Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"Anatomic Features Associated with Operative Strategy in Minimally Invasive Gastric GIST Resection: A Single-Center Retrospective Cohort Study.","authors":"Tamar Tsenteradze, Steven P Bowers, Enrique F Elli","doi":"10.1177/10926429261491045","DOIUrl":"https://doi.org/10.1177/10926429261491045","url":null,"abstract":"<p><strong>Background: </strong>Operative decision-making in gastric gastrointestinal stromal tumor (GIST) surgery is strongly influenced by tumor anatomy. Although surgeons routinely consider anatomic features such as proximity to the gastroesophageal junction, posterior wall location, and endophytic growth during operative planning, their combined association with operative strategy has not been systematically evaluated.</p><p><strong>Methods: </strong>We evaluated whether commonly recognized anatomic features of gastric GISTs were associated with operative strategy in a contemporary minimally invasive surgical cohort. Tumors were characterized according to the presence of three predefined anatomic features: proximal location near the gastroesophageal junction, posterior wall involvement, and endophytic growth pattern. Cases were grouped as lower (0-1 features) or higher (2-3 features) complexity. The primary outcome was operative strategy, categorized as simple (wedge resection or enucleation) or complex (partial gastrectomy or transgastric resection). Associations between anatomic complexity and operative approach were evaluated.</p><p><strong>Results: </strong>A total of 83 patients were included, with 50 (60.2%) classified as lower complexity and 33 (39.8%) as higher complexity. Operative strategy varied significantly by complexity group. Tumors in the higher complexity group were more frequently managed with complex operative techniques, including partial gastrectomy and transgastric resection (<i>P</i> = .002). This association remained significant after adjustment for tumor size (odds ratio 2.87, 95% CI: 1.12-7.65, <i>P</i> = .031). A graded relationship was observed, with increasing use of complex techniques as the number of anatomical features increased. The robotic platform was used more frequently in higher complexity cases (<i>P</i> = .03). Perioperative outcomes were comparable between groups.</p><p><strong>Conclusions: </strong>Recognized anatomical features of gastric GISTs were associated with operative strategy and reflected real-world surgical decision-making. Systematically describing these features may facilitate preoperative assessment and improve consistency in reporting operative approaches.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261491045"},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076482","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 Versus Multiport Robotic Colorectal Surgery: A Systematic Review and Meta-Analysis.","authors":"Vitória Maia Corrêa, Fernanda de Moraes Nava, Felippe Furlan Kelher, Lucas Monteiro Delgado, Claudia Theis, Sérgio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga, Bernardo Fontel Pompeu","doi":"10.1177/10926429261491175","DOIUrl":"https://doi.org/10.1177/10926429261491175","url":null,"abstract":"<p><strong>Background: </strong>Single-port (SP) robotic surgery has emerged as a reduced-access alternative to conventional multiport (MP) robotic colorectal surgery. However, its comparative perioperative benefits remain uncertain. This systematic review and meta-analysis compared outcomes between SP and MP robotic colorectal surgery.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were searched from inception through August 2026 for comparative studies evaluating SP versus MP robotic colorectal surgery. Odds ratios and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation.</p><p><strong>Results: </strong>Ten comparative studies comprising 628 patients (SP, 288; MP, 340) were included, of whom 598 contributed to the pooled analyses. SP surgery was associated with shorter hospital stay (MD -0.9 days; 95% CI: -1.4 to -0.4; <i>I</i>² = 62.2%), shorter console time (MD: -39.6 minutes; 95% CI: -72.5 to -6.8; <i>I</i>² = 85.4%), and lower postoperative pain on postoperative day 1 (POD1, MD: -0.10 NRS points; 95% CI: -0.18 to -0.03; <i>I</i>² = 0%). No significant differences were observed in operative time, harvested lymph nodes, anastomotic leakage, postoperative ileus, or Clavien-Dindo grade ≥III complications. Sensitivity analyses suggested shorter operative time and lower estimated blood loss with SP surgery after exclusion of the studies contributing most to heterogeneity. Four studies had serious and six moderate overall risk of bias. Certainty of evidence was very low.