Annals of Surgical Treatment and Research最新文献

{"title":"Clinical efficacy of parathyroid autotransplantation into the forearm muscle in thyroid surgery: a retrospective cohort study on functional restoration.","authors":"Lifen Bai, Huiyin Zhu, Ling Zhou, Sheng Liu","doi":"10.4174/astr.2026.110.5.311","DOIUrl":"10.4174/astr.2026.110.5.311","url":null,"abstract":"<p><strong>Purpose: </strong>This study was conducted to evaluate the clinical efficacy of autologous parathyroid transplantation into the forearm brachioradialis muscle during thyroid surgery and analyze the timing of graft function recovery.</p><p><strong>Methods: </strong>A total of 52 patients undergoing thyroid surgery with autologous parathyroid transplantation were selected. Serum parathyroid hormone (PTH) levels were measured at various postoperative intervals, and instances of hypoparathyroidism were recorded.</p><p><strong>Results: </strong>Postoperative PTH levels on the transplant side were significantly higher than on the non-transplant side from week 1 to 1 year. Effective graft rates were 1.9% on day 1, 40.4% at week 1, 84.6% at 1 month, and stabilized at around 73% after 1 year. Transient hypoparathyroidism was observed in 17.3% of patients, with no permanent cases.</p><p><strong>Conclusion: </strong>Autologous parathyroid transplantation into the forearm brachioradialis muscle effectively preserves parathyroid function, with grafts regaining optimal function within 2-3 months and the graft still having good secretory function 1 year after surgery.</p>","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 5","pages":"311-316"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WWP2 ubiquitin ligase promotes colorectal cancer progression by targeting p53 for degradation: an experimental study.","authors":"Seung-Jun Lee, Han-Gil Kim, Young-Tae Ju, Young-Sool Hah, Jeongyun Hwang, Jihun Choi, Jin-Kyu Cho, Chi-Young Jeong, Young-Joon Lee, Ji-Ho Park, Ju-Yeon Kim, Jae-Myung Kim, Seung-Jin Kwag","doi":"10.4174/astr.2026.110.5.331","DOIUrl":"10.4174/astr.2026.110.5.331","url":null,"abstract":"<p><strong>Purpose: </strong>Colorectal cancer (CRC) remains a leading cause of cancer-related mortality, necessitating the identification of novel therapeutic targets. The E3 ubiquitin ligase WW domain-containing E3 ubiquitin protein ligase 2 (WWP2) has been implicated in various cancers, yet its specific role and underlying molecular mechanisms in CRC are poorly understood. This study aimed to investigate the functional role of WWP2 in CRC progression and to elucidate its regulatory mechanisms.</p><p><strong>Methods: </strong>WWP2 expression was evaluated in CRC patient tissues and cell lines using immunohistochemistry, quantitative real-time polymerase chain reaction, and western blotting. The biological functions of WWP2 were assessed using <i>in vitro</i> assays for cell proliferation, migration, and invasion following adenovirus-mediated overexpression. The molecular mechanism was investigated by analyzing the protein expression levels of p53 and its downstream target, p21, via western blot. An <i>in vivo</i> xenograft mouse model was used to confirm the oncogenic role of WWP2.</p><p><strong>Results: </strong>WWP2 expression was significantly upregulated in CRC tissues. Overexpression of WWP2 promoted CRC cell proliferation, migration, and invasion. Mechanistically, increased WWP2 expression led to a marked reduction in the protein levels of the tumor suppressor p53. Consequently, the expression of the p53 downstream target, the cell cycle inhibitor p21, was also suppressed. In the xenograft model, WWP2 overexpression significantly enhanced tumor growth.</p><p><strong>Conclusion: </strong>Our findings demonstrate that WWP2 functions as an oncogene in CRC. It promotes cancer progression by destabilizing the tumor suppressor p53 and downregulating p21. This study highlights the WWP2-p53-p21 axis as a potential novel therapeutic target for CRC.