Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"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}

{"title":"Holding Up at 80: Feasibility and Safety of Elective Type IV Hiatal Hernia Repair in Octogenarians.","authors":"Jessica E Wahi, Fadi Alsayegh, Jacob Kalathoor, Fernando M Safdie","doi":"10.1089/lap.2025.0017","DOIUrl":"10.1089/lap.2025.0017","url":null,"abstract":"<p><p><b><i>Background:</i></b> The aging population has led to an increase in the prevalence of symptomatic paraesophageal hernias (PEHs), particularly among octogenarians. While elective repair is associated with improved outcomes compared to emergency repair, there are limited data on the safety and efficacy of robotic-assisted PEH repair in this high-risk population. <b><i>Methods:</i></b> We conducted a retrospective review of patients aged 65-89 who underwent robotic-assisted elective type IV PEH repair by a single surgeon at Mount Sinai Medical Center from 2020 to 2023. Patients were divided into two cohorts: octogenarians (80-89 years) and seniors (65-79 years). Demographics, perioperative outcomes, and complications were analyzed. <b><i>Results:</i></b> A total of 38 patients were included, with 15 octogenarians and 23 seniors. The mean ages were 84 ± 2 years and 73 ± 5 years, respectively. The majority of patients were female (73% octogenarians, 87% seniors), and the average body mass index was comparable between cohorts (25 kg/m² ± 3.7 versus 25 ± 4.7). The mean hospital length of stay was 2.7 ± 1.8 days for octogenarians and 2.4 ± 1.8 days for seniors (<i>P</i> = .6). No intraoperative complications or 30-day mortality occurred. Two octogenarians (13%) and three seniors (13%) were readmitted within 30 days. At 6 months, 87% of octogenarians and 69% of seniors reported resolution of preoperative symptoms (<i>P</i> = .3). <b><i>Conclusions:</i></b> Robotic-assisted repair of type IV PEHs is a safe and effective option for both octogenarians and seniors. The absence of intraoperative complications and 30-day mortality supports its feasibility in elderly patients, including those in their eighth decade of life. These findings advocate for elective minimally invasive repair in carefully selected patients, regardless of advanced age, and highlight the importance of further studies to validate long-term outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"538-541"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217422","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":"Single-Port-Plus-One Thoracoscopic Lobectomy for Infants with Congenital Pulmonary Airway Malformation: Initial Experience.","authors":"Xiaofeng Yang, Chi Sun, Hui Zhou, Yue Wang, Wenbo Wang, Meng Li, Suolin Li","doi":"10.1089/lap.2024.0255","DOIUrl":"10.1089/lap.2024.0255","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To investigate the safety and feasibility of single-port-plus-one (SP + 1) thoracoscopic lobectomy in the treatment of congenital pulmonary airway malformation (CPAM) in infants. <b><i>Methods:</i></b> The clinical data of 35 infants who underwent SP + 1 thoracoscopic lobectomy from May 2017 to December 2023 were retrospectively analyzed. The median age was 7 months, and the median weight was 8 kg. Included: 4 cases of upper lobectomy, 3 cases of middle lobectomy, and 28 cases of lower lobectomy. <b><i>Results:</i></b> SP + 1 thoracoscopic lobectomy was successfully completed in all infants. One case developed a postoperative air leak. There were no deaths and no other postoperative complications such as pulmonary infection, bleeding, atelectasis, bronchopleural fistula, and chylothorax. <b><i>Conclusion:</i></b> SP + 1 thoracoscopic lobectomy for infants with CPAM is safe, feasible, and cosmetic with satisfactory perioperative results in our preliminary experience.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"578-581"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056579","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":"Prospective Evaluation of the Effect of Vesical Imaging Reporting and Data System Scoring on the Identification of Candidates for Repeated Transurethral Resection.","authors":"Ali Ayten, Mithat Eksi, Orkun Civan, Yunus Colakoglu, Yusuf Arıkan, Selcuk Sahin, Ali Ihsan Tasci","doi":"10.1089/lap.2025.0073","DOIUrl":"10.1089/lap.2025.0073","url":null,"abstract":"<p><p><b><i>Background:</i></b> To determine the diagnostic accuracy of the Vesical Imaging Reporting and Data System (VI-RADS) scoring system in identifying candidates for second transurethral resection (reTUR-BT) and investigate the success of VI-RADS in detecting muscle-invasive bladder cancer (MIBC). <b><i>Methods:</i></b> Data from 186 patients who underwent primary TUR-BT for bladder cancer (BC) at our center between April 2022 and April 2023 were prospectively collected. Preoperative bladder multiparametric magnetic resonance imaging was performed for all patients to determine the VI-RADS score. A cutoff value of VI-RADS ≥4 was accepted for detecting muscle invasion. