Journal of minimally invasive surgery最新文献

{"title":"Super-selective distal splenic artery embolization-assisted laparoscopic partial splenectomy for a benign splenic cyst: a case report.","authors":"Tze Hee Zac Tay, Doruk Seyfi, Muddassir Rashid, Ramesh Damodaran Prabha","doi":"10.7602/jmis.2026.29.3.172","DOIUrl":"10.7602/jmis.2026.29.3.172","url":null,"abstract":"<p><p>Splenic cysts are uncommon, and contemporary management increasingly favors minimally invasive, spleen-preserving approaches. Partial splenectomy provides definitive treatment but may be limited by intraoperative bleeding risk. Selective distal splenic artery embolization (SAE) can reduce arterial inflow, create a parenchymal demarcation plane, and facilitate safer resection. We report the case of an 18-year-old male patient with a recurrent symptomatic splenic cyst who underwent super-selective distal SAE followed by laparoscopic partial splenectomy the following day. Embolization produced a clear revascularized upper-pole segment, enabling precise transection while preserving the remaining spleen. Estimated blood loss was 150 mL, recovery was uneventful, and histopathology confirmed a benign squamous cyst. Follow-up imaging at 3 months demonstrated preserved splenic tissue and no recurrence, with full return to contact sports. To our knowledge, laparoscopic partial splenectomy performed after selective distal SAE for a benign splenic cyst has not previously been described and may expand spleen-preserving options in carefully selected patients.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 3","pages":"172-176"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979192","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":"Intraoperative \"white test\" for bile leak detection during liver resection: a video vignette.","authors":"Nicola Colucci, Anastasios D Giannou, Muhammad Uzair Khalid, Maja Segedi, Stéphanie Chartier-Plante, Peter Tw Kim, Michael S Bleszynski, Graziano Oldani","doi":"10.7602/jmis.2026.29.3.167","DOIUrl":"10.7602/jmis.2026.29.3.167","url":null,"abstract":"<p><p>Postoperative bile leak remains a significant source of morbidity after liver resection, especially following major or complex hepatectomies. The intraoperative \"white test\" is a simple technique to improve detection of bile leaks through retrograde injection of a lipid emulsion into the biliary tree, enabling direct visualization of open bile ducts on the transection surface. We report its use during a minimally invasive extended left hepatectomy for colorectal liver metastases. After parenchymal transection, the white test was performed via the cystic duct stump using Intralipid (Fresenius Kabi), identifying a focal bile leak near the left pedicle stapling line, which was promptly secured. The postoperative course was uneventful, with no bile leak or liver-related complications. Follow-up imaging showed no recurrence or biloma. This case highlights the technical simplicity and high visual contrast of the white test for intraoperative bile leak detection, with the accompanying video offering added educational value beyond a written description.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 3","pages":"167-171"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979104","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":"User perceptions of an artificial intelligence-based computer-aided detection system in colonoscopy: a single-center exploratory survey study.","authors":"Seon Yeong Ko, Byung Chang Kim, Chang Won Hong, Bun Kim, Kyung Su Han, Dae Kyung Sohn","doi":"10.7602/jmis.2026.29.3.140","DOIUrl":"10.7602/jmis.2026.29.3.140","url":null,"abstract":"<p><strong>Purpose: </strong>Artificial intelligence (AI)-based computer-aided detection (AI-CADe) systems can improve adenoma detection during colonoscopy. However, successful clinical implementation depends on diagnostic performance and user acceptance, usability, and workflow integration. This study evaluated user perceptions before and after the clinical implementation of AI-CADe.</p><p><strong>Methods: </strong>This single-center, repeated, cross-sectional descriptive survey evaluated the endoscopy unit staff perceptions of AI-CADe at the National Cancer Center. Two anonymous online surveys were administered before and 1 month after the system installation. The surveys assessed the perceived diagnostic benefits, workflow impact, user satisfaction, concerns regarding false-positive detection, dependence on AI, and factors influencing acceptance and continued use. The analyses were descriptive and exploratory.</p><p><strong>Results: </strong>Twenty-nine and 25 participants completed the pre- and post-installation surveys, respectively. Positive responses regarding the interest in AI-CADe, perceived adenoma detection rate improvement, expected lesion removal, patient satisfaction, procedural satisfaction, and workflow impact were reported in both survey phases. Concerns regarding overdetection, unnecessary biopsies, and increased dependence on AI were also reported. Accuracy and sensitivity were the most frequently selected adoption factors, followed by cost and false-positive rates. Open-ended feedback included positive comments regarding lesion recognition, procedural support, and limitations related to repeated alerts, false-positive alarms, delayed detection, and system responsiveness.