Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

{"title":"The Role of Artificial Intelligence Large Language Models in Literature Search Assistance to Evaluate the Impact of Smoking Inguinal and Ventral Hernia Repairs: A Post-Hoc Analysis.","authors":"Joao Pedro Kasakewitch, Marina Eguchi, Victor Perim, Gabriele Eckerdt Lech, Carlos Balthazar, Raquel Nogueira, Flavio Malcher, Diego L Lima","doi":"10.1177/10926429251393122","DOIUrl":"10.1177/10926429251393122","url":null,"abstract":"<p><strong>Background: </strong>Smoking is associated with higher complication and recurrence rates in ventral and inguinal hernia repairs, but evidence is fragmented. This study evaluated the efficacy of AI-based large language models (LLMs) for identifying literature on the impact of smoking on hernia repairs.</p><p><strong>Methods: </strong>ChatGPT 4.0, ChatGPT 4o, Microsoft Copilot, and Google Gemini were instructed to search PubMed, Embase, and Scopus for retrospective/prospective studies and randomized controlled trials regarding smoking's effects on ventral and inguinal hernia repairs. The models' outputs were cross-checked against previous systematic reviews to assess accuracy.</p><p><strong>Results: </strong>The artificial intelligence (AI) tools generated 24 citations, of which only nine (37.5%) proved valid and relevant. Thirteen (54.2%) were fabricated references, and two (8.3%) cited studies that did not match the specified criteria. Additionally, the AIs identified two studies missed by previous systematic reviews but overlooked 35 (79.5%) recognized by those reviews.</p><p><strong>Conclusions: </strong>Although LLMs can quickly compile potentially relevant references, they are prone to fabricating or omitting crucial studies. Human verification remains essential for conducting reliable, comprehensive literature searches in systematic reviews and meta-analyses.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"664-670"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490810","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 Outcomes of Surgical Resection in Primary Tracheal Tumors: A Single-Center Experience.","authors":"Mustafa Vedat Doğru, Umut Kilimci, Gizem Özçıbık Işık, Oğuzhan Bayraktar, Efsun Gonca Uğur Chousein, Mehmet Akif Özgül, Merih Dilan Albayrak, Mehmet Ali Bedirhan, Celal Buğra Sezen, Özkan Saydam","doi":"10.1177/10926429261449960","DOIUrl":"10.1177/10926429261449960","url":null,"abstract":"<p><strong>Introduction: </strong>Primary tracheal tumors are rare pathologies that pose significant diagnostic and therapeutic challenges due to their low incidence, nonspecific symptoms, and technical complexity of surgical management. This study aimed to evaluate the clinical characteristics, surgical outcomes, and oncological results of patients treated for primary tracheal tumors at a single experienced center.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of patients who underwent surgical treatment for primary tracheal tumors between October 2010 and October 2025. Patients treated for tracheal stenosis or managed with nonsurgical modalities alone were excluded. Demographic data, tumor characteristics, surgical approaches, perioperative outcomes, pathological findings, adjuvant treatments, and survival data were analyzed.</p><p><strong>Results: </strong>Nineteen patients (63.2% female, 36.8% male) with a mean age of 58.4 years were included. Surgical approach was individualized according to tumor localization and consisted of collar incision, collar incision combined with partial sternotomy, thoracotomy, or video-assisted thoracoscopic surgery. No difference was seen in the means of complication, survival, operation time, or length of hospital stay between continuous or interrupted sutures with PDS or polypropylene materials. Postoperative complications occurred in three patients (15.8%), including wound infection in two patients and anastomotic dehiscence complicated by pneumonia in one patient, which resulted in postoperative mortality. Malignant pathology was identified in 84.2% of patients, and selected cases with tumor-positive surgical margins received adjuvant radiotherapy. No tumor recurrence was observed, and 89.5% of patients were alive at the end of follow-up. Mean overall survival was 157.7 months.</p><p><strong>Conclusions: </strong>In the management of primary tracheal tumors, early diagnosis, appropriate patient selection, surgical treatment performed in experienced centers, and the use of a multimodal treatment approach when indicated constitute the key determinants of successful oncological and functional outcomes.