JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献

Objective: To evaluate whether a gynecology-specific laparoscopic trainer better prepares premedical and medical students to perform a laparoscopic vaginal cuff surgical task than the current standard laparoscopic trainer.

Methods: In a masked, block-randomized controlled trial, 49 premedical and preclinical medical students were recruited, then randomized to a laparoscopic simulator: Essentials in Minimally Invasive Gynecologic Surgery (EMIGS) or Fundamentals of Laparoscopic Surgery (FLS). A total of 26 participants were initially randomized to EMIGS and 23 participants to FLS. They trained for 2.5 hours on their assigned simulator. Video recordings of participants performing a laparoscopic vaginal cuff suturing task were collected before and after simulator training. Videos were masked and reviewed by expert minimally invasive gynecologic surgery (MIGS) surgeons and graded using a modified Global Operative Assessment of Laparoscopic Skills (GOALS) rubric. The pretraining and post-training GOALS scores were then compared between simulator groups.

Results: Most demographic characteristics were similar across both groups. Ultimately, 24 participants from the EMIGS group and 21 participants from the FLS group were included in the final analysis. The mean difference between post and pre-composite GOALS scores was 6.50 for EMIGS and 4.07 for FLS, P = .34. The mean EMIGS post-pre difference was greater for six of the eight individual GOALS domains, although all P-values > .05.

Conclusions: Neither EMIGS nor FLS was associated with better performance on the vaginal cuff suturing task after a single 2.5-hour training session.

Background and objectives: To date, no Japanese studies have compared robotic transabdominal preperitoneal repair (R-TAPP) and laparoscopic totally extraperitoneal repair (L-TEP). Herein, we present our initial experience from a single Japanese hospital, comparing both procedures and evaluating their short-term outcomes in the context of potential inclusion under Japan's national health insurance system.

Methods: Patients with inguinal hernias who had not undergone previous anterior hernioplasty were retrospectively analyzed. Demographic factors (age, sex, body mass index) and perioperative data were collected. Surgical variables and postoperative outcomes were compared between patients who underwent R-TAPP using the da Vinci ξ robotic platform (Intuitive Surgical, Sunnyvale, CA) and those who underwent L-TEP. Data were assessed for all, unilateral, and bilateral cases. Five surgeons participated in this study. Surgeon-specific variables, including the number of R-TAPP and L-TEP procedures performed by each surgeons, operative times, and complication rates, were also collected to evaluate the influence of the surgeon's experience on perioperative outcomes.

Results: Resident participation significantly differed between the 2 techniques across total, unilateral, and bilateral groups. In the unilateral subgroup, the mean operative time was shorter for R-TAPP (95.4 minutes) than for L-TEP (122.3 minutes). The R-TAPP group had higher costs, but complication rates were comparable. One Clavien-Dindo grade III postoperative bleeding event occurred in the L-TEP group, while only minor complications, including paralytic ileus and inferior epigastric artery injury, were observed after R-TAPP. The surgeon-specific analysis demonstrated variability in operative times among the 5 surgeons; however, 4 of the 5 surgeons showed consistently shorter operative times with R-TAPP than with L-TEP, suggesting a procedural trend favoring R-TAPP despite differences in experience.

Conclusion: Both R-TAPP and L-TEP were performed safely, with no notable differences in perioperative outcomes. However, R-TAPP may provide improved operative efficiency, particularly in primary unilateral inguinal hernias. Although surgeon experience influenced operative performance, the consistent trend toward shorter operative times across surgeons suggests that R-TAPP may offer intrinsic procedural advantages. Further prospective studies with balanced surgeon distribution and long-term follow-up are warranted.

Background: Gallbladder anomalies are rare congenital defects resulting from developmental disruptions. These variations in shape, position, or number are often incidental findings but can present with symptomatic gallstone disease. Undiagnosed anomalies may lead to surgical complications like bile duct injuries and incomplete cholecystectomy. Despite their clinical significance, standardized guidelines remain limited. This systematic review consolidates current knowledge on classification, diagnosis, and management.

Methods: Given the rarity of gallbladder anomalies, single case reports were excluded. The database search yielded 3,789 articles, with 1,975 excluded based on language, relevance, and duplication. After screening, 164 articles underwent full-text review, and seven case series met inclusion criteria.

Results: The selected studies covered embryological development, classification, diagnostic imaging, and surgical approaches. Common imaging methods included ultrasound, magnetic resonance cholangiopancreatography (MRCP), and computed tomography (CT) scans.

