus is associated with autonomic nervous system dysfunction, we assessed whether BNM induced autonomic rebalancing translates into measurable improvement of glycemic control through a change of HRV.</p><p><strong>Methods: </strong>The BNM device was implanted on a 69-year-old male with a 25-year history of insulin-dependent type-2 diabetes mellitus under treatment with 22 IU/night of insulin plus semaglutide and metformin. HRV was assessed before and after the procedure. After the implant, continuous glucose monitoring (CGM) with an Abbott FreeStyle Libre sensor (15-minute sampling interval) was performed.</p><p><strong>Results: </strong>The endoscopic procedure was uneventful and lasted 15 minutes. The BNM device remained in a stable position throughout the observation period. HRV analysis confirmed increased variability. Post-implant morning HRV showed progressive parasympathetic recovery compared with baseline. Within 2 months of implantation, therapy with semaglutide and metformin was discontinued, and insulin was progressively reduced from 22 to 0 IU.</p><p><strong>Conclusions: </strong>The BNM implant was feasible and safe, with clinically meaningful improvement in glycemic control associated with autonomic rebalancing within approximately 10 weeks of implantation. These data provide compelling preliminary evidence that correcting sympathetic dominance through vagal afferent stimulation may alter the clinical course of insulin-dependent type 2 diabetes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"777-785"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406733","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":"Staple Line Suturing in Sleeve Gastrectomy: Its Effect on Resistance to Leakage and Leakage Localization.","authors":"Gizem Fırtına, Onur İlhan, Emre Gönüllü, Adem Yüksel, Kerem Karaman","doi":"10.1177/10926429261452421","DOIUrl":"10.1177/10926429261452421","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric surgery method worldwide. However, it includes the longest staple line (SL), remaining the major source of complications, with leak rates of 0.7% up to 5.7%. Because leaks occur just below the esophagogastric junction in up to 90% of cases, SL reinforcement is widely used, though its effect on failure locations remains insufficiently characterized.</p><p><strong>Method: </strong>This <i>ex vivo</i> study evaluated whether SL reinforcement affects mechanical resistance and leak localization. Sixty human LSG specimens (20/group) from routine resections were randomized to oversewing (Group 1), through-through suturing (Group 2), or no reinforcement (Group 3), using 3/0 polypropylene. Specimens were tested within 40 minutes by intraluminal insufflation via Veres needle and manometer while submerged; burst pressure and leak site were recorded.</p><p><strong>Results: </strong>Baseline characteristics were comparable across groups (<i>P</i> > .05). Leaks occurred distally in 70% and proximally in 30% of specimens. Reinforcement affected leak topography (<i>P</i> = .011): Distal leaks predominated in Groups 1 (85%) and 2 (80%), while Group 3 concentrated proximally (55%). Burst pressure differed significantly (<i>P</i> = .001): Highest with oversewing (mean 116.84 ± 16.35; median 120 [110-130] mm Hg), intermediate with through-through sutures (78.52 ± 14.27; median 80 [65-90] mm Hg), and lowest without reinforcement (41.00 ± 9.26; median 40 [30-50] mm Hg).</p><p><strong>Conclusion: </strong>Oversewing provides the greatest pressure safety window and shifts failure from the high-risk proximal region to distal SL, suggesting reinforcement strategies should anticipate distalized leak patterns, while <i>in vivo</i> validation remains necessary.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"828-833"},"PeriodicalIF":1.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037192","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-Assisted Removal of Gastric Bezoars in Children: Feasibility and Technical Evolution in a Case Series.","authors":"Fabrizio Vatta, Rani Kassir, Alessandra Rancan, Marianna Gortan, Carmen Capito, Thomas Blanc","doi":"10.1177/10926429261497068","DOIUrl":"https://doi.org/10.1177/10926429261497068","url":null,"abstract":"<p><strong>Purpose: </strong>Gastric bezoars are rare entities usually affecting young girls, frequently associated with underlying psychological disorders. Although open gastrotomy has historically been the gold-standard treatment, minimally invasive techniques are increasingly being used. This study aimed to evaluate the feasibility and outcomes of robotic-assisted laparoscopic removal of gastric bezoars in pediatrics, with particular attention to trocar configuration strategies.