</p>","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 5","pages":"331-346"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of microvascular invasion and post-resection prognosis using ADV, AFP-PIVKA-II, and MoRAL scores in hepatocellular carcinoma patients: an international multicenter cohort study with 9,061 patients.","authors":"Minha Choi, Shin Hwang, Masaki Kaibori, Minkyeong Jo","doi":"10.4174/astr.2026.110.5.317","DOIUrl":"10.4174/astr.2026.110.5.317","url":null,"abstract":"<p><strong>Purpose: </strong>Microvascular invasion (MVI) is a well-known pathological prognostic factor in hepatocellular carcinoma (HCC). This study aimed to predict MVI and to assess post-resection prognosis using the ADV (multiplication of AFP, des-γ-carboxyprothrombin-also known as proteins induced by vitamin K absence or antagonist-II [PIVKA-II], and tumor volume), AP (multiplication of AFP and PIVKA-II), and MoRAL (model to predict tumor recurrence [TR] after liver transplantation) scores.</p><p><strong>Methods: </strong>This international multicenter study included 9,061 patients who underwent hepatic resection for solitary HCC measuring 1.0-10 cm from 2010 to 2017 at ten Korean centers and 73 Japanese centers, and were followed up until 2020.</p><p><strong>Results: </strong>The receiver operating characteristic (ROC) area under the curve (AUC) for diagnosis of MVI was 0.734 for the ADV score at 4.7log, 0.684 for the AP score at 3.7log, and 0.705 for the MoRAL score at 162.0. The ADV score exhibited the strongest predictive ability for MVI. The ROC AUC for actuarial 5-year TR was 0.586 for the ADV score, 0.583 for the AP score, and 0.586 for the MoRAL score, demonstrating similar prognostication efficacy. The hazard ratios for TR and overall survival demonstrated strong, stepwise positive correlations with increases in both the ADV and AP scores, but not the MoRAL score.</p><p><strong>Conclusions: </strong>The ADV score is a superior integrated biomarker for predicting post-resection prognosis in patients with HCC, outperforming both the AP and MoRAL scores. The AP score appears to be a simplified alternative to the ADV score, particularly in cases of small HCC.</p>","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 5","pages":"317-330"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study on microbial dynamics in drainage fluid during trauma recovery.","authors":"Hyun-Hee Hong, Tae-Hwan Kim, Dowan Kim, Jungchul Kim, Younggoun Jo, Yunchul Park, Euisung Jeong, Naa Lee, Hyunseok Roh, Hyunseok Jang, Su-Man Kim","doi":"10.4174/astr.2026.110.5.347","DOIUrl":"10.4174/astr.2026.110.5.347","url":null,"abstract":"<p><strong>Purpose: </strong>Drainage fluid may serve as a biologically informative indicator of immune and infectious status during postsurgical recovery after trauma. However, microbiome shifts in drainage fluid associated with clinical resilience have not yet been characterized. This study aimed to investigate microbial dynamics in drainage fluid across the intensive care unit (ICU) and ward recovery phases in Korean trauma patients.</p><p><strong>Methods: </strong>A total of 25 drainage and 10 stool samples were collected from 10 trauma patients who underwent abdominal surgery at a regional trauma center. Microbial composition was analyzed using 16S ribosomal RNA amplicon sequencing. Alpha and beta diversity were compared between sample types and recovery stages. Linear mixed-effects models were used to identify recovery-associated taxa while adjusting for clinical variables, and predicted metabolic pathways were assessed using PICRUSt2.</p><p><strong>Results: </strong>Drainage fluid harbored distinct microbial communities independent of the intestinal microbiota. Shared taxa between drainage and stool increased significantly in patients with bowel injury, suggesting microbial translocation. Seven genera and 5 species showed significantly decreased abundance during the ward stage, with <i>Modestobacter</i> and <i>Blastococcus tunisiensis</i> demonstrating the highest discriminative ability between recovery stages (area under the curve = 0.721). Predicted metabolic pathways related to fatty acid degradation, amino acid degradation, and pro-inflammatory processes were more active during the ICU stage.