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"677-681"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857485","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 Management of Pediatric Superior Mesenteric Artery Syndrome: A Single Institution Continued Experience.","authors":"Seth A Saylors, Shawn D St Peter","doi":"10.1177/10926429261450553","DOIUrl":"10.1177/10926429261450553","url":null,"abstract":"<p><strong>Introduction: </strong>Superior mesenteric artery syndrome (SMAS) is an uncommon cause of abdominal pain, emesis, and weight loss in children. While there are many surgical options, we previously reported a small series of laparoscopic duodenal lowering (DL), which became our standard first approach. Here, we report our expanded experience on the surgical management of patients with SMAS.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of patients who underwent surgical management of SMAS between January 2008 and December 2023 at our institution.</p><p><strong>Results: </strong>22 patients underwent surgical management for SMAS during this study period. The majority of patients were female (<i>n</i> = 19, 86%), and median age at time of surgery was 17 years (interquartile ranges: 16.0, 18.4). The median measured aorto-SMA angle was 16° (12, 20), with 3 patients having an aorto-SMA angle as narrow as 10°. Twenty patients underwent laparoscopic DL, and 2 patients underwent laparoscopic duodenojejunostomy, as they had previously undergone surgical procedures for SMAS at another institution (open duodenal de-rotation, open DL, and median arcuate ligament release). Of the 20 patients who underwent DL, 12 patients (60%) had resolution of their symptoms. Two of these patients had recurrence of symptoms within 6 months and underwent subsequent LDJ. Of the 8 patients without improvement after DL, 2 underwent subsequent LDJ with improvement of symptoms. The median follow-up for all patients was 51 days (33, 321). In both univariate and multivariate statistical analyses, having a diagnosis of Ehlers-Danlos syndrome was predictive of failure to achieve symptom resolution after DL (<i>P</i> = .004). No other clinical or demographic characteristics were found to be predictive of successful resolution of symptoms from surgery.</p><p><strong>Conclusions: </strong>Patients with SMAS are a complex population. The more conservative DL can be an efficacious first step when approaching surgical management of SMAS. Future investigation is warranted to characterize which patients are more likely to fail operative intervention or require repeat operations.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"691-695"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943728","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":"Construction of an Intelligent Decision-Making Model for Laparoscopic Common Bile Duct Repair.","authors":"Xuhao Wang, Yuesheng Sun, Xiaomin Xu, Min Li, Lidan Gao, Yiren Hu, Wenhuan Wang","doi":"10.1177/10926429261427263","DOIUrl":"10.1177/10926429261427263","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to develop a machine learning-based decision-support model to assist surgeons in intraoperatively selecting the optimal repair strategy (primary duct closure [PDC] versus T-tube drainage [TTD]) following laparoscopic common bile duct exploration (LCBDE).</p><p><strong>Methods: </strong>Clinical data from 117 patients with common bile duct stones (CBDS) who underwent LCBDE were retrospectively analyzed. Patients were categorized into PDC (<i>n</i> = 66) and TTD (<i>n</i> = 51) groups. After baseline comparison using SPSS, the dataset was standardized and split. Feature selection was performed using SelectKBest, Recursive Feature Elimination (RFE), and RFE with Cross-Validation (RFECV). Several machine learning classifiers were trained and evaluated based on accuracy, F1 score, precision, recall, and the area under the ROC curve (AUC).</p><p><strong>Results: </strong>Baseline characteristics were similar between groups, except for higher total protein and more frequent purulent bile in the TTD group. RFE identified five optimal predictive features: age, white blood cells, C-reactive protein, total protein, and albumin. The Random Forest classifier, combined with RFE feature selection, demonstrated the best predictive performance, achieving an AUC of 0.83, an accuracy of 0.72, a precision of 0.87, and a recall of 0.62.</p><p><strong>Conclusion: </strong>We successfully constructed an intelligent decision-making model for laparoscopic bile duct repair. Utilizing RFE and Random Forest, the model identifies key clinical features to provide personalized surgical recommendations, which may enhance precision treatment for patients with CBDS.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"682-690"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576120","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":"Characterizing Trends in Preoperative Workup and Evaluation for Pediatric Patients Needing Gastrojejunostomy Tube Placement.","authors":"Sage A Vincent, Emily Meneses, Alexandra Barone-Camp, Shannon N Acker, Jose Diaz-Miron","doi":"10.1177/10926429261450398","DOIUrl":"10.1177/10926429261450398","url":null,"abstract":"<p><strong>Introduction: </strong>Gastrojejunostomy tube (GJT) placement in pediatric patients may be indicated for a variety of reasons. Standard pathways exist for preoperative evaluation of patients prior to gastrostomy tube (GT) placement; however, the workup and referral patterns for patients needing GJT are not well described.