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the curve (AUC) were calculated to evaluate the performance of VI-RADS in distinguishing MIBC from non-muscle-invasive bladder cancer (NMIBC) after primary TUR-BT. In the second phase, following the application of exclusion criteria, the study proceeded with 52 patients who underwent reTUR-BT, the primary target population of the study. Preoperatively calculated VI-RADS scores were compared with reTUR-BT pathology findings. <b><i>Results:</i></b> VI-RADS scoring was statistically significant in distinguishing MIBC from NMIBC. However, the performance of VI-RADS in identifying persistent NMIBC and upstaged MIBC in patients undergoing reTUR-BT was statistically nonsignificant. For VI-RADS ≥4, the sensitivity was 45.4%, specificity was 90.2%, PPV was 55.5%, and NPV was 86%. The AUC was 0.67 (95% confidence interval: 0.46-0.88; <i>P</i> = .079). <b><i>Conclusions:</i></b> Histopathologic sampling via reTUR-BT remains the gold standard, and the performance of VI-RADS in identifying candidates for reTUR-BT has been found to be suboptimal.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"557-563"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227431","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":"Minimally Invasive Repair of Pectus Excavatum Without Stabilizers Does Not Result in Increased Bar Displacement or Other Postoperative Complications.","authors":"Cory Nonnemacher, Meredith Elman, Seth Saylors, Ismael Elhalaby, Pablo Aguayo","doi":"10.1089/lap.2025.0070","DOIUrl":"10.1089/lap.2025.0070","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Bar dislocation is one of the most dreaded complications following minimally invasive repair of pectus excavatum (PE). Practice patterns vary regarding bar securement, with some providers using unilateral or bilateral titanium stabilizers. Foreign bodies can be associated with increased morbidity including infection rate and complications during bar removal. We assess patients without the use of stabilizers compared to those with stabilizers. <b><i>Methods:</i></b> A retrospective analysis of patients treated for PE from November 2020 until June 2024 at a tertiary children's hospital. A comparison of those patients who used stabilizers to those without stabilizers was performed. Rates of bar displacement and bar-related complications were compared. <b><i>Results:</i></b> Ninety-seven total patients were analyzed with 63 receiving stabilizers and 34 with no stabilizers. There was no statistically significant difference in length of stay, readmission, complications, or bar displacements. <b><i>Conclusion:</i></b> Nuss bar placement without stabilizers can be a safe means of correcting PE without increased risk of bar displacement. Minimizing the amount of foreign material has the potential to mitigate postoperative infection, irritation, and pain from surgery. <b><i>Level of Evidence:</i></b> Level 2, retrospective study.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"570-573"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042578","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":"Navigating Complexity in Liver Resection: A Narrative Review of Factors Influencing Intraoperative Difficulty.","authors":"Meet Patel, Anthony R Glover, Thomas J Hugh","doi":"10.1089/lap.2025.0041","DOIUrl":"10.1089/lap.2025.0041","url":null,"abstract":"<p><p><b><i>Background:</i></b> Liver resection remains the cornerstone for curative management in primary liver malignancies. Liver surgery ranges from simple wedge resections to complex hepatectomies involving vascular or biliary reconstructions. The anatomical complexity of the liver and these varied surgical approaches create challenges in assessing operative difficulty. This literature review explores the key factors influencing operative difficulty in liver resection for primary liver malignancy across surgical techniques. <b><i>Methods:</i></b> A broad literature review was conducted to determine the factors that were associated with increased operative difficulty in liver resection using the Embase, PubMed, and Cochrane databases for studies published between 2000 and 2025. <b><i>Results:</i></b> This review identifies several patient, tumor, and surgical factors that influence operative difficulty in liver resection. Numerous difficult scoring systems were identified, yet their applicability across different operative approaches remains uncertain. Across open and minimally invasive techniques, tumor size and location are commonly used to determine complexity. However, debate remains regarding the optimal cutoff for tumor diameter. Other identified factors include the extent of resection, patient-specific variables (e.g., cirrhosis, body mass index, previous surgeries), and surgical technique. In addition, liver resection procedures classified based on the 2000 Brisbane terminology have been stratified into three groups of increasing