</p><p><strong>Conclusion: </strong>These findings provide preliminary evidence that drainage fluid microbiome profiles may reflect recovery dynamics following trauma, supporting its potential utility for microbiome-based monitoring and biomarker discovery in trauma surgery.</p>","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 5","pages":"347-358"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of metabolic bariatric surgery in patients aged ≥55 years: a multicenter retrospective cohort study in East Asians.","authors":"Yoontaek Lee, Han Hong Lee, Ho Seok Seo, Chang Min Lee, Sang-Yong Son, Young Suk Park, Sang Hyun Kim","doi":"10.4174/astr.2026.110.5.281","DOIUrl":"10.4174/astr.2026.110.5.281","url":null,"abstract":"<p><strong>Purpose: </strong>Metabolic bariatric surgery (MBS) efficacy and safety is established for older patients, but East Asian data are limited. This study aimed to evaluate the safety and efficacy of MBS by comparing older (≥55 years) and younger (<55 years) East Asian patients with obesity.</p><p><strong>Methods: </strong>This multicenter, retrospective review included 410 patients undergoing MBS from January to December 2019. Patients were stratified into the older group (OG, age ≥55 years; n = 39) and the younger group (YG, age <55 years; n = 371). We compared surgical safety, weight parameters, and comorbidity resolution rates.</p><p><strong>Results: </strong>The OG had lower mean body weight (97.9 ± 16.4 kg <i>vs.</i> 113.2 ± 23.1 kg, P < 0.001) but more comorbidities and lower average ABCD score for type 2 diabetes mellitus (T2DM) remission. Postoperative complication rate (12.8% <i>vs.</i> 7.5%, P = 0.400) and postoperative hospital stay (4.1 ± 1.8 days <i>vs.</i> 4.0 ± 8.9 days, P = 0.773) showed no significant differences. At 12 months, the percentage of total weight loss was significantly lower in the OG (23.7 ± 6.9% <i>vs.</i> 27.8 ± 8.4%, P = 0.014). Remission rates for T2DM (47.6% <i>vs.</i> 80.5%, P < 0.001), hypertension (34.6% <i>vs.</i> 57.5%, P = 0.073), and dyslipidemia (12.5% <i>vs.</i> 44.4%, P = 0.012) were also lower in the OG, yet still demonstrated clinically meaningful metabolic improvement.</p><p><strong>Conclusion: </strong>MBS is a safe and effective treatment for older East Asians with obesity, offering substantial comorbidity resolution despite achieving a lower weight loss compared to the younger patients.</p>","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 5","pages":"281-289"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of carcinoembryonic antigen kinetics in predicting distant metastatic recurrence of breast cancer: a multicenter cohort study.","authors":"Bong Kyun Kim, Dooreh Kim, Jong Min Baek, Yong Hwa Eom, Young-Joon Kang, Jiyoung Rhu, Juneyoung Ahn, Ye Won Jeon, Woo Young Sun","doi":"10.4174/astr.2026.110.5.299","DOIUrl":"10.4174/astr.2026.110.5.299","url":null,"abstract":"<p><strong>Purpose: </strong>Distant metastasis of breast cancer significantly affects the prognosis. Serum markers such as CEA and cancer antigen (CA) 15-3 are used for surveillance. However, the nonspecificity and nonmalignant elevation of CEA limit its absolute value in predicting metastatic recurrence. We reevaluated the clinical value of CEA kinetics in predicting metastatic recurrence in breast cancer.</p><p><strong>Methods: </strong>In this multicenter retrospective cohort study, we utilized electronic medical record data from eight institutions (2008-2023), including 4,872 surgically treated patients with invasive breast cancer. Novel CEA kinetic indices were defined. Predictive capabilities were assessed using logistic regression, Kaplan-Meier survival curves, and Cox proportional hazards models.</p><p><strong>Results: </strong>CEA velocity (vCEA) and last-interval vCEA (vCEA-L) showed higher accuracy and sensitivity in predicting distant metastasis than absolute CEA indices. All tumor marker indices were independent predictors; vCEA, vCEA-L, and maximum vCEA (vCEAmax) showed the highest association. In the 5-year distant disease-free survival analysis of patients, vCEA showed the most significant difference based on whether its cutoff value was exceeded (84.1% <i>vs.