Discussion: Gallbladder anomalies pose diagnostic and surgical challenges, increasing the risk of bile duct injury. Greater awareness and standardized guidelines are needed. This review highlights early recognition and tailored intervention to optimize outcomes, emphasizing the need for standardized protocols.

Background: We conducted a quality improvement initiative aimed at reducing operating room disposable supply costs during sleeve gastrectomy.

Methods: We implemented a cost reduction strategy for all sleeve gastrectomy operations at a single center which involved switching from ECHELON+ stapler with routine use staple line buttressing to a single-fire stapler (Titan SGS) to standardize the amount of staple reloads and afterwards, switching to the easyEndoLite stapler with shorter staple heights and selective use of staple line reinforcements and clip appliers.

Results: We included 638 cases of primary laparoscopic sleeve gastrectomy performed from January 2020 to June 2024. There were no significant differences in the total operating room supply costs after switching to a single-fire stapler, but after switching to a less costly stapler and selectively using staple line reinforcements and clip appliers, we demonstrated a cost savings of $1,283 (95% confidence interval [CI]: $1,216 to $1,351) per case (P < .001), without any differences in length of stay or 30-day weight loss or risk of reoperation or readmission.

Conclusion: During sleeve gastrectomy, surgeons should consider adopting operating room cost-reduction strategies such as selective use of clip appliers, judicious usage of staple line reinforcement material, and choosing less costly stapler devices.

Introduction: Obesity prevalence has nearly doubled globally in the past 30 years. Among treatment options, surgery remains the most effective. Staple line leaks are a major complication in bariatric surgery, often linked to mismatched stapler cartridge and gastric wall thickness (GWT). Understanding factors influencing this thickness is critical. This study evaluates previously known variables and additionally investigates waist circumference, duration of obesity, alcohol use, and asthma.

Methods: Between December 2024 and July 2025, patients who underwent bariatric surgery for obesity were evaluated. A total of 58 patients were included in the study. Immediately following laparoscopic sleeve gastrectomy (LSG), the freshly resected gastric specimens were assessed in the operating room. Prior to measurement, a standardized pressure of 8 g/mm² was applied to the gastric tissue for 15 seconds.

Results: Male sex was associated with increased thickness in the corpus and fundus, smoking with the fundus, and body mass index (BMI) with the antrum. Height affected all regions, while weight influenced the antrum and fundus. Waist circumference increased thickness in all areas. Overall, thickness decreased from antrum to fundus, but in 10% of patients, the corpus was thicker than the antrum.

Conclusion: There are few and conflicting studies in the literature regarding factors affecting GWT. In this study, waist circumference was found to increase GWT in all regions, while duration of obesity, alcohol consumption, and asthma had no significant effects. It may be reasonable for surgeons to consider waist circumference, in addition to BMI, height, weight, and male sex, when selecting staplers.

Background and objectives: To overcome the limitations of intraperitoneal mesh and technically demanding extraperitoneal techniques, the "Falciform Ligament Laparoscopic Approach for Preperitoneal Ventral Hernia Repair" method, enables direct optical entry into the preperitoneal space using the falciform fat as a safety buffer. This approach avoids fascial division to maintain structural integrity.

Methods: Between December 2018 and December 2024, 50 patients with primary, midline, medium-sized ventral hernias underwent repair using the technique. Primary outcomes included operative duration, complication rate and recurrence. Preperitoneal entry was achieved by a 5-mm optical trocar in the epigastrium. Upon space creation and hernia reduction, mesh was placed without fixation.

Results: Fifty patients (mean age 41.2 ±7.6 years; body mass index [BMI] 29.4 ±4.7 kg/m²) with umbilical/paraumbilical hernia (M3-European Hernia Society classification) and mean defect size 2.9 ±0.6 cm underwent repair using the technique. All surgeries were completed laparoscopically without intraoperative complications. Median operative time was 85 minutes; median hospital stay was 1 day. Pain scores (visual analogue scale) were low: 1.7 (evening), 1.3 (day 1), 0.8 (day 7). No complications occurred, except one hematoma-resolved after aspiration; two seromas-no intervention needed; no recurrences observed over a 41-month median follow-up.

Conclusion: It is a feasible, safe, structurally preserving technique with favorable outcomes. By eliminating mesh fixation and enabling early discharge with minimal postoperative pain, it offers a potential cost advantage. Further multicenter validation is warranted.

Background: Postoperative hypoparathyroidism is the most common complication of total thyroidectomy, often resulting from injury or devascularization of the parathyroid glands.

