Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery最新文献

{"title":"Endoscopic ultrasound-guided radiofrequency ablation of pancreatic insulinoma.","authors":"Silvia Johanna Lozada-Calle, Mateus Pereira Funari, Matheus de Oliveira Veras, Rayssa Kethlyn Alves de Campos, Jurandir Batista da Cruz Junior, Wanderley Bernardo, Eduardo Guimarães Hourneaux de Moura","doi":"10.1590/0102-67202025000052e1921","DOIUrl":"10.1590/0102-67202025000052e1921","url":null,"abstract":"<p><strong>Background: </strong>Insulinoma is a rare pancreatic neuroendocrine tumor (pNET) arising from beta cells, leading to excessive insulin secretion and life-threatening hypoglycemia. While surgical resection remains the gold standard, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as a minimally invasive alternative, particularly for patients unfit for surgery.</p><p><strong>Aims: </strong>A meta-analysis was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to compare the efficacy and safety of EUS-RFA and surgery for pancreatic insulinomas.</p><p><strong>Methods: </strong>Systematic searches were conducted in PubMed, Cochrane Library, Embase, and Scopus, using MeSH terms related to insulinoma, RFA, and surgery. Eligible studies included cohort studies and case series reporting clinical outcomes, adverse events, recurrence rates, and hospitalization. Statistical analyses were performed with Comprehensive Meta-analysis Software and RevMan 5.</p><p><strong>Results: </strong>A total of 20 studies were included, comprising 142 patients treated with EUS-RFA and 249 with surgery. Clinical success was higher in the EUS-RFA group (97.5%) compared with surgery (88.9%). Patients undergoing EUS-RFA experienced fewer complications (23 vs. 59%), shorter hospital stays (mean 2.4 vs. 11 days), and zero procedure-related mortality. However, recurrence rates were greater with EUS-RFA (11%) than with surgery (4.8%). No significant differences were found in overall survival during follow-up.</p><p><strong>Conclusions: </strong>EUS-RFA is a safe, effective, and less invasive option for managing pancreatic insulinomas, ensuring rapid recovery and fewer complications. Nevertheless, its higher recurrence rate highlights the importance of patient selection and strict follow-up. Surgery remains the treatment of choice in resectable cases, while EUS-RFA represents a valuable alternative in high-risk or inoperable patients.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1921"},"PeriodicalIF":1.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prompt engineering in medical education. Dissecting the new technological frontier in Digestive Surgery.","authors":"Ozimo Pereira Gama Filho, Breno Dias Lima Ribeiro, Paulo Kassab","doi":"10.1590/0102-67202026000007e1936","DOIUrl":"10.1590/0102-67202026000007e1936","url":null,"abstract":"<p><p>Generative Artificial Intelligence (AI) has become a tangible reality in medical education, yet many struggle to interact effectively with these models. This editorial introduces Prompt Engineering as the modern \"digital stethoscope\"-a systematic approach to maximize AI potential. A structured prompt relies on four pillars (Context, Request, Persona, Format) and advances through four levels of complexity. Strategies like instructing the AI to \"think step by step\" mitigate logical errors in clinical tasks. However, users must remain vigilant against AI \"hallucinations\" and phantom citations by using verified databases. Ultimately, while AI processes vast data, human clinical judgment remains the irreplaceable filter for patient safety.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1936"},"PeriodicalIF":1.8,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced handgrip strength and body mass index, gender, and diagnosis are associated with length of stay in hospitalized patients.","authors":"Lucas Rosasco Mazzini, Vania Aparecida Leandro-Merhi","doi":"10.1590/0102-67202026000005e1934","DOIUrl":"10.1590/0102-67202026000005e1934","url":null,"abstract":"<p><strong>Background: </strong>Handgrip strength assessment may be a useful indicator for nutritional diagnosis and association with outcomes.</p><p><strong>Aims: </strong>To investigate the relationship between handgrip strength and clinical outcomes in hospitalized patients.</p><p><strong>Methods: </strong>A cross-sectional study with 100 patients, investigating clinical outcome variables and explanatory variables (disease, surgery, comorbidities, gender, age, handgrip strength, body mass index, and subjective global assessment). The χ2 test, Fisher's exact test, Mann-Whitney test, Spearman correlation coefficient, simple and multiple Cox regression analysis, and the Poisson regression model were used for data analysis.</p><p><strong>Results: </strong>The variables that, together, best explained the length of hospital stay were handgrip strength (p<0.0001; estimated parameter=-0.020432; standard error=0.003443), body mass index (p<0.0001; estimated parameter=-0.029020; standard error=0.004952), gender (p<0.0001; estimated parameter=0.302456; standard error=0.069615), and diagnosis. Body mass index and handgrip strength were inversely associated with the length of hospital stay. Male gender and vascular or orthopedic disease, compared to other diseases, were also associated with a higher length of hospital stay. No variable was considered an associated factor for complications.