</i> 47.2%) (P < 0.001). Cox analysis showed that vCEA was the strongest predictor (hazard ratio, 4.509; P < 0.001). vCEAmax remained prognostic even when CEAmax was below its cutoff value.</p><p><strong>Conclusion: </strong>Analysis of dynamic CEA changes, particularly velocity-based indices, offers superior predictive power than the static-based CEA indices for metastatic recurrence in breast cancer. These kinetic markers enhance prognostic accuracy when combined with CA 15-3. Future research should integrate these markers with imaging, liquid biopsy, and artificial intelligence for personalized follow-up.</p>","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 5","pages":"299-310"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ERAS compliance outweighs patient risk in high-risk colon cancer surgery.","authors":"Jeonghyun Kang","doi":"10.4174/astr.2026.110.4.203","DOIUrl":"10.4174/astr.2026.110.4.203","url":null,"abstract":"","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 4","pages":"203-204"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized strategy of treatment for ruptured abdominal aortic aneurysm using causal inference model: a retrospective observational study.","authors":"Youngki Sohn, Youngje Woo, Sangkyun Mok, Eunju Jang, Ki-Yoon Moon, Sun Cheol Park, Sang Seob Yun, Jang Yong Kim","doi":"10.4174/astr.2026.110.4.259","DOIUrl":"10.4174/astr.2026.110.4.259","url":null,"abstract":"<p><strong>Purpose: </strong>This study was performed to predict individualized treatment strategies in ruptured abdominal aortic aneurysm (rAAA) by estimating the survival benefit of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) based on anatomical and physiological features using a causal inference model.</p><p><strong>Methods: </strong>This retrospective study included 45 patients with de novo rAAA who underwent EVAR or OSR between 2012 and 2024. Thirty-three variables were analyzed. The model estimated individualized treatment effects (ITE) for 30-day survival. Model interpretability was assessed using Shapley Additive Explanations (SHAP) analysis. Five-fold cross-validation, receiver operating characteristic (ROC) analysis, and calibration plots were used for model evaluation. A clinical decision tree was developed to derive simplified decision rules.</p><p><strong>Results: </strong>The mean ITE was 0.22 ± 0.42, with 33% of patients classified as OSR-benefit candidates. SHAP analysis revealed that suprarenal angle, infrarenal angle, iliac anatomy, and proximal neck characteristics strongly influenced treatment effects. However, some predictors, such as low hemoglobin and systolic blood pressure favoring OSR, conflicted with clinical intuition. ROC analysis showed an area under the curve of 1.00, but calibration suggested overfitting due to a small sample size. Treatment-matched patients had a higher 30-day mortality rate than mismatched patients, suggesting potential bias or unmeasured confounding. The decision tree identified clinically relevant features but displayed structural inconsistencies and impractical cutoff values due to the limited sample size.</p><p><strong>Conclusion: </strong>The X-learner model demonstrated the feasibility of individualized treatment prediction in rAAA but suffered from overfitting and limited generalizability. Validation with larger multicenter cohorts is necessary to confirm clinical applicability.</p>","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 4","pages":"259-272"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of weight reduction on liver volume in living liver donors with steatosis: a retrospective cohort study.","authors":"Kwangpyo Hong, Kwang-Woong Lee, Su Young Hong, Sola Lee, Hyun Hwa Choi, Jiyoung Kim, Jaewon Lee, Jae-Yoon Kim, Jeong-Moo Lee, Suk Kyun Hong, YoungRok Choi","doi":"10.4174/astr.2026.110.4.273","DOIUrl":"10.4174/astr.2026.110.4.273","url":null,"abstract":"<p><strong>Purpose: </strong>Weight reduction (WR) can reduce liver volume, affecting the graft-to-recipient weight ratio (GRWR). This study aimed to evaluate the decrease in liver volume after WR and analyze risk factors affecting liver volume reduction in potential liver donors with steatosis.