Frontiers in Surgery最新文献

Background: Bronchogenic cyst is a rare congenital developmental abnormality of the anterior bowel. Peri-pancreatic bronchogenic cyst (PBC) is extremely rare, when only a few cases reported worldwide. Diagnosis of PBC is difficult due to the lack of specific clinical features and symptoms, laboratory and imaging findings. Currently, the diagnosis of PBC mainly relies on the comprehensive judgment of multidisciplinary collaboration, combined with clinical manifestations, imaging features and pathological verification. Most bronchogenic cysts are benign and the long-term survival rate after complete resection is close to 100%.

Case presentation: A 21-year-old male with a pancreatic mass was admitted to our hospital. CT scan showed a low-density cystic shadow about 3.6 × 3.5 cm² on the pancreatic body, with clear boundaries, no enhancement, and no dilation of the main pancreatic duct. The patient underwent open distal pancreatectomy. Postoperative histopathological findings allowed for a definitive diagnosis of PBC. There was no recurrence for two years postoperatively.

Conclusion: In this study, we reported a rare case of PBC. At present, radical surgical resection remains the most effective treatment for bronchogenic cyst with mass effects, infection, bleeding, rupture, or larger than 3 cm in diameter. Further research on the diagnosis and treatment strategies of PBC is required.

Background: Natural orifice transluminal endoscopic surgery, abbreviated as NOTES, a novel surgical technique, involves the insertion of a flexible endoscope into a natural orifice, such as the oral cavity, stomach, vagina, colon, or bladder, to access a specific site for endoscopically assisted surgical procedures. In recent years, endoscopy-mediated NOTES research has witnessed substantial progress.

Objective: This study seeks to offer a bibliometric analysis of the trends and prospects within the NOTES domain.

Methods: On January 3, 2026, this study utilized the Web of Science Core Collection (WOSCC) to retrieve literature related to NOTES. The R package "Bibliometrix" was employed to provide fundamental bibliometric data. VOSviewer was instrumental in conducting keyword analysis, authors analysis, and co-occurrence analysis. Meanwhile, CiteSpace was employed for the analysis of reference bursts and keyword bursts. Moreover, we obtained clinical trial data published within the study period via the PubMed database, aiming to assess clinical advancements in this domain.

Conclusion: This study identified a total of 2,196 publications spanning a 28-year period from 1998 to 2025. The United States led in the number of articles published, with Surgical Endoscopy And Other Interventional Techniques being the most prolific journal, and Harvard University emerging as the most productive institution. The keyword "cholecystectomy" has gained considerable popularity in recent years. Clinical trials in this field have focused on the advantages of NOTES over traditional laparoscopic surgery, as well as the surgical efficacy of VNOTES in the treatment of benign gynecological diseases. Through bibliometric analysis, this paper delineates a foundational intellectual framework, suggesting that NOTES is entering a novel phase of development and is poised to retain its academic significance in forthcoming research endeavors.

Weight-bearing computed tomography (WBCT) provides three-dimensional (3D), high-resolution imaging with patients in either a unipodal or bipodal stance, allowing visualization of dynamic joint alterations that might be missed in conventional radiographs or in non-weight-bearing exams, such as conventional computed tomography (CT) or magnetic resonance imaging (MRI) scans. Multiple lines of research are exploring its application for the evaluation of knee osteoarthritis, knee ligamentous instability, malalignment syndromes, patellofemoral disorders, and postoperative assessment following total knee arthroplasty. Despite its growing clinical utility, the development of standardized imaging protocols, broader accessibility, and integration with advanced image-analysis tools remain important areas for further progress. This review summarizes the current evidence supporting the clinical applications of WBCT in knee assessment and discusses future directions aimed at optimizing its role in personalized musculoskeletal care.

Background: Ureteral stent removal using an extraction string after lithotripsy is gaining popularity; however, evidence regarding patient outcomes remains limited. This meta-analysis aimed to evaluate pain and complications associated between string-based and cystoscopic stent removal.