</p><p><strong>Methods: </strong>A single-center, retrospective cohort study of pediatric patients who underwent GJT placement between 2014 and 2024 was performed. Included were patients undergoing primary GJT (pGJT) placement and those undergoing staged GJT (sGJT) if the conversion from GT to GJT was within 1 year of index placement. sGJT was further grouped by planned and delayed cohorts, referring to the presence or absence of a plan for short-interval GJT exchange after GT placement. Preoperative workup methods and long-term enteral access outcomes were assessed.</p><p><strong>Results: </strong>There were 90 patients who underwent GJT, including 30 pGJT, 29 planned sGJT, and 31 delayed sGJT. Most were referred by gastroenterology (45.6%), followed by intensivists (21.1%). Upper gastrointestinal fluoroscopic swallow study (60.0%), trial of transpyloric feeds (55.6%), and trial of proton pump inhibitors (41.1%) were frequently obtained preoperatively. The median time from GJT recommendation to surgery was 17.5 days. One year postoperatively, 92.2% of patients had ongoing GJT utilization, compared with 62.2% of patients at most recent follow-up (median: 4.08 years).</p><p><strong>Conclusion: </strong>Pediatric GJT placement referral patterns and preoperative workup are heterogeneous. About 40% of patients undergoing GJT placement will have alternative access at the median 4-year follow-up. Standardization of preoperative evaluation and workflow is warranted.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"696-702"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935134","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":"Complete Mesocolic Excision Versus D2 Lymphadenectomy for Right Colon Cancer: A Bayesian Meta-Analysis of Randomized Trials Assessing Surgical and Perioperative Outcomes.","authors":"Bernardo Fontel Pompeu, Lucas Monteiro Delgado, Gabriel Leal Barone, Giovanna Barbaroto Pilon, Giulia Luiza Garcia, Patricia Viana, Claudia Theis, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga","doi":"10.1177/10926429261432594","DOIUrl":"10.1177/10926429261432594","url":null,"abstract":"<p><strong>Introduction: </strong>Complete mesocolic excision (CME) may increase lymph node retrieval and provide a more complete oncologic excision compared with D2 dissection, although its perioperative safety remains uncertain. This systematic review and Bayesian meta-analysis compared clinical and operative outcomes between CME and D2 in right colectomy.</p><p><strong>Methods: </strong>PubMed, EMBASE, and Cochrane Central were searched through November 2025. Randomized controlled trials comparing CME with D2 were included. Frequentist analyses used random-effects models with DerSimonian-Laird estimation. Bayesian random-effects models applied weakly informative priors (binary outcomes: log[RR] ∼ N(0, 1.5²), τ ∼ Half-Normal(0.5); blood loss: μ ∼ N(0, 100²), τ ∼ Half-Normal(100); lymph node yield: μ ∼ N(0, 6²), and τ ∼ Half-Normal(3)). Heterogeneity was assessed using <i>I</i>² and Cochran's Q. Analyses were conducted in R (v4.4.2) with bayesmeta.</p><p><strong>Results: </strong>Three randomized trials (1378 patients; CME 678, D2 700) met inclusion criteria. CME resulted in higher lymph node harvest (MD + 3.9; 95% CI: 2.8 to 5.0; <i>P</i> < .001) and longer operative time (MD + 11.6 minutes; 95% CI: 6.6 to 16.7; <i>P</i> < .001). No significant differences were found in blood loss, overall complications, severe complications, intraoperative complications, conversion, or 30-day mortality. Bayesian modeling provided very strong evidence for increased nodal yield (P[CME > D2] = 99.1%) and hemostatic equivalence (P[equivalent ± 50 mL] = 95.9%), with a modest probability favoring fewer severe complications (P[RR < 1] = 82.9%).</p><p><strong>Conclusion: </strong>CME offers superior oncologic radicality, reflected by higher lymph node retrieval, while maintaining perioperative outcomes equivalent to D2. Bayesian evidence reinforces CME as an effective and safe surgical strategy for right-sided colon cancer.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"650-663"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500484","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":"Stage IV Esophageal Cancer: Room for Improvement?","authors":"Pamela Milito, Stefano Siboni, Serena Grimaldi, Pietro Masseria, Daniele Bernardi, Matteo Melloni, Valentina Milani, Emanuele Asti","doi":"10.1177/10926429261486385","DOIUrl":"https://doi.org/10.1177/10926429261486385","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess short- and long-term outcomes in patients undergoing surgery for pathological stage IV esophageal cancer.