</p><p><strong>Methods: </strong>Retrospective monocentric study between 2015 and 2025. Four girls underwent robotic surgery using the Da Vinci Xi^® platform. In the first two, trocars were positioned along the transumbilical plane. In the last two cases, trocars configuration was changed, consisting of a transumbilical camera port followed by placement of three additional 8-mm robotic trocars along the Pfannenstiel line. Surgical management consisted of gastrotomy and bezoar extraction using an endobag through a Pfannenstiel incision.</p><p><strong>Results: </strong>Median age was 10.9 years (IQR: 8-12), with a median weight of 38 kg (IQR: 34-43). All bezoars were gastric, with in one an associated jejunal extension. Median operative time was 282 minutes (IQR: 210-318). No intraoperative complications occurred. One patient developed a postoperative sub-occlusion managed medically. Median hospital stay was 5.5 days (IQR: 4.5-7.5). At a median follow-up of 3 years, all patients remained asymptomatic. The suprapubic trocar configuration provided satisfactory exposure and allowed extraction through concealed incisions.</p><p><strong>Conclusion: </strong>Robotic-assisted laparoscopic management of gastric bezoars appears feasible and safe. Given the frequent psychological vulnerability of the patients affected, reducing visible scarring may represent an additional advantage over conventional laparotomy or standard robotic approaches.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261497068"},"PeriodicalIF":1.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167235","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":"Tumor Biology and Surgical Margin Patterns in Colorectal Liver Metastases: Association Between KRAS/BRAF Status and Type of Resection <i>Margin-BRAF-KRAS LiverMet Collaborative Group</i>.","authors":"Cecilia Ferrari, Gian Mario D'Ambrosio, Victor Molina, Simone Famularo, Flavio Milana, Renato Patrone, Nadia Russolillo, Laura Alaimo, Ignacio Roldán-Ortiz, Nicola Nocchi, Charles-Henri Wassmer, Sofia De la Serna, Alejandra García-Botella, Federico Mocchegiani, Silvia Bitto, Mattia Garancini, Fabrizio Romano, Luis Filipe Abreu de Carvalho, Frederik Berrevoet, Riccardo Aurelio Nasto, Guido Fallani, Matteo Serenari, Antonella Delvecchio, Valentina Valle, Mohamad Halloum, Pier Cristoforo Giulianotti, Riccardo Memeo, Matteo Cescon, Roberto Troisi, Kjell De Winter, Cristina Ciulli, Paola Tarchi, Marco Vivarelli, Luis Ignacio Díez Valladares, Christian Toso, Antonio Taddei, Mario Serradilla-Martín, Andrea Ruzzenente, Alessandro Ferrero, Francesco Izzo, Guido Torzilli, Antonio Moral Duarte, Santiago Sánchez Cabús","doi":"10.1177/10926429261497618","DOIUrl":"https://doi.org/10.1177/10926429261497618","url":null,"abstract":"<p><strong>Background: </strong>Surgical strategies for colorectal liver metastases (CRLM) have progressively evolved toward parenchyma-sparing approaches, increasing the relevance of understanding the relationship between tumor biology and resection margin patterns. In parallel, KRAS and BRAF mutations have emerged as key determinants of tumor behavior in CRLM. The interaction between mutational status and surgical margin type, however, remains insufficiently characterized.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients undergoing curative-intent liver resection for CRLM between 2016 and 2021 across 17 international HPB centers. Clinicopathological variables were compared according to mutational status and margin type.</p><p><strong>Results: </strong>Among 1078 eligible patients, KRAS-mutated patients more frequently presented synchronous metastases, nodal involvement, and administration of perioperative chemotherapy compared with wild-type patients. Higher tumor burden was associated with both R1 parenchymal (R1P) and R1 vascular (R1V) resections. Within KRAS-mutated patients, synchronous disease and bilobar involvement were more frequently associated with R1P resections.</p><p><strong>Conclusions: </strong>KRAS/BRAF mutational status is associated with distinct clinicopathological patterns in patients undergoing liver resection for CRLM. Higher tumor burden and biologically aggressive disease features are more frequently associated with R1P and R1V resections, particularly among KRAS-mutated tumors.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261497618"},"PeriodicalIF":1.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167468","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}