Methods: A systematic search of PubMed, Web of Science, Embase, the Cochrane Library, and Scopus was conducted up to September 2025. Eligible randomized controlled trials (RCTs) compared string-based stent removal with cystoscopic stent removal. The primary outcome was pain, assessed using the Visual Analog Scale (VAS), with subgroup analyses performed by sex. Secondary outcomes included urinary tract infection (UTI) and other complications. Data synthesis was performed using Review Manager 5.4, and risk of bias and certainty of evidence were assessed using the GRADE approach.

Results: Five RCTs involving 598 patients were included. Compared with cystoscopic stent removal, string-based stent removal significantly reduced pain [mean difference (MD) -2.49, 95% confidence interval (CI) -3.55 to -1.43, p < 0.01], particularly among women (MD -1.66, 95% CI -2.69 to -0.64, p < 0.01), while no significant pain reduction was observed among men (MD -1.05, 95% CI -3.75 to 1.64, p = 0.44). The incidence of UTI did not differ significantly between groups (risk ratio 1.45, 95% CI 0.48-4.42). Sensitivity analyses suggested instability of results, and stent migration could not be quantitatively assessed due to low event rates.

Conclusion: Extraction string-based removal may be associated with lower pain, especially among female patients, without a clear increase in complications. However, the limited number of studies and substantial heterogeneity result in a low certainty of evidence, and further well-designed RCTs are needed to confirm these findings.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251069187, PROSPERO CRD420251069187.

Introduction: Patient safety is crucial in donor nephrectomy. Individualized 3D reconstructions from CT imaging are gaining popularity for improving preoperative planning. This study evaluates whether such models enhance anatomical assessment and surgical preparation in robotic live donor nephrectomy.

Methods: This retrospective pilot study included 24 patients who underwent robotic live donor nephrectomy between 2022 and 2025. 3D models were reconstructed by the surgeon using MED EINS software and compared to conventional CT reports regarding vascular anatomy.

Results: Of the 24 nephrectomies, 75% were left-sided. No intraoperative complications occurred; minor postoperative complications (Clavien-Dindo I/II) were observed in 16.7% of cases. Donors had a mean age of 52.9 years and a mean BMI of 28.0. Most had a single renal artery (83.3%) and vein (91.7%). The mean operative time was 205 min, and hospital stay averaged 6.4 days. Donors were often parents or partners (each 41.7%). 3D reconstructions showed high concordance with CT reports. In one case, a second artery was missed on the CT report but visible on the 3D model, demonstrating its utility for detecting anatomical variants.

Conclusion: 3D reconstructions have the potential to support and refine preoperative planning in robotic donor nephrectomy by enhancing anatomical visualization. However, their clinical benefit should be further validated in prospective studies.

Objective: To investigate the effect of a sequential olive oil-lactulose approach within an enhanced recovery after surgery (ERAS) pathway on perioperative bowel management and postoperative recovery in patients undergoing day-case laparoscopic inguinal hernia repair.

Methods: A total of 204 patients who underwent day-case laparoscopic inguinal hernia repair between June 2024 and June 2025 were divided into two groups according to bowel-preparation regimen: a study group (n = 102) and a control group (n = 102). The study group received a sequential regimen of olive oil and lactulose bowel preparation. The control group underwent traditional polyethylene glycol (PEG) bowel preparation. Both groups received standard ERAS measures. Outcomes compared between groups included bowel-preparation compliance and tolerance, gastrointestinal recovery (time to first flatus and defecation), time to first ambulation, length of hospital stay, incidence of complications, 24-h postoperative pain score by visual analogue scale (VAS), and discharge satisfaction.