</p><p><strong>Background data: </strong>Esophageal cancer has a very poor prognosis in advanced stages, with 5-year survival rates below 6% in stage IV disease. Although current guidelines generally discourage surgery in metastatic patients, selected cases with oligometastatic disease may benefit from esophagectomy within a multimodal treatment framework.</p><p><strong>Methods: </strong>We retrospectively reviewed a prospectively maintained database of 437 esophagectomies performed between January 2013 and June 2024. Sixty patients with pathological stage IV esophageal carcinoma (AJCC 8th edition) were included, including adenocarcinoma, squamous cell carcinoma, and undifferentiated tumors. Patients were divided into stage IV-A (<i>n</i> = 39) and stage IV-B (<i>n</i> = 21), all of whom were oligometastatic according to the OMEC classification. The primary endpoints were overall survival (OS) and disease-free survival (DFS).</p><p><strong>Results: </strong>Median age was 63.5 years, and 61.7% of patients were male. Neoadjuvant chemoradiotherapy was administered in 48.3% of cases. Postoperative morbidity was 43.3%, and in-hospital mortality rate of 5%, showing no significant differences between groups. Median OS was significantly longer in stage IV-A compared with stage IV-B (18.0 versus 8.0 months, <i>P</i> = .003), as was median DFS (10.0 versus 3.0 months, <i>P</i> = .010). Among stage IV-B patients, survival differed according to metastatic site, with better outcomes in nodal-only disease.</p><p><strong>Conclusion: </strong>Esophagectomy may be feasible in highly selected stage IV patients, offering meaningful survival in stage IV-A cases, while outcomes in stage IV-B remain limited and influenced by metastatic pattern.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261486385"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876709","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":"SADI-S Versus Distal OATB (SASI): Does the Duodenal Pathway Matter in Ileal-Level Single-Anastomosis Surgery?","authors":"Patrick Noel, Carlos Augusto Scussel Madalosso, Paulo Reis Rizzo Esselin de Melo, Sergio Santoro, Moises Jacobs, Nilton T Kawahara, Victor Ramos Mussa Dib","doi":"10.1177/10926429261449961","DOIUrl":"10.1177/10926429261449961","url":null,"abstract":"<p><strong>Background: </strong>Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SG) (SADI-S) and distal one anastomosis transit bipartition (dOATB) represent two distal single-anastomosis metabolic procedures sharing similar anatomical configurations but differing fundamentally in their approach to duodenal transit. Both combine SG with an omega-loop anastomosis to the distal ileum approximately 250-300 cm from the ileocecal valve. However, SADI-S positions the anastomosis on the duodenal bulb, achieving complete duodenal exclusion, while dOATB performs a prepyloric antral anastomosis, preserving duodenal transit through a bipartition mechanism. This fundamental difference raises a critical question: Does complete duodenal exclusion matter for metabolic outcomes in distal intestinal procedures?</p><p><strong>Methods: </strong>We conducted a narrative review comparing anatomical, physiological, and clinical aspects of SADI-S and dOATB, emphasizing the role of duodenal exclusion in weight loss (WL), metabolic improvements, and nutritional consequences. We examined the hypotheses to provide a theoretical framework for understanding these procedures.</p><p><strong>Results: </strong>Both procedures demonstrate excellent WL, with total WL ranging from 35% to 45% and excess WL exceeding 80% at medium-term follow-up. Type 2 diabetes remission rates are remarkably high in both groups (85%-95%). SADI-S has a more extensive evidence base with longer follow-up and IFSO and ASMBS endorsement. Distal OATB, while demonstrating comparable metabolic efficacy, offers theoretical advantages in nutritional preservation through maintained duodenal transit and facilitated endoscopic access to the biliopancreatic system. The holoileum hypothesis suggests that adequate ileal stimulation through an elongated common channel may be more important than duodenal exclusion <i>per se</i>.</p><p><strong>Conclusions: </strong>Current evidence suggests that excellent metabolic outcomes can be achieved with distal single-anastomosis procedures regardless of duodenal exclusion status. The elongated common channel and ileal stimulation appear to be the critical determinants of metabolic success. Distal OATB may offer advantages in nutritional preservation and endoscopic accessibility while maintaining comparable metabolic efficacy. Prospective randomized trials directly comparing these procedures are warranted.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"641-649"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845449","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 Compared to Laparoscopic Resection of Rectal Cancer in Patients Aged ≥65 Years: A Propensity Score-Matched Analysis of the NCDB.","authors":"Noam Kahana, Sameh Hany Emile, Michal Perets, Elad Boaz, Nir Horesh, Zubair Bayat, Maher Al Khaldi, Anjelli Wignakumar, Steven D Wexner","doi":"10.1177/10926429261444874","DOIUrl":"10.1177/10926429261444874","url":null,"abstract":"<p><strong>Background: </strong>Older adults constitute a large proportion of patients with rectal cancer, yet rectal-specific comparative data on minimally invasive approaches remain limited. This study compared outcomes of laparoscopic versus robotic rectal resection in patients aged ≥65 years.