</p><p><strong>Conclusion: </strong>Endoscopy unit staff members showed favorable perceptions of AI-CADe and recognized its potential value in colonoscopy practice. However, concerns regarding false-positive detection, workflow integration, and dependence on AI indicate the need for user-centered optimization and long-term real-world evaluation.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 3","pages":"140-147"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979121","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 single-port totally extraperitoneal inguinal hernia repair with excision of a canal of Nuck cyst using the da Vinci SP system: a video vignette","authors":"Chul Seung Lee, Choon Sik Chung, Gwan Cheol Lee, Dong Geun Lee","doi":"10.7602/jmis.2026.29.3.163","DOIUrl":"10.7602/jmis.2026.29.3.163","url":null,"abstract":"<p><p>The da Vinci single‑port (SP) robotic system (Intuitive Surgical, Inc.) provides enhanced dexterity and visualization through a single incision, making it effective for complex groin pathology in women. We report a 46‑year‑old female with a long history of right inguinal bulge and pain. Preoperative imaging revealed a cystic lesion over 3 cm along the round ligament, closely associated with an indirect hernia sac, consistent with a canal of Nuck cyst. Because complete excision is essential to relieve symptoms and prevent recurrence, robotic SP totally extraperitoneal (TEP) hernia repair with cyst excision was performed. A 10 × 15‑cm self‑adhesive mesh was deployed using the Hansol‑roll method. Operative and console times were 58 and 45 minutes, respectively. The patient was discharged on postoperative day 1 without complications. This case highlights the safety and efficacy of robotic SP TEP repair for simultaneous management of hernia and canal of Nuck cyst.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 3","pages":"163-166"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979181","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":"Decision-centered artificial intelligence for perioperative care outside the operating room: a practical review for surgeons.","authors":"Soyul Han","doi":"10.7602/jmis.2026.29.3.117","DOIUrl":"10.7602/jmis.2026.29.3.117","url":null,"abstract":"<p><p>Artificial intelligence (AI) is increasingly being applied across the spectrum of surgical care; however, most existing review articles have organized prior studies primarily by algorithmic type or predicted outcomes. Consequently, a structured understanding of \"when\" and \"why\" AI is integrated into real-world clinical workflows, and how its outputs inform surgical decisionmaking, remains insufficiently developed. Although both the preoperative and postoperative phases involve risk prediction, they differ fundamentally in their decision contexts, data characteristics, and modes of clinical application. This review sought to reorganize the surgical AI literature using a decision-centered framework. AI applications during the operation itself-including surgical video analysis, robotic automation, and real-time image guidance-are outside the scope of this review. Instead, this review focuses on AI that supports decision-making before and after surgery, emphasizing decision points relevant to minimally invasive surgical practice, including patient selection, treatment planning, surgical extent and approach planning, postoperative monitoring, discharge readiness, and surveillance planning. This review examined PubMed-indexed studies published between 2015 and 2025, analyzing the literature according to the clinical decision points each study was intended to support, rather than emphasizing comparative model performance. Among the studies reviewed, preoperative AI was predominantly applied to support patient selection and treatment planning in the context of diagnostic uncertainty. In contrast, postoperative AI was mainly used to support time-sensitive management and prognostic assessment. This review reframes surgical AI not as a standalone predictive instrument, but as an integral component of phase-specific clinical decision pathways across the surgical care continuum.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 3","pages":"117-129"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979008","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":"Operative workflow characterization of the Hugo robotic-assisted surgery and da Vinci Multiport systems in left-sided colorectal surgery: a single-institution pilot analysis.","authors":"Jae Hyun Park, Youngjin Kim, Min Jung Kim, Ji Won Park, Seung-Bum Ryoo, Kyu Joo Park, Seung-Yong Jeong","doi":"10.7602/jmis.2026.29.3.130","DOIUrl":"10.7602/jmis.2026.29.3.130","url":null,"abstract":"<p><strong>Purpose: </strong>The modular four-cart design of the Hugo robotic-assisted surgery (RAS) system raises a practical concern: does it impose a greater operative workflow burden than established platforms? We characterized operative workflow across the Hugo RAS and da Vinci Multiport systems, incorporating a concurrent mature-adoption Multiport cohort as an institutional maturity reference.