difficulty. <b><i>Conclusion:</i></b> The ability to predict operative difficulty is useful for case selection, surgical planning, and risk stratification for meaningful shared decision-making. Future research should focus on refining predictive models by integrating composite measures, including patient-reported outcomes and long-term survival. A unified, validated scoring system applicable across surgical techniques could enhance consistency in clinical practice and research to improve outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"519-530"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042584","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":"Long-Term Outcomes of Sleeve Gastrectomy at a Veterans Affairs Medical Center.","authors":"Fatima Khambaty, R Natalie Reed, James Alex Randall, Lila Brody, Parini Shah, Jennifer C Kerns","doi":"10.1089/lap.2025.0072","DOIUrl":"10.1089/lap.2025.0072","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure for morbid obesity. However, there is limited data on long-term outcomes in the veteran population. This study attempts to determine long-term weight loss and resolution of comorbidities following an LSG in a veteran population. <b><i>Methods:</i></b> A retrospective review was performed of a prospectively maintained database of LSG patients at a single veterans Affairs Medical Center from 2013 to 2019. Patient preoperative factors, 5-year weight loss, resolution of comorbidities, and morbidities were collected and analyzed using univariate and multivariate analysis. An alpha level of 0.05 was used to determine significance. Statistical analyses were performed by using SAS version 9.4. <b><i>Results:</i></b> A total of 153 patients underwent LSG, with 98.7% completing a 5-year follow-up. At 5 years, rates of diabetes (50.9% versus 37.7%, <i>P</i> < .001), hypertension (59.2% versus 49.7%, <i>P</i> < .001), gastroesophageal reflux disease (51.6% versus 40.9%, <i>P</i> < .001), and sleep apnea (67.3% versus 40.9%, <i>P</i> < .001) were significantly reduced from baseline. Average total weight lost was 13.5% from baseline weight, with no perioperative mortalities. Preoperative body mass index (BMI) was the only factor predictive of postoperative BMI. <b><i>Conclusions:</i></b> LSG remains a safe and effective option for veterans with morbid obesity with concurrent resolution of several comorbidities. As the treatment of obesity continues to evolve, postoperative data remains critical to guide patient care.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"513-518"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129177","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":"Learning Curve of Single-Port Robotic-Assisted Extraperitoneal Radical Prostatectomy: A CUSUM-Based Analysis.","authors":"Valerio Santarelli, Fabio Maria Valenzi, Muhannad Aljoulani, Hakan Bahadır Haberal, Luca A Morgantini, Arianna Biasatti, Stefano Salciccia, Giovanni Battista Di Pierro, Giorgio Franco, Riccardo Autorino, Simone Crivellaro","doi":"10.1089/lap.2025.0055","DOIUrl":"10.1089/lap.2025.0055","url":null,"abstract":"<p><p><b><i>Background:</i></b> Single-port robotic-assisted radical prostatectomy (SP-RARP) has been demonstrated to be a feasible and safe procedure. Nonetheless, the challenges of SP surgery could limit the transferability of skills from multi-port (MP) console. The aim of our study was to assess the learning curve of SP-RARP. <b><i>Methods:</i></b> SP-RARPs performed by a single experienced surgeon were reviewed. The surgical learning curve was assessed using risk-adjusted cumulative summation (CUSUM) methodology in terms of operative time, separately for SP-RARPs with pelvic lymphadenectomy (PLND) and without PLND. <b><i>Results:</i></b> 119 extraperitoneal SP-RARPs were evaluated, 83 with PLND and 36 without PLND. After CUSUM calculation, a cubic polynomial regression was performed to plot the learning curves. The inflection points, representing the number of cases required to achieve proficiency, corresponded to the 42^nd and 20^th procedure, respectively, for SP-RARP with and without PLND. The learning curves were subsequently divided into a learning phase and a proficiency phase to compare perioperative and postoperative outcomes of the two phases. In both groups, cases in the proficiency phase demonstrated significantly lower median operative times (<i>P</i> = .01 and <i>P</i> < .001) and hospital stays (<i>P</i> = .015 and <i>P</i> = .04). In the SP-RARP without the PLND group, patients in the proficiency phase demonstrated significantly lower postoperative pain scores (<i>P</i> = .04). No differences were found in terms of estimated blood loss, complication rates, and positive surgical margin rates (<i>P</i> > .05). <b><i>Conclusion:</i></b> Results from our analysis suggest that the learning curve of extraperitoneal SP-RARP is not longer than that reported for MP-RARP. Moreover, when cautiously approached, the learning process can be undertaken