Results: The study group showed a significantly higher bowel-preparation compliance and tolerance than the control group (100% vs. 95.1%; 96.1% vs. 68.6%; P < 0.05). Compared with the control group, the study group had shorter times to first flatus (14.2 ± 3.1 h vs. 22.7 ± 5.3 h), first defecation (18.4 ± 4.2 h vs. 27.1 ± 6.3 h), first ambulation (8.9 ± 2.3 h vs. 14.1 ± 3.4 h), and length of hospital stay (1.8 ± 0.6 d vs. 2.7 ± 0.9 d) (all P < 0.001). The incidences of abdominal distension (10.8% vs. 70.6%), nausea/vomiting (7.8% vs. 35.3%), and dry mouth (21.6% vs. 44.1%) were lower in the study group (both P < 0.001), whereas the rate of urinary retention did not differ significantly between groups (P > 0.05). Postoperatively, the study group had lower VAS pain scores (2.1 ± 0.7 vs. 3.8 ± 1.1) and higher satisfaction scores (4.3 ± 0.7 vs. 2.9 ± 0.8) (both P < 0.001).

Conclusions: Within the ERAS pathway, the sequential approach of olive oil and lactulose significantly improved bowel preparation compliance and tolerance in patients undergoing daytime laparoscopic inguinal hernia repair. This approach accelerated gastrointestinal function recovery, shortened hospital stays, reduced complication rates, alleviated postoperative pain, and enhanced patient satisfaction.

Background: To compare mid-term outcomes of plate cage systems (PC) vs. stand-alone cages (SA) in two-level ACDF for cervical spondylotic myelopathy (CSM) with cervical kyphosis, and to assess the influence of preoperative segmental kyphosis reducibility on sagittal alignment maintenance.

Methods: This retrospective cohort analyzed 130 patients (SA = 64, PC = 66) with ≥24-month follow-up. Radiographic parameters (cervical lordosis [CL], fusion segmental lordosis [FSL], disc wedge, C2 SVA) and clinical outcomes (NDI, VAS, JOA, EQ-5D, dysphagia) were assessed preoperatively, postoperatively, and at final follow-up. Patients were stratified based on preoperative reducibility of segmental kyphosis.

Results: Both groups showed comparable clinical improvement (p < 0.05) and fusion rates (93.8% SA vs. 95.4% PC, p = 0.667). SA had shorter operation time (78.0 ± 11.5 vs. 86.6 ± 12.5 min, p < 0.001), less blood loss (193.0 ± 85.6 vs. 256.7 ± 110.3 mL, p < 0.001), and lower dysphagia incidence (12.5% vs. 20.3%, p = 0.014). However, the PC group demonstrated superior maintenance of cervical sagittal alignment in CL (13.6° ± 0.9° vs. 12.3° ± 2.4°, p < 0.001), FSL (13.2° ± 1.2° vs. 11.9° ± 2.9°, p = 0.001), and disc wedge (10.2° ± 1.3° vs. 8.9° ± 2.6°, p < 0.001) at follow-up, particularly in patients with non-reducible kyphosis (p < 0.05).

Conclusion: SA offers operative efficiency advantages, while PC is more effective in maintaining sagittal alignment, especially in rigid kyphosis. PC is recommended for patients with non-reducible cervical kyphosis.

Purpose: Small bowel obstruction (SBO) usually resolves with medical therapy but requires surgery, preferentially under the guidance of laparoscopy. We performed single-port flexible endoscopic enterolysis for abdominal adhesions under the guidance of dual-channel electromagnetic navigation technology and evaluated the feasibility and safety of this method in a pig model.

Method: Hypochlorite-induced abdominal adhesions was induced in 8 pigs. A long gastric tube with a magnetic navigation wire (sensor 1) was inserted into the distal end of the small intestine. The electromagnetic signal emitter was activated, and a second magnetic navigation wire (sensor 2) was continuously adjusted on the abdominal surface to obtain the two coordinates closest to the incised skin. The trocar was placed, and pneumoperitoneum was established. An endoscope with a second wire was placed through the trocar, and diagnostic intraperitoneal endoscopy was performed. The fibrotic bands and peritoneal congestion were observed, and the fibrous bands were dissected with a Dual knife.

Results: Abdominal adhesions model was evaluated. One case experienced intraoperative bleeding because the small mesenteric artery was damaged. Both the peritoneum and operating space were sufficiently visible in all cases except one, in which intestinal inflation significantly affected visibility. Seven of 8 (87.5%) of fibrous bands were successfully dissected. The total procedure duration was 48 (35-60) mins. Compared with that in the hypochlorite-induced abdominal adhesions model, weight gain was 6 (4-9) kg.