</p><p><strong>Conclusions: </strong>SP robotic colorectal surgery was associated with shorter hospital stay and console time and lower POD1 pain scores, without significant differences in operative time, major morbidity, or harvested lymph nodes in the primary analyses. Sensitivity analyses suggested potential additional operative benefits, but the observational evidence, heterogeneity, risk of bias, and very low certainty preclude conclusions of clinical superiority.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261491175"},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076548","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":"Concomitant Cholecystectomy During Bariatric Surgery: Surgical Technique and Safety.","authors":"Cihan Atar, Mehmet Deniz, Orkun Harun Çebi, Onur Dülgeroğlu, Emir Çapkınoğlu, Cihan Uras","doi":"10.1177/10926429261491052","DOIUrl":"https://doi.org/10.1177/10926429261491052","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing bariatric surgery have a substantially elevated risk of gallstone disease, both at baseline and as a consequence of rapid postoperative weight loss. The optimal management of biliary pathology identified at the time of bariatric surgery remains unsettled. We aimed to describe the clinical, radiological, surgical, and histopathological characteristics, and the short-term safety, of simultaneous laparoscopic cholecystectomy performed during bariatric surgery in patients with documented preoperative biliary pathology.</p><p><strong>Methods: </strong>A single-center retrospective cohort of patients who underwent bariatric surgery in 2024 was analyzed. Of 692 bariatric procedures performed by a single surgical team, 117 patients with preoperative ultrasonography-confirmed gallstones or gallbladder polyps who underwent simultaneous laparoscopic cholecystectomy were included. Demographic, anthropometric, comorbidity, imaging, intraoperative, histopathological, and 30-day complication data were extracted from medical records. Only descriptive statistics were used; no concurrent control group was available, and no inferential testing was performed.</p><p><strong>Results: </strong>The cohort comprised 109 women (93.2%) with a mean age of 42.1 ± 10.5 years and a mean body mass index of 42.3 ± 6.4 kg/m². Hypertension (15.4%), asthma (10.3%), and diabetes mellitus (8.5%) were the most frequent comorbidities. Preoperative imaging revealed multiple gallstones in 63.2%, a single stone in 30.8%, and an isolated gallbladder polyp in 6.0%; the largest stone measured a median of 14 mm (range 3-43). Hepatic steatosis was present in 94.0% of patients and hepatomegaly in 42.7%. Sleeve gastrectomy was performed in 108 patients (92.3%) and gastric bypass in 9 (7.7%); concomitant hiatal hernia repair was carried out in 41 patients (35.0%) and revisional bariatric surgery in 8 (6.8%). Cholecystectomy was performed through the existing 5-mm epigastric liver-retractor port in every patient, with no additional trocar required and no conversion to open surgery. Histopathology demonstrated chronic cholecystitis in all specimens, with an associated cholesterol polyp in 62.4%. A single patient (0.9%) developed early postoperative bleeding that resolved with conservative management and transfusion; no surgical re-exploration was required, and 30-day mortality was zero.</p><p><strong>Conclusion: </strong>Simultaneous laparoscopic cholecystectomy can be incorporated into bariatric surgery in patients with imaging-confirmed biliary pathology with a low short-term complication rate and without the need for an additional trocar in this single-team series. Prospective, multicenter, randomized studies remain necessary to define the optimal management of asymptomatic gallstone disease at the time of bariatric surgery.