</p><p><strong>Conclusions: </strong>Handgrip strength and body mass index were inversely associated with the length of hospital stay. Male gender and vascular or orthopedic disease, compared to other diseases, were associated with a higher length of hospital stay.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1934"},"PeriodicalIF":1.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probe-based confocal laser endomicroscopy for prediction of uterine rejection in a patient submitted to live-donor uterus transplantation.","authors":"Adriana Vaz Safatle-Ribeiro, Dani Ejzenberg, Fernanda Carvalho Franco, José Maria Soares Junior, Edmundo Chada Baracat, Pedro Augusto Monteleone, Wellington Andraus","doi":"10.1590/0102-67202026000008e1937","DOIUrl":"10.1590/0102-67202026000008e1937","url":null,"abstract":"<p><p>Uterus transplantation is a relatively new procedure, with successful births performed using living donors in Sweden since 2014 and a deceased donor, for the first time in Brazil, in 2016. Probe-based confocal endomicroscopy is considered an optical biopsy method (with 1000 times magnification), allowing detailed visualization of tissue cytoarchitecture and microvascular patterns at a penetration depth of approximately 50 to 60 μm. The application of confocal endomicroscopy to the uterine cervix emerges as a promising alternative to weekly cervical examinations in the follow-up of patients who have undergone uterus transplantation. The authors report the case of a 34-year-old woman with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, diagnosed at 15 years of age, who in August 2026 underwent the first successful live-donor uterus transplantation performed in Latin America. The surgical procedure was uneventful. The confocal endomicroscopy of the uterine cervix was employed to evaluate its potential utility in identifying inflammatory changes that might precede graft rejection. No irregular or distorted epithelium or severe inflammation was observed, and this finding was confirmed by biopsies and histological analysis. They concluded that the probe-based confocal endomicroscopy may support more effective and individualized post-transplant management, representing a meaningful advancement in the fields of regenerative medicine and transplantation. Uterus transplantation is a relatively new procedure, with successful births performed using living donors. More than 100 transplants have already been performed in recent years in various countries around the world, achieving excellent results. Probe-based confocal endomicroscopy (pCLE) is considered an optical biopsy method (with 1000 times magnification), allowing detailed visualization of tissue cytoarchitecture and microvascular patterns at a penetration depth of approximately 50 to 60 μm. The application of confocal endomicroscopy to the uterine cervix has previously been reported as an adjunctive tool for guiding targeted biopsies during colposcopy evaluation. The use of pCLE in the follow-up of patients undergoing uterus transplantation enables early detection of graft rejection while avoiding the risks associated with biopsy.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1937"},"PeriodicalIF":1.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication: a novel method to demonstrate postoperative morphology and better understand hiatal hernia recurrence.","authors":"Renato Abrantes Luna, Vitor Moreira Sardenberg, Romulo Varella de Oliveira, Gerson da Silva Ribeiro, Maria Eduarda Azevedo Lima, Heron Werner Junior, Daiane Decker, John G Hunter","doi":"10.1590/0102-67202026000006e1935","DOIUrl":"10.1590/0102-67202026000006e1935","url":null,"abstract":"<p><strong>Background: </strong>Collis gastroplasty for esophageal lengthening is a complex adjunct to hiatal hernia repair in patients with esophageal foreshortening.</p><p><strong>Aims: </strong>To study the final morphology of the repair using state-of-the-art imaging: computed tomography with three-dimensional reconstruction.</p><p><strong>Methods: </strong>Nine patients with prior Collis gastroplasty and hiatal hernia repair were studied with three-dimensional computed tomography reconstruction to evaluate the anatomy of the repair and screen for hiatal hernia recurrence. Secondary outcomes were quality of life and surgical morbidity.</p><p><strong>Results: </strong>After a medium follow-up of 34 months, objective recurrence of the hiatal hernia was observed in three patients (1.5, 2.2, and 3 cm), and two patients were symptomatic. The gastroesophageal junction tube (neo-esophagus) created by the gastroplasty was similar in shape and volume to the native esophagus in all patients. The fundoplication previously performed covered the neo-esophagus in only two of the nine patients. No fistulas or mortality were observed.</p><p><strong>Conclusions: </strong>Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication reliably demonstrates postoperative anatomy and helps better understand hiatal hernia recurrence.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1935"},"PeriodicalIF":1.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delta Madureira Filho. Former President of the Brazilian College of Digestive Surgery (2019-2020).","authors":"José Eduardo Ferreira Manso","doi":"10.1590/0102-67202026000009e1938","DOIUrl":"10.1590/0102-67202026000009e1938","url":null,"abstract":"","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1938"},"PeriodicalIF":1.