Conclusion: Flexible endoscopy adhesiolysis under the guidance of electromagnetic navigation for abdominal adhesions is comparatively safe and feasible.

Objective: This study aimed to identify predictors of cage subsidence following stand-alone oblique interbody fusion (SA-OLIF) in non-osteoporotic patients.

Methods: A retrospective analysis was performed on 98 patients who underwent SA-OLIF. Cage subsidence was defined to have occured when a cage was subsided into the adjacent endplate by more than 2 mm on the last follow up radiographs. Patients were categorized into subsidence and non-subsidence groups accordingly. Patient characteristics, radiographic parameters, and clinical outcomes were recorded. Sarcopenia was assessed using the L3 skeletal muscle index on axial computed tomography images. Multivariate logistic regression analysis was conducted to identify the predictors of cage subsidence following SA-OLIF.

Results: Of the 98 patients who underwent SA-OLIF, subsidence occurred in 32 (32.7%). The subsidence group had a higher mean age (P = 0.005) and lower bone mineral density (BMD) (P < 0.001). The prevalence of sarcopenia was significantly greater in the subsidence group compared with the non-subsidence group (P = 0.003). Multivariate logistic regression identified sarcopenia (P = 0.021), age (P = 0.011), and BMD (P < 0.001) as predictors of cage subsidence. The areas under the curve for age and BMD in predicting cage subsidence were 0.676 and 0.783, respectively.

Conclusion: Cage subsidence following SA-OLIF was a common complication in non-osteoporotic patients, with an incidence rate of 32.7%. Preoperative sarcopenia, age of >59.5 years, and T-score < -1.9 were predictors of cage subsidence following SA-OLIF in non-osteoporotic patients. Patients with sarcopenia had nearly 4-fold increased odds of subsidence. OLIF with instruments might be considered an alternative surgical method for patients with these predictor factors to decrease the incidence of cage subsidence.

Background: Esophageal squamous cell carcinoma (ESCC) remains a common malignancy with high mortality. Minimally invasive esophagectomy (MIE) was developed to reduce the morbidity of conventional open esophagectomy (OE), but comparative evidence specifically addressing oncologic adequacy and postoperative recovery in ESCC is limited. This systematic review synthesizes comparative data on MIE vs. OE in ESCC.

Methods: We conducted a PRISMA-compliant systematic review registered on PROSPERO (CRD420251158559). PubMed/MEDLINE, Web of Science, and the Cochrane Library were searched for studies published between January 2010 and May 2024. Nine comparative studies (n = 5,342; 2,968 MIE, 2,374 OE) met inclusion criteria. Methodological quality was assessed using the Newcastle-Ottawa Scale. Prespecified endpoints included overall survival (OS), disease-free survival (DFS), lymph node yield, R0 resection rate, perioperative complications, intraoperative blood loss, and lengths of ICU and hospital stay.

Results: Aggregate data indicate oncologic equivalence between MIE and OE: R0 resection rates were uniformly high (≥92%), and lymph node yields were comparable. Five out of nine studies (55.6%) reported no statistically significant differences in overall survival (OS) or disease-free survival (DFS) between MIE and OE. However, selected analyses favored MIE (e.g., 3-year OS HR 0.54, 95% CI 0.43-0.68). Perioperatively, MIE demonstrated consistent advantages, including reduced intraoperative blood loss, shorter hospital length of stay, and lower rates of pulmonary complications-particularly pneumonia-each of which was reported in seven of the nine included studies (77.8%). Anastomotic leak rates were similar; reports of recurrent laryngeal nerve injury were heterogeneous.

Conclusion: In ESCC, MIE achieves oncologic outcomes comparable to OE while conferring reduced pulmonary morbidity, lower blood loss, and accelerated postoperative recovery, supporting its consideration as a standard surgical approach.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251158559, PROSPERO CRD420251158559.