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261491052"},"PeriodicalIF":1.1,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070462","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":"New Frontiers in Robotic Ventral Hernia Repair: A Qualitative Systematic Review of Robotic Approaches Other than Da Vinci.","authors":"Gabriela Lyons, Clara Avelar Mendes de Vasconcellos, Thiago Souza E Silva, Mariana de Macedo Torves, Luiza da Silva de Carvalho, Raquel Nogueira, Leandro Totti Cavazzola, Diego Lima, Flavio Malcher","doi":"10.1177/10926429261490774","DOIUrl":"https://doi.org/10.1177/10926429261490774","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted ventral hernia repair has expanded over the last decade, largely driven by the widespread adoption of the da Vinci platform. Although this system offers advantages in visualization, precision, and dexterity, concerns regarding cost, accessibility, and platform design have stimulated the development of alternative robotic systems. However, evidence evaluating the clinical implementation and technological impact of these emerging platforms in abdominal wall surgery remains limited. We conducted a systematic review to assess new robotic platforms used for ventral hernia repair.</p><p><strong>Methods: </strong>This mixed-methods systematic review was conducted in accordance with PRISMA 2020 guidelines. Studies reporting robotic ventral hernia repair performed using non-da Vinci platforms were included. PubMed/MEDLINE, Embase, LILACS, Cochrane Library, SciELO, and Web of Science were systematically searched from database inception to July 2025. Qualitative thematic synthesis served as the primary analysis, complemented by descriptive evaluation of perioperative clinical outcomes. Extracted data included study characteristics, robotic platform, surgical approach, operative and docking times, postoperative complications, conversion, and length of hospital stay. Due to clinical and methodological heterogeneity, quantitative meta-analysis was not performed.</p><p><strong>Results: </strong>From 218 records identified, 10 studies (6 case series, 3 case reports, and 1 cohort), comprising 95 patients, met inclusion criteria. Three robotic platforms were evaluated: Hugo, Versius, and SSI Mantra. Qualitative synthesis identified consistent domains influencing platform adoption, primarily related to intrinsic robot strengths and limitations, surgeon-robot interaction, intraoperative characteristics, and economic considerations. A secondary qualitative analysis further contextualized these findings within ventral hernia surgery, highlighting domains related to abdominal wall reconstruction, mesh-based repair, workflow adaptability, and learning-curve progression. Across studies, emerging platforms demonstrated clinical feasibility with four conversions reported overall (3 in Hugo and 1 in Versius). Operative time ranged from 39 to 450 minutes, while docking time varied from 10 to 30 minutes. Perioperative outcomes were generally favorable, with isolated complications reported, including seroma, hematoma, urinary retention, wound infection, and drain-related complications, and no recurrences observed during short-term follow-up (7-310 days).</p><p><strong>Conclusion: </strong>New robotic platforms for ventral hernia repair demonstrate early clinical feasibility with favorable short-term outcomes. Current evidence remains limited, and further prospective comparative studies are required to clarify their role in robotic abdominal wall surgery.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261490774"},"PeriodicalIF":1.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065665","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 Robotic Posterior Retroperitoneoscopic Adrenalectomy (SPRe-Ad): A GelPOINT Mini-Enabled Floating-Docking Technique.","authors":"Marco Raffaelli, Priscilla Francesca Procopio, Antonio Laurino, Pierpaolo Gallucci, Carmela De Crea, Francesco Pennestrì","doi":"10.1177/10926429261491057","DOIUrl":"https://doi.org/10.1177/10926429261491057","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a GelPOINT Mini-enabled access configuration for single-port posterior retroperitoneoscopic adrenalectomy (SPRe-Ad) using the da Vinci SP system, with emphasis on floating docking, posterior abdominal-wall tenting, and early perioperative outcomes.</p><p><strong>Materials and methods: </strong>Two consecutive adults underwent unilateral SPRe-Ad through a 3-cm posterior incision. The GelPOINT Mini accommodated the SP cannula and a 12-mm assistant trocar through the same GelSeal cap. Aggregate perioperative data from 32 multiport robotic PRA procedures performed within the same institutional program were reviewed as a descriptive benchmark; no inferential comparison was undertaken.