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First robotic telesurgery applied to bariatric surgery in Latin America: technical fundamentals, operational challenges and perspectives in clinical practice.","authors":"Paulo Afonso Nunes Nassif, Osvaldo Malafaia, Gualter Lisboa Ramalho, Augusto de Almeida Junior, Rafael Mourato Inácio da Silva, Mariano Palermo, Leandro Totti Cavazzola, Marcelo de Paula Loureiro","doi":"10.1590/0102-672020260000010e1939","DOIUrl":"10.1590/0102-672020260000010e1939","url":null,"abstract":"<p><strong>Background: </strong>The use of robotic systems in bariatric surgery has reached a stage of maturity that supports its application with consistent results in the management of severe obesity. At the same time, the improvement of communication networks and digital support bases has renewed the debate on telesurgery as an alternative to extend the reach of specialized surgical care, particularly in contexts marked by the unequal concentration of highly complex services.</p><p><strong>Aims: </strong>To present the first teleassisted bariatric robotic operation in Latin America between two states of Brazil separated by 3,200 km, in order to demonstrate its operational capacity in real time.</p><p><strong>Methods: </strong>Vertical gastrectomy was performed with two separate teams: one performing the procedure in the metropolitan area of Curitiba (PR), and the other in the city of João Pessoa (PB), both in Brazil.</p><p><strong>Results: </strong>The procedure was performed without significant operative differences when compared to the face-to-face system and in the same way that it could have been done without the use of telesurgery.</p><p><strong>Conclusions: </strong>Within this transition process, robotic assisted bariatric surgery stands out as a strategic environment for experimentation, systematic evaluation and consolidation, giving access to new approaches, such as telesurgery, contributing to the construction of a more integrated and innovative surgical model.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1939"},"PeriodicalIF":1.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central pancreatectomy: a Latin American experience of parenchyma-sparing surgery for benign and low-grade pancreatic neoplasms.","authors":"Danny Conde-Monroy, Guilherme Naccache Namur, Francisco Tustumi, Lucas Cata Preta Stolzemburg, Ricardo Jureidini, José Jukemura, Ulysses Ribeiro Junior, Paulo Herman, Thiago Costa Ribeiro","doi":"10.1590/0102-67202026000003e1932","DOIUrl":"10.1590/0102-67202026000003e1932","url":null,"abstract":"<p><strong>Background: </strong>Central pancreatectomy (CP) is a parenchyma-sparing alternative to standard resections for benign or low-grade lesions of the pancreatic neck. While it aims to preserve endocrine and exocrine function, it is associated with significant technical complexity and high rates of postoperative pancreatic fistula (POPF).</p><p><strong>Aims: </strong>To analyze the CP at a single high-volume Brazilian center.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained database was conducted. All patients undergoing CP at a single high-volume Brazilian center between January 2009 and December 2024 were included. Data on demographics, operative details, pathology, complications (International Study Group of Pancreatic Surgery - ISGPS/Clavien-Dindo criteria), and long-term pancreatic function were collected.</p><p><strong>Results: </strong>Twenty-two patients underwent CP (mean age 54 years, 72% female). The majority of lesions were cystic (50%) or neuroendocrine tumors (36.4%). The POPF rate was 86.4%, all Grade B, most managed conservatively via prolonged drainage. No Grade C fistulas, postoperative hemorrhages, or mortality occurred. Delayed gastric emptying occurred in 22.7%. After a median follow-up of 5.59 years, endocrine insufficiency developed in 9% of patients without prior diabetes (none insulin-dependent), and exocrine insufficiency in 13.6%. Only one locoregional recurrence was observed (isolated metastasis).</p><p><strong>Conclusions: </strong>This first Latin American series demonstrates that central pancreatectomy is a feasible and effective parenchyma-sparing procedure. It provides excellent long-term preservation of pancreatic function with low severe morbidity, despite high rates of manageable POPF. These outcomes support its role as a valuable surgical option for selected patients in experienced centers.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1932"},"PeriodicalIF":1.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anal fistulas: do classification systems predict surgical outcomes?","authors":"José Américo Bacchi Hora, Lucas Faraco Sobrado, Carlos Walter Sobrado, Natally Horvat, Carlos Frederico Sparapan Marques, Ulysses Ribeiro Junior, Sérgio Carlos Nahas","doi":"10.1590/0102-67202025000058e1927","DOIUrl":"10.1590/0102-67202025000058e1927","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anal fistulas remain challenging in colorectal surgery, with recurrence and postoperative incontinence common despite advances in treatment. Multiple classification systems exist, but their predictive value for surgical and functional outcomes is unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;The aim of this study was to compare Parks, American Society of Colon and Rectal Surgeons (ASCRS), and St. James's University Hospital (SJUH) MRI-based classifications in predicting surgical outcomes, including continence preservation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Retrospective analysis of 89 patients undergoing definitive surgical treatment for anorectal fistulas at a single referral center (2012-2019). Exclusions included rectovaginal fistulas, Crohn's disease, or prior pelvic radiotherapy. Fistulas were classified using Parks, ASCRS, and, when available, SJUH (n=49). Outcomes included the number of procedures, type of initial procedure, fistula closure, and closure without continence deterioration. Continence was assessed using the Cleveland Clinic Jorge-Wexner score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Most fistulas were transsphincteric (Parks Type 2, 62%) and complex (ASCRS, 65%). Overall, 86.5% achieved fistula closure, and 73% achieved closure without continence deterioration. Parks and ASCRS were significantly associated with fistula closure with continence preservation (p=0.008 and 0.007, respectively) and type of initial procedure. Parks remained significant when considering closure alone (p=0.005), while ASCRS showed a borderline association (p=0.051). SJUH classification was associated only with procedure selection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Parks and ASCRS classifications were associated with fistula closure with continence preservation and type of initial procedure. Considering closure alone, only Parks remained significant. SJUH was limited to procedure selection. Overall, Parks and ASCRS guide surgical planning and prediction of functional outcomes, with Parks slightly more sensitive.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Central message: &lt;/strong&gt;Parks and ASCRS classifications are strongly associated with initial procedure choice and functional outcomes, including fistula closure with continence preservation. SJUH classification predicts only procedure selection. Parks appears slightly more sensitive, highlighting its value for surgical planning and anticipating postoperative function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Perspectives: &lt;/strong&gt;Accurate classification of anal fistula is essential for guiding surgical strategies and counseling patient effectively. The Parks and ASCRS classification systems help predict which fistulas are likely to close successfully while preserving continence. Understanding the strengths and limitations of each system allows clinicians to select appropriate procedures, set realistic expectations, and facilitate shared decisionmaking. This approach ultimately improves outcomes in the management of complex anal fistulas.&lt;/","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1927"},"PeriodicalIF":1.8,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic surgery for median arcuate ligament syndrome: technical aspects and imaging correlation.","authors":"Michele Andreza Fidelis Siqueira, Rafael Hardman Daim, Maria Eduarda Hardman Knaesel, Ricardo Lemos Cotta-Pereira","doi":"10.1590/0102-67202026000004e1933","DOIUrl":"10.1590/0102-67202026000004e1933","url":null,"abstract":"<p><strong>Background: </strong>Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by chronic and intermittent abdominal pain, typically postprandial, and weight loss, caused by extrinsic compression of the celiac trunk by the median arcuate ligament. The pathophysiology of the disease is not fully understood. Diagnosis is challenging due to nonspecific symptoms, and requires a careful correlation between clinical findings and imaging studies.</p><p><strong>Aims: </strong>To demonstrate the feasibility, safety, and technical aspects of robotic median arcuate ligament release using a case-based approach with detailed imaging correlation.</p><p><strong>Methods: </strong>The authors report the technical aspects in an elderly male patient with typical symptoms of MALS, who underwent robotic-assisted median arcuate ligament release using the da Vinci X platform. Preoperative evaluation included CT angiography and color Doppler ultrasound, demonstrating focal proximal celiac trunk stenosis.</p><p><strong>Results: </strong>The robotic approach allowed precise dissection and complete decompression of the celiac trunk without intraoperative complications. Postoperative imaging demonstrated resolution of the stenosis and normalization of Doppler flow parameters. The patient experienced complete symptom resolution, and remained asymptomatic after one year of follow-up.</p><p><strong>Conclusions: </strong>Robotic median arcuate ligament release is a safe and effective minimally invasive option, providing excellent visualization and precise dissection in a challenging anatomical region. This technique should be considered a valuable approach for selected patients with MALS.</p><p><strong>Central message: </strong>Robotic surgery, due to the surgeon's ergonomics and the stability of the arms and instruments, wrist movement, and magnified threedimensional vision, allows for facilitated and safe access to the origin of the celiac artery as well as the dissection of fibrous tissues, innervation, and lymphatic vessels surrounding it. Given this, robotic surgery becomes feasible, effective, and safe for treating this syndrome, and it should be considered a preferred option in selected patients.</p><p><strong>Perspectives: </strong>The median arcuate ligament syndrome should be considered in cases of abdominal pain with no defined causes. A high index of suspicion can diagnose and treat more cases. Moreover, it is expected that robotic surgery will become increasingly accessible, allowing for an expansion of its indications.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1933"},"PeriodicalIF":1.8,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}