</p><p><strong>Methods: </strong>We performed a retrospective analysis of patients with stage I-III rectal adenocarcinoma from the U.S. National Cancer Database (NCDB) from 2010 to 2021. Patients undergoing laparoscopic or robotic-assisted surgery were identified and propensity-score matched for clinically relevant covariates. The primary outcome was conversion to open surgery. Secondary outcomes included short-term mortality, readmission, hospital stay, pathological outcomes, and 5-year overall survival (OS).</p><p><strong>Results: </strong>Among 18,877 eligible patients, 4099 patients were matched in each group. Robotic surgery was more frequently performed for patients with stage III tumors (45.0% versus 36.9%), elevated carcinoembryonic antigen levels (60.2% versus 48.1%), and those who underwent abdominoperineal resection (25.2% versus 18.9%). After matching, robotic surgery was associated with a significantly lower conversion rate compared with laparoscopy (6.2% versus 14.9%; OR 0.38, 95% CI 0.33-0.44; <i>P</i> < .001). No significant differences were observed in 30-day mortality (1.2% versus 1.5%), 90-day mortality (2.5% versus 2.7%), unplanned 30-day readmission (7.3% versus 7.6%), or 5-year OS (70.5% versus 69.0%; <i>P</i> = .062). Median hospital stay was 5 days for both groups. Suboptimal lymph node yield (<12 nodes) was more frequent after laparoscopy (27.7% versus 24.1%; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>In older adults with rectal cancer, robotic surgery was associated with significant reduction in conversion rates and potentially modestly improved lymph node harvest, while both approaches provided comparable safety and long-term oncologic outcomes.These findings must be considered in the context of the heterogenous definitions of conversion and the availability of the robotic platform and training in both robotic and laparoscopic technqiues.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"633-640"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700646","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":"Evaluation of the Learning Curve of Freehand Transperineal Prostate Biopsy Performed Under Local Anesthesia.","authors":"Ali Emre Fakir, Alper Bitkin, Mithat Ekşi, Azad Akdağ, Mehmet Karadağ, Ahmet Koşargelir, Serdar Karadağ, Hakan Polat, Taner Kargı, Ali İhsan Taşçı","doi":"10.1177/10926429261481659","DOIUrl":"https://doi.org/10.1177/10926429261481659","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the learning curve (LC) of office-based freehand transperineal prostate biopsy (f-TPBx) performed under local anesthesia and its correlation with the operator experience.</p><p><strong>Methods: </strong>A total of 176 patients who underwent f-TPBx between June and November 2023 were retrospectively analyzed. The first 44 cases of four different physicians (2 consultant urologists and 2 urology residents) were included, and patients were stratified into quartiles (Q1-Q4). The LC was assessed based on differences in procedure time, fibromuscular core rates, cancer detection rates, and complication rates across quartiles. A multivariate analysis was performed to identify factors affecting procedure time. LC of consultant urologists and urology residents was compared.</p><p><strong>Results: </strong>There was a significant reduction in procedure duration across quartiles (Q1: 22.3 ± 4.2 minutes versus Q4: 13.7 ± 4.1 minutes; <i>P</i> < .001), alongside an increase in clinical significant prostate cancer detection rates (<i>P</i> = .034). Fibromuscular core rates significantly decreased, and overall complication rates declined over time (both <i>P</i> = .001). It has been observed that the LC for consultant urologists was completed after approximately 20 cases. Cumulative SUM and locally weighted scatterplot smoothing analyses demonstrated that consultant urologists reached the plateau phase earlier. According to multivariate regression analysis, quartile variable were among the factors significantly affecting procedure time (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>The LC for f-TPBx appears to plateau after approximately 20 cases, suggesting that stable procedural performance can be achieved within a relatively short period. The technique provides notable advantages, including high patient comfort, a strong safety profile, and rapid learnability, which support its successful integration into clinical practice.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"10926429261481659"},"PeriodicalIF":1.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820195","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}