</p><p><strong>Results: </strong>The cases involved a 17-mm left pheochromocytoma and a 9-mm right aldosterone-producing adenoma. Docking, console, and total operative times were 4, 40, and 71 minutes and 6, 50, and 83 minutes, respectively. In the multiport cohort, corresponding median times were 6.0 (IQR, 4.3-7.8), 18.0 (12.3-22.8), and 57.5 (45.3-74.3) minutes. Neither SPRe-Ad case required conversion or developed intraoperative or 30-day postoperative complications, and hospital stay was 2 days in both patients.</p><p><strong>Conclusion: </strong>GelPOINT Mini-enabled floating docking provided single-incision assistant access and mechanical posterior abdominal-wall tenting during da Vinci SPRe-Ad. These first two cases support technical applicability within an established robotic PRA program; prospective comparative studies should determine whether this configuration increases operative workspace, reduces insufflation-pressure requirements, or improves operative efficiency and clinical outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261491057"},"PeriodicalIF":1.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070433","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":"Intracorporeal Versus Extracorporeal Anastomosis in Minimally Invasive Ileocecectomy or Ileocolic Resection for Crohn's Disease: A Systematic Review and Meta-Analysis.","authors":"Beatriz Yukari Yokoyama, Victória Recidivi E Silva, Lucas Carvalho Lemos de Souza Aguiar, Hélder Santos Gonçalves, Lucas Monteiro Delgado, Claudia Theis, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga, Bernardo Fontel Pompeu","doi":"10.1177/10926429261491060","DOIUrl":"https://doi.org/10.1177/10926429261491060","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive right colectomy is a standard treatment for Crohn's disease. Although intracorporeal anastomosis (ICA) has shown favorable outcomes in minimally invasive colorectal surgery, evidence specific to Crohn's disease remains limited. We performed the first systematic review and meta-analysis comparing ICA and extracorporeal anastomosis (ECA) in this setting.</p><p><strong>Methods: </strong>PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched from database inception through June 2026 for comparative studies evaluating ICA versus ECA in adult patients undergoing minimally invasive ileocecectomy or ileocolic resection for Crohn's disease. Random-effects meta-analyses were performed using odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was assessed using ROBINS-I, and certainty of evidence was evaluated with the GRADE approach.</p><p><strong>Results: </strong>Four retrospective cohort studies involving 672 patients (186 ICA and 486 ECA) were analyzed. ICA significantly reduced overall postoperative complications compared with ECA (OR: 0.44, 95% CI: 0.28-0.70; <i>P</i> < .001; <i>I² =</i> 0%). Anastomotic leak, surgical site infection, 30-day readmission, length of hospital stay, clinical recurrence, endoscopic recurrence, and surgical recurrence were comparable between groups. Operative time was longer with ICA (MD 70.2 minutes, 95% CI: 55.2-85.2; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>ICA was associated with fewer postoperative complications than ECA during minimally invasive ileocolic resection for Crohn's disease, without increasing anastomotic failure, hospital stay, or disease recurrence, although operative time was longer.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261491060"},"PeriodicalIF":1.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026609","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":"Revisional Options after Roux-en-Y Gastric Bypass: A MBSAQIP Analysis of Biliopancreatic Diversion with Duodenal Switch Versus Limb Lengthening.","authors":"Yeisson Rivero-Moreno, Arturo Estrada, Jenny Choi, Erin Moran-Atkin, Diego Camacho","doi":"10.1177/10926429261491051","DOIUrl":"https://doi.org/10.1177/10926429261491051","url":null,"abstract":"<p><strong>Background: </strong>Recurrent weight gain after Roux-en-Y gastric bypass (RYGB) has become increasingly common. This study aimed to compare short-term surgical outcomes between patients undergoing Limb Lengthening (LL) versus Biliopancreatic Diversion with Duodenal Switch (BPD/D) after RYGB.</p><p><strong>Methods: </strong>A retrospective analysis of the MBSAQIP database (2020-2023) was performed, including patients that underwent revisional surgery with LL or BPD/DS following RYGB. Thirty-day postoperative outcomes including overall postoperative complications (OPC) and unplanned health care utilization (UHCU), were analyzed. A multivariable logistic regression analysis and subgroup analysis were used to assessed for Bias.