</p><p><strong>Methods: </strong>We retrospectively reviewed data of 147 potential liver donors with steatosis who participated in a WR program prior to liver transplantation between January 2016 and December 2021. Total liver volume (TLV) was measured using CT and MRI. Risk factors for large liver volume reduction (≥10%) were analyzed using multivariate logistic regression.</p><p><strong>Results: </strong>Ninety-seven donors (66.0%) underwent donor hepatectomy after WR. Liver volumes showed a statistically significant decrease (from 1,399.6 ± 315.4 mL to 1,283.6 ± 271.2 mL, P < 0.05). Thirty-eight donors (42.7%) showed large liver volume reduction. There was a more significant reduction in weight, AST, and ALT in the large liver volume reduction group than in the small liver volume reduction group (all P < 0.05). WR percentage and ALT abnormalities were independent risk factors for large liver volume reduction (odds ratio, 1.184 [95% confidence interval, 1.054-1.329] and odds ratio, 5.502 [95% confidence interval, 1.660-18.229], respectively; all P < 0.05).</p><p><strong>Conclusion: </strong>Potential liver donors with 7% or more WR or ALT abnormality require liver volume/GRWR remeasurement after WR to ensure adequate graft size and prevent small-for-size syndrome.</p>","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 4","pages":"273-280"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pure single-incision laparoscopic cholecystectomy using an articulating instrument: the Ewha Method in a retrospective observational study.","authors":"Yeongsoo Jo, Seog Ki Min","doi":"10.4174/astr.2026.110.4.225","DOIUrl":"10.4174/astr.2026.110.4.225","url":null,"abstract":"<p><strong>Purpose: </strong>Conventional multiport laparoscopic cholecystectomy (CMLC) is the gold standard for benign gallbladder disease. Single-incision laparoscopic cholecystectomy (SILC) offers superior cosmesis but has limited adoption due to technical challenges. We introduce the Ewha Method, a modified SILC technique using an articulating instrument to improve visualization, ergonomics, and safety.</p><p><strong>Methods: </strong>We retrospectively analyzed 530 patients who underwent SILC between November 2023 and August 2024. Surgical outcomes were compared between senior (n = 338) and junior (n = 192) surgeons. Difficult surgery (DS) was defined as conversion to CMLC or operative time >60 minutes. Multivariable analysis identified risk factors for DS, and the learning curve was evaluated.</p><p><strong>Results: </strong>The junior surgeon group included more high-risk patients, with higher proportions of elderly (≥65 years, 42.2% <i>vs.</i> 12.7%), male (53.6% <i>vs.</i> 29.9%), comorbidities, preoperative percutaneous transhepatic gallbladder drainage (PTGBD; 30.7% <i>vs.</i> 0.0%), and gangrenous cholecystitis (7.3% <i>vs.</i> 0.3%). The conversion rate was higher for junior surgeons (10.4% <i>vs.</i> 0.3%), but the severe complication rate was similar (0.5% <i>vs.</i> 0.0%). No bile duct injuries or incisional hernias occurred. Independent predictors of DS included diabetes mellitus (hazard ratio [HR], 4.045), preoperative PTGBD (HR, 5.780), leukocytosis (HR, 7.457), impacted stones (HR, 7.913), and gangrenous cholecystitis (HR, 38.736). The learning curve plateaued after 38 cases in low-risk patients.</p><p><strong>Conclusion: </strong>The Ewha Method standardizes SILC, ensuring safety and efficiency with a short learning curve and minimal complications. It may serve as a viable alternative to CMLC, warranting further validation in diverse clinical settings.</p>","PeriodicalId":8071,"journal":{"name":"Annals of Surgical Treatment and Research","volume":"110 4","pages":"225-236"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}