</p><p><strong>Methods: </strong>This retrospective study analyzed 15 consecutive qualifying cases per cohort: Hugo RAS, initial da Vinci Multiport (de novo adoption), and recent da Vinci Multiport (mature adoption, concurrent with Hugo RAS). Primary endpoints were workflow time intervals across five phases derived from prospectively recorded timestamps. Secondary endpoints included 30-day complications, TME completeness, lymph node yield, and resection margin status.</p><p><strong>Results: </strong>Hugo RAS access phase (27 minutes; IQR, 20-55 minutes) was equivalent to both the initial (p > 0.999) and recent Multiport cohorts (p = 0.693). Nonsurgical time was equivalent between Hugo RAS and recent Multiport cohorts (45 vs. 40 minutes; p = 0.461), operated by the same team at identical institutional maturity. Workflow differences between Hugo RAS and initial Multiport were mirrored by equivalent differences between initial and recent Multiport cohorts-implicating institutional maturity rather than platform effects. TME completeness was 100% in all evaluable cases, and lymph node yield was equivalent across all cohorts (all pairwise p > 0.999).</p><p><strong>Conclusion: </strong>The Hugo RAS four-cart architecture did not impose a greater workflow burden than the da Vinci Multiport system under equivalent institutional conditions. Remaining differences reflected case-mix heterogeneity and asymmetric adoption maturity, supporting continued multi-platform robotic colorectal program development.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 3","pages":"130-139"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979142","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":"Short-term safety and feasibility of laparoscopic-endoscopic cooperative surgery for gastric subepithelial tumors: a retrospective observational study of the first single-center experience in Mongolia.","authors":"Khaliunaa Battulga, Amarbat Baatarnum, Ganbaatar Rentsenbalbar, Jargalsaikhan Duntei, Erdene-Ochir Yansan, Souya Nunobe","doi":"10.7602/jmis.2026.29.3.148","DOIUrl":"10.7602/jmis.2026.29.3.148","url":null,"abstract":"<p><strong>Purpose: </strong>Laparoscopic-endoscopic cooperative surgery (LECS) is a minimally invasive, organ-preserving approach for gastric subepithelial tumors (SETs). Although well established in high-volume East Asian centers, its use in Mongolia has not been reported. We report on our first experience and assess short-term safety and feasibility.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients who underwent LECS for gastric SETs at the National Cancer Center of Mongolia (November 2022-May 2025). Clinicopathologic characteristics, operative outcomes, and postoperative events were analyzed; complications were graded by the Clavien-Dindo classification.</p><p><strong>Results: </strong>Thirty-five patients underwent LECS during the study period. The mean age was 55 ± 12 years, and 60% were female. The mean tumor size was 27 ± 11 mm, and most tumors originated from the fourth endoscopic ultrasonography layer (muscularis propria). Histopathological analysis revealed that gastrointestinal stromal tumors accounted for 65.7% of all resected lesions. The mean operative time was 118 ± 57 minutes, and the mean blood loss was 44 ± 20 mL. All procedures were completed laparoscopically with R0 resection and no conversion to open surgery. No postoperative complications of Clavien-Dindo grade ≥II occurred. The mean postoperative hospital stay was 5.9 ± 0.9 days, and no reoperation, readmission, or recurrence was observed during a mean follow-up of 17.8 ± 7.2 months.</p><p><strong>Conclusion: </strong>LECS was safely introduced in Mongolia, achieving excellent perioperative outcomes and complete resection. These findings support LECS as a feasible, function-preserving option for appropriately selected gastric SETs.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 3","pages":"148-157"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979136","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":"Optimizing ergonomics during laparoscopic cholecystectomy in situs inversus abdominis with levocardia: a technical note.","authors":"Vikram Saini, Parshant Kumar, Saikumar Kumbar, Sourabh Meena, Tulsi Ratilal Patodia","doi":"10.7602/jmis.2026.29.3.177","DOIUrl":"10.7602/jmis.2026.29.3.177","url":null,"abstract":"<p><p>Laparoscopic cholecystectomy in patients with situs inversus abdominis with levocardia is technically challenging because of mirror-image anatomy and unfamiliar ergonomics. We describe technical modifications for safe laparoscopic cholecystectomy in a 38-year-old woman with symptomatic cholelithiasis. Preoperative imaging