</p><p><strong>Results: </strong>A total of 1456 patients were included: 58.8% (<i>n</i> = 857) underwent LL and 41.1% (<i>n</i> = 599) BPD/DS. Female patients (88.0%, <i>n</i> = 1,282), mean age of 49.5 ± 9.4 years. Patients undergoing BPD/DS had higher BMI (47.3 versus 42 kg/m²), ASA class III-V (91.1% versus 80.7%), drain placement (31.7% versus 9.2%), and robotic approach (40.2% versus 18.7%), longer procedure time (212.2 versus 119.5 minutes), hospital length of stay (2.9 versus 1.5 days), (all <i>P</i> < .001). BPD/DS patients had higher OPC (15.2% versus 4.9%), including higher leaks, surgical site infections, and ICU admission, adjusted OR = 3.22 (95% CI = 1.81-5.72); they also had higher UHCU (27.2% versus 14.5%). On multivariate analysis, besides BPD/DS revision, BMI > 50, history of pulmonary embolism, and drain placement were identified as independent risk factors for OPC.</p><p><strong>Conclusions: </strong>Compared with RYGB-LL, patients undergoing RYGB-BPD/DS had longer operative time, hospital stay, and OPC. BPD/DS as a conversion technique, BMI > 50, history of pulmonary embolism, and drain placement were identified as independent risk factor for OPC.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261491051"},"PeriodicalIF":1.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026627","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":"Totally Endoscopic Sublay Repair for Postpartum Diastasis Recti Using Staplers: Surgical Technique and Preliminary Outcomes.","authors":"Guoyong Fan, Gan Yao, Qingfeng Zhang, Qiaobin Duan, Xuming Deng","doi":"10.1177/10926429261491147","DOIUrl":"https://doi.org/10.1177/10926429261491147","url":null,"abstract":"<p><strong>Purpose: </strong>Recently, staplers have been introduced for the management of diastasis recti; however, current literature primarily reports transabdominal or infraumbilical open approaches. This study aims to describe in detail a totally endoscopic sublay repair technique using staplers for diastasis recti and to present its preliminary clinical outcomes.</p><p><strong>Methods: </strong>Clinical data were retrospectively analyzed from patients who underwent laparoscopic retromuscular mesh repair for postpartum diastasis recti using staplers at the Department of Hernia and Abdominal Wall Surgery, The First People's Hospital of Foshan, between September 2022 and January 2026. Collected variables included age, sex, body mass index, operative time, width of diastasis recti, intraoperative blood loss, postoperative complications, visual analog scale (VAS) pain score, length of hospital stay, recurrence rate, and follow-up findings.</p><p><strong>Results: </strong>A total of 22 patients successfully completed the surgery. The mean inter-rectus distance was 4.04 cm (range: 2.9-8.0 cm). One patient with severe diastasis recti (8 cm) experienced intraoperative dislodgement of posterior sheath staplers due to high fascial tension, necessitating medial release of the posterior rectus sheath relative to the neurovascular bundles to reduce tension and achieve secure closure. Five patients underwent concomitant abdominoplasty following laparoscopic repair. The mean operative time was 190 minutes (range: 100-371 minutes), with a mean blood loss of 27.5 mL (range: 5-150 mL). The average length of hospital stay was 5.2 days (range: 3-8 days). Postoperatively, 4 patients (18.2%) developed seromas, all of which resolved with conservative management. No recurrences were observed during the follow-up period.</p><p><strong>Conclusions: </strong>Totally endoscopic sublay repair using staplers is a feasible, safe, and effective option for the correction of mild-to-moderate postpartum diastasis recti. While short-term outcomes are favorable, long-term efficacy and durability require validation through larger studies with extended follow-up.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261491147"},"PeriodicalIF":1.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026624","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":"Perioperative Outcomes of 3D Transperitoneal Laparoscopic Adrenalectomy Stratified by Tumor Size.","authors":"Merary Nazario Pérez, Gustavo Alayón-Rosario, Adriana L Colón-Martínez, Gustavo Christian-Colón, Krystell Ceballos-Álvarez, Kenneth Cintron-Cartagena, Gilberto Ruíz-Deyá, Fabian A Ramirez Rivera","doi":"10.1177/10926429261491146","DOIUrl":"https://doi.org/10.1177/10926429261491146","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic adrenalectomy is the standard surgical approach for most adrenal tumors. Although three-dimensional (3D) transperitoneal laparoscopic adrenalectomy (TLA) is increasingly used, size-stratified perioperative outcomes remain incompletely characterized. We evaluated perioperative outcomes following 3D TLA by comparing patients with adrenal tumors <5 cm and ≥5 cm.