Objective: Indocyanine green fluorescence (ICG) technique has been applied in the last 10 years in different kinds of surgery including colorectal, oncological lymph node and endocrine surgery. Minimally invasive thyroidectomy, introduced more than 25 years ago, is a valid surgical option for selected benign and malignant thyroid disease with advantages in terms of cosmetic results and postoperative pain. Aim of this study is to evaluate the feasibility and safety of ICG during minimally invasive thyroidectomy to assess and predict parathyroid gland perfusion and guide preservation.

Methods: We report the initial experience in our center of ICG during minimally invasive video-assisted total thyroidectomy in a case series of 9 patients, using the Striker System® to assess parathyroid perfusion and guide preservation. Demographic and surgical data were registered with special attention to hypoparathyroidism.

Results: All patients underwent standard minimally invasive video-assisted total thyroidectomy; a standardized dose of ICG was administered intravenously. Real-time near-infrared imaging allowed for clear visualization of parathyroid vascularization, enabling the preservation of well-perfused glands and the auto transplantation of those removed into the sternothyroid muscle. Postoperative assessments, including serial measurements of serum calcium and parathyroid hormone levels, revealed a transient drop in two patients with overall correspondence to indocyanine green evaluation.

Conclusion: These findings suggest that ICG angiographic imaging is a valuable adjunct in thyroid surgery, potentially reducing the risk of hypocalcemia by optimizing parathyroid preservation. Further studies are needed to standardize the technique and the evaluation score to confirm preliminary results on definitive hypoparathyroidism.

Background and objectives: Robotic platforms are increasingly employed in colorectal surgery for their technical and ergonomic benefits. However, surgeons face a significant learning curve, and there is no standardized definition or threshold to proficiency. This systematic review aimed to evaluate published evidence on learning curves in robotic colorectal surgery, focusing on proficiency thresholds, analytic methodologies, and the effect of experience on clinical and oncological outcomes.

Methods: A systematic literature search of PubMed was performed through April 7, 2025. Studies reporting learning curve data for robotic colorectal procedures were included. Screening and selection were conducted using Rayyan. Extracted data included operative time, case numbers to proficiency, conversion and complication rates, and oncological metrics. Study quality was assessed using the Newcastle-Ottawa Scale. A narrative synthesis was undertaken due to heterogeneity in study design and outcomes.

Results: Nineteen studies met inclusion criteria. The number of cases required to reach proficiency ranged from 15-55, with operative time being the most analyzed parameter. CUSUM and RA-CUSUM were the predominant analytic methods. Improved outcomes such as reduced complications, lower conversion rates, and enhanced oncological quality were generally observed in the post-proficiency phase. Variability in learning curve definitions and analytic approaches was significant across studies.

Conclusion: Robotic colorectal surgery involves a measurable learning curve that impacts both technical and patient-centered outcomes. While most studies demonstrate improved metrics with experience, the lack of standardized methodology limits cross-study comparisons. Structured training pathways and consensus on learning curve analysis are needed to support safe adoption and credentialing in robotic colorectal surgery.

Background and objectives: This study aimed to compare the efficiency and diagnostic performance of carbon dioxide (CO₂) versus saline as a distension medium during routine cystoscopy performed after laparoscopic gynecologic surgery.

Methods: We conducted a prospective, comparative study involving patients undergoing total laparoscopic hysterectomy for benign indications. Participants were randomly assigned to undergo diagnostic cystoscopy using either CO₂ or saline for bladder distension. Primary outcomes included total cystoscopy duration and time to visualize bilateral ureteral jets. Secondary outcomes were intraoperative detection rates of lower urinary tract injuries and any postoperative urinary complications.

Results: A total of 529 patients were included (CO₂ group: 270; 51.1%; saline group: 259; 48.9%). Cystoscopy duration was significantly shorter in the CO₂ group compared to the saline group (150 vs 120 seconds; P < .001). Time to visualize ureteral jets was also reduced in the CO₂ group (43 seconds; P < .001). One bladder injury and 1 ureteral obstruction were identified intraoperatively and successfully repaired in the same surgical session. The use of CO₂ eliminated the need for diuretics or chromatic dyes, streamlining the diagnostic process and potentially reducing costs.

Conclusion: CO₂ cystoscopy is a safe, efficient, and diagnostically effective alternative to conventional saline cystoscopy following gynecologic laparoscopy. Its use significantly reduces procedural time without compromising the detection of urinary tract injuries and avoids the need for additional agents such as dyes or diuretics. These findings support the integration of CO₂ cystoscopy into routine intraoperative surveillance protocols during minimally invasive gynecologic surgery.