confirmed left-sided positioning of the liver and gallbladder with a normally positioned heart. A modified four-port configuration with mirrored subcostal ports was used, with the surgeon positioned on the patient's right side. Hartmann's pouch was retracted with the dominant right hand, while Calot's triangle was dissected through the epigastric port with the left hand. After adhesiolysis, an anomalous cystic artery located to the right of the cystic duct was identified. The critical view of safety was achieved before division of the cystic structures. The procedure was completed without complications, and the patient was discharged on postoperative day 1. Individualized port placement and surgeon positioning may facilitate safe surgery in patients with situs anomalies.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 3","pages":"177-180"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979130","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":"Non-exposure organ-preserving resection of gastric gastrointestinal stromal tumors using the CLEAN-NET technique.","authors":"Chatbadin Thongchuam, Chainarong Phalanusitthepha, Vitoon Chinswangwatanakul, Thawatchai Akaraviputh, Asada Methasate, Jirawat Swangsri, Tharathorn Suwatthanarak","doi":"10.7602/jmis.2026.29.3.158","DOIUrl":"10.7602/jmis.2026.29.3.158","url":null,"abstract":"<p><p>Gastric gastrointestinal stromal tumors (GISTs) require oncologically safe resection while preserving gastric function. The Combination of Laparoscopic and Endoscopic Approaches to Neoplasia with Non-Exposure Technique (CLEAN-NET) integrates laparoscopic and endoscopic guidance to achieve full-thickness gastric resection while minimizing deformity and preventing tumor exposure. We present a video demonstration of CLEAN-NET in a 73-year-old female with a 4 cm gastric GIST at the lesser curvature near the incisura angularis. A cooperative laparoscopic-endoscopic approach was employed, including endoscopic submucosal injection, circumferential seromuscular incision, and tumor eversion into the peritoneal cavity. Full-thickness resection was completed using a laparoscopic linear stapler without spillage. The patient recovered uneventfully, resumed oral intake early, and was discharged without complications. Pathology confirmed a low-risk GIST with negative margins. CLEAN-NET is a safe, reproducible, and organ-preserving technique for selected gastric GISTs.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 3","pages":"158-162"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979166","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":"Minimally invasive surgery in the elderly population in Korea: temporal trends across major abdominal surgeries.","authors":"Kyung Sik Kim","doi":"10.7602/jmis.2026.29.2.61","DOIUrl":"10.7602/jmis.2026.29.2.61","url":null,"abstract":"<p><p>Korea's rapid transition toward a super-aged society has markedly increased the demand for major abdominal surgery in older adults. Although minimally invasive surgery (MIS) provides perioperative advantages, including reduced surgical trauma, lower blood loss, and accelerated postoperative recovery, it also introduces pathophysiological challenges that require preoperative evaluation and risk stratification. This presidential lecture summarizes trends in geriatric surgery in Korea, highlights perioperative considerations for elderly patients undergoing MIS, and presents longitudinal outcomes from Severance Hospital. Surgical trends and perioperative outcomes were evaluated for major abdominal procedures, including gastrectomy, colectomy, major hepatectomy, and pancreatoduodenectomy (PD), in patients aged ≥70 years. Analyses demonstrated a progressive transition from open surgery toward minimally invasive approaches. Laparoscopic and robotic techniques have become the predominant approaches for gastrectomy and colectomy, including in octogenarians, while MIS adoption for complex procedures, such as major hepatectomy and PD, has also expanded substantially. Comparative analyses within this elderly cohort demonstrated that MIS was associated with superior perioperative outcomes compared with open surgery, including significantly reduced estimated blood loss, shorter hospitalization, and lower rates of clinically significant complications, such as postoperative pancreatic fistula, without compromising procedural safety. Advances in surgical technology and accumulated institutional expertise have established MIS as a feasible, standardized approach for major abdominal surgery in older adults. Integrating comprehensive preoperative assessment, particularly frailty screening, with the selective application of MIS may represent the optimal strategy for reducing operative risk and promoting postoperative functional recovery in geriatric surgical care.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"29 2","pages":"61-69"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13279652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273984","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}