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 57 consecutive patients who underwent 3D TLA at Hospital Episcopal San Lucas between 2018 and 2025. Patients were stratified into a small category (SC) (<5 cm) and a large category (LC) (≥5 cm). Primary outcomes included operative time, estimated blood loss (EBL), perioperative complications, conversion to open surgery, and length of hospital stay.</p><p><strong>Results: </strong>Twenty-two patients had tumors <5 cm and 35 had tumors ≥5 cm. Median operative time was significantly longer in the large-tumor group (80 versus 60 minutes; <i>P</i> < .001). EBL was not significantly different between groups, and median hospital stay was 28.27 hours in the SC group and 29.46 hours in the LC group (<i>P</i> = .554). More than 90% of patients were discharged within 48 hours. No patients required blood transfusion or conversion to open surgery, and no intraoperative or postoperative complications were observed.</p><p><strong>Conclusions: </strong>In this single-center cohort, 3D TLA was feasible for both small and large adrenal tumors. Tumors ≥5 cm were associated with longer operative time but not with significantly greater EBL or longer hospitalization. More than 90% of patients were discharged within 48 hours, and no conversions, transfusions, or perioperative complications were observed. Because this study lacked a contemporaneous 2D comparator, no conclusions regarding the incremental benefit or superiority of 3D visualization can be drawn.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261491146"},"PeriodicalIF":1.1,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013116","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":"Endosonography Overestimates Preoperative Staging of Primarily Resectable Esophageal Cancer Compared to Pathological T and N Status.","authors":"Aram Abu Hejleh, Julia Buttermann, Sonja Lang, Karl Knipper, Nikolai Schleußner, Hans Schlößer, Hans Fuchs, Philipp Kasper, Thomas Schmidt, Alexander Quaas, Christiane Bruns, Jin-On Jung, Seung-Hun Chon","doi":"10.1177/10926429261490767","DOIUrl":"https://doi.org/10.1177/10926429261490767","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative staging of esophageal carcinoma guides the choice between neoadjuvant therapy and primary surgery. Endoscopic ultrasound (EUS) remains the principal modality for locoregional staging, yet its accuracy varies. We evaluated EUS diagnostic performance against final pathology in a homogeneous cohort undergoing primary esophagectomy at a high-volume center and identified factors influencing its reliability.</p><p><strong>Methods: </strong>This retrospective analysis included 295 patients with esophageal adenocarcinoma (78%) or squamous cell carcinoma (22%) who underwent oncological esophagectomy between 2006 and 2017, primarily without neoadjuvant therapy. Preoperative uTNM staging by EUS was compared with pathological pTNM. Predictors of staging concordance were assessed by multivariate logistic regression.</p><p><strong>Results: </strong>Overall T-stage accuracy was 57.2%. EUS correctly identified 85.9% of pT1 tumors but only 17.0% of pT2 and 64.6% of pT3 lesions. Tumors were overstaged in 36.6% and understaged in 6.1% of cases. Nodal staging accuracy was 65.8% (sensitivity 65%, specificity 68%). Younger age, female sex, shorter height, and ASA II status were independent predictors of reduced T-stage accuracy; no significant predictors emerged for N-stage.</p><p><strong>Conclusion: </strong>EUS accurately detects early-stage esophageal cancer but shows limited reliability for intermediate stages, particularly pT2 tumors, in this single-center study. Given the risk of misclassification, EUS findings should be interpreted cautiously and complemented by additional diagnostic tools to improve preoperative assessment and enable individualized treatment decisions.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261490767"},"PeriodicalIF":1.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992249","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}