without compromising safety and oncological outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"542-549"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081578","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":"What Is the Red Flag for VATS Pneumonectomy? When to Perform or Avoid the Procedure?","authors":"Melike Ülker, Volkan Erdoğu, Merve Ekinci Fidan, Ayşegül Çiftçi, Ezgi Kılıçaslan, Meral Selin Onay Mahmuti, Erdinç Denizli, Celal Buğra Sezen, Özkan Saydam, Muzaffer Metin","doi":"10.1089/lap.2025.0057","DOIUrl":"https://doi.org/10.1089/lap.2025.0057","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The safety and efficacy of video-assisted thoracoscopic surgery (VATS) in pneumonectomy for patients with non-small cell lung cancer (NSCLC) were compared with open surgery. <b><i>Methods:</i></b> Between January 2020 and October 2024, we conducted a retrospective review of 177 pneumonectomy cases at our center. Fifty-eight cases were performed using VATS (VATS Group), while 119 were performed using thoracotomy (Thoracotomy Group). <b><i>Results:</i></b> The average age of the patients was 61.2 ± 8.3 years (range: 39-83), and the majority were male (<i>n</i> = 155, 87.6%). Perioperative blood loss (VATS Group: 152 ± 131 mL, range 100-700 mL versus Thoracotomy Group: 314 ± 455 mL, range 100-3500 mL) and hospital stay durations (VATS Group: 5.3 ± 2.4 days, range 3-13 versus Thoracotomy Group: 7.5 ± 4.1 days, range 2-22) were found to be significantly lower in the VATS Group (<i>P</i> < .001 for both). Left-sided resections were more frequent in the VATS Group (74% versus 57.1%, <i>P</i> = .049), and tumor sizes were observed to be smaller (4.8 ± 2.2 cm versus 6.2 ± 3.6 cm, <i>P</i> = .009). No significant differences were observed between the groups in terms of postoperative early morbidity and 30-day mortality (<i>P</i> = .784 and <i>P</i> = .549, respectively). <b><i>Conclusion:</i></b> VATS pneumonectomy is a method that can be preferred by experienced centers in patients with NSCLC, offering the advantages of reduced perioperative bleeding and shorter hospital stays compared with the thoracotomy approach, without compromising oncological principles.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499045","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":"Endoscopically Implanted, Self-Powered, Vagal Nerve Stimulation Device: Experimental Feasibility Study.","authors":"Valerio Cigaina, Alfredo Saggioro, Paolo Fabris, Arfeo Canaglia, Ugo Scalabrin, Simone Cigaina, Quan Wang, Gianluca Bonitta, Luigi Bonavina","doi":"10.1089/lap.2025.0093","DOIUrl":"https://doi.org/10.1089/lap.2025.0093","url":null,"abstract":"<p><p><b><i>Background:</i></b> The prevalence of metabolic disorders and obesity is increasing worldwide. The underlying pathogenetic mechanisms include an imbalance of the autonomic nervous system secondary to a relative decrease of the parasympathetic vagal tone or increase of the sympathetic tone. Previous clinical experience with a surgically implanted gastric pacemaker for morbid obesity showed that augmenting the vagal tone effects satiety and weight control. The aim of this study was to assess the feasibility of endoscopic implantation of a brain-neuromodulator (BNM) within the proximal gastric wall. <b><i>Methods:</i></b> Experimental study testing the prototype of an original, self-powered BNM implanted in pigs through upper gastrointestinal endoscopy. The miniaturized electronic device, designed to deploy depolarization signals through the afferent fibers of the vagus nerve, was placed submucosally at the level of the proximal lesser gastric curve. The feasibility, biocompatibility, and biosafety of the procedure were evaluated radiologically, endoscopically, and at the time of the explant. Heart rate variability (HRV) was assessed at baseline and during and after the procedure to measure changes in the vagal tone. <b><i>Results:</i></b> The procedure was uncomplicated, and the BNM remained in a stable position at the level of the lesser gastric curve without notable side effects or device displacement as assessed radiologically and endoscopically. Compared to baseline measurements, post-procedural HRV consistently increased, confirming that signaling through the afferent vagal pathway has the potential to increase parasympathetic tone. Autopsy showed that the device was in the original position, embedded in the gastric wall and without any sign of transmural ulceration. <b><i>Conclusions:</i></b> This feasibility study shows that a miniaturized battery-free and catheter-free BNM can be placed endoscopically in the submucosal layer of the lesser gastric curve. The device was well-tolerated, biocompatible, and safe. Rigorous validation of the physiological endpoints and optimization of the stimulation parameters are necessary for future clinical application of BNM.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477661","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}