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.

Objective: We aimed to determine key perioperative factors affecting postoperative complications and long-term survival in gastric cancer patients undergoing gastrectomy and to evaluate their predictive value for clinical outcomes.

Methods: We conducted a retrospective analysis of clinical data from patients who underwent radical gastrectomy at our institution between January 2011 and December 2019. Logistic regression, along with univariate and multivariate analyses, and Kaplan-Meier survival curves were utilized to identify significant factors impacting postoperative morbidity and long-term survival.

Results: Patients were categorized into complication and noncomplication groups based on postoperative outcomes. Comparative analysis revealed significant associations between postoperative complications and the following variables: sex, hypertension, serum albumin (ALB) level, lactate dehydrogenase, prognostic nutritional index (PNI), α-fetoprotein (AFP), anastomotic method, laparoscopic versus open surgery and operative time (all P < .05). Multivariate logistic regression analysis indicated that laparoscopic versus open surgery, PNI, and hypertension were independent risk factors for postoperative complications. Kaplan-Meier survival analysis showed significant correlations between 3-year overall survival (OS) and age, PNI, ALB, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), tumor diameter, TNM stage, lymphovascular invasion (LVI), perineural invasion, resection extent, and reconstruction method (all P < .05). Receiver operating characteristic curve analysis identified optimal cutoff values for 3-year OS prediction: PNI (area under the curve [AUC] = 0.709, cutoff = 41.55) and tumor diameter (AUC = 0.661, cutoff = 4.75 cm). Univariate and multivariate Cox regression analyses identified the following independent prognostic factors: LVI, advanced TNM stage, age, PNI, hypoalbuminemia, CEA, and CA19-9.

Conclusion: Laparoscopic surgery and adequate nutritional status are associated with a reduced incidence of postoperative complications. The PNI, LVI, TNM stage, ALB, CA19-9, age, and CEA were identified as independent perioperative risk factors for long-term survival in gastric cancer patients undergoing gastrectomy. The PNI is an independent factor influencing both short-term complications and long-term survival.

Background: Laparoscopic nephrectomy is widely preferred for its advantages over open surgery, and secure hilar control is a critical procedural step. Although both clips and staplers are commonly used, studies comparing these techniques outside the setting of donor nephrectomy remain limited. This study evaluates the safety and effectiveness of en-bloc stapler ligation versus separate arterial and venous clipping.

Materials and methods: This retrospective study included patients aged 18-80 who underwent laparoscopic nephrectomy between 2020 and 2025. Demographic, perioperative, and postoperative data were collected, and complications were classified using the Clavien-Dindo system. Hilar control was performed either by en-bloc stapling or separate clipping. Statistical analyses included comparative tests and logistic regression, with significance set at P < .05.

Results: A total of 171 patients were analyzed (80 EndoGIA, 91 clip). Baseline characteristics were comparable. Operative time (122 vs 135 minutes; P = .004) and blood loss (175 vs 198 mL; P = .025) were lower in the EndoGIA group. Overall complication rates were similar (30% vs 28.5%; P = .500), with mostly grade I-II. Major complications were rare in both groups. No arteriovenous fistulas were detected after en-bloc stapling. Multivariate analysis identified prolonged operative time and chronic obstructive pulmonary disease (COPD) as independent predictors of postoperative complications.

Conclusion: Both en-bloc stapler ligation and separate clipping are safe methods for hilar control in laparoscopic nephrectomy. En-bloc stapling may reduce operative time and associated complications, offering particular advantages in complex dissections or when minimizing surgery duration is critical, thereby supporting its broader adoption in clinical practice.

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.

Objective: Esophageal hiatus closure during hiatal hernia repair is essential. Improper closure can lead to recurrence and high patient morbidity. Our aim is to introduce an easy and reproducible method of calculating the surface area (hiatal surface area [HSA]) of the esophageal hiatus. Standardization of this value will enable surgeons to have an evidence-based approach for hiatal hernia closure during laparoscopic repair.

Methods and procedures: We developed a measurement of HSA of the esophageal hiatus corresponding to a right-angle triangle: Area = (1/2) base × height. The height was defined as the left crus of the diaphragm. The base was defined as perpendicular to the crus and tangential to the medial edge of the esophagus. The mean esophageal hiatus surface area was calculated from deceased patients without a hiatal hernia undergoing full autopsies and compared to patients undergoing laparoscopic repair.

Results: A total of 237 (37 cadaveric) hiatuses were measured. The median HSA defect in the cadaveric group was 1.97 cm² with an interquartile range (IQR) of 1.13 to 3.0 cm² was significantly larger compared to 5.0 cm² with an IQR of 3.5 to 7.5 cm² in the operative group (P < .001). Multivariate linear regression demonstrated an overall significant positive correlation between esophageal hiatus surface area defect and the variables of age and weight but not with gender.

Conclusion: This study demonstrated a new reproducible method of measurement for esophageal hiatus. The significant difference between the two groups suggests that our formula can be utilized to develop a standardized value for the surface area of the esophageal hiatus.

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: Ruptured tubal ectopic pregnancy continues to pose a critical challenge in gynecologic emergencies. While conventional laparoscopy (CL) has long been the preferred operative method, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is increasingly recognized for its minimally invasive characteristics. However, comparative data between these techniques in acute cases remain scarce.

Methods: The present retrospective analysis reviewed women treated with salpingectomy for ruptured tubal ectopic pregnancy between Sep 2023 and Jan 2025. Twenty-four patients were evaluated, of whom 12 underwent vNOTES and 12 underwent CL. Baseline clinical and demographic features were similar across both groups. Perioperative and short-term postoperative outcomes were systematically analyzed.

Results: The vNOTES technique demonstrated a significantly reduced operative time (30 ± 10 minutes) compared to CL (41 ± 14 minutes, p < 0.05). Insufflation pressure averaged lower in the vNOTES group (8 mmHg) than in the CL group (13 mmHg), with a statistically significant difference (p < 0.05), whereas hematocrit variations and postoperative opioid requirements remained comparable between the two methods. Pain evaluations at 1, 6, and 24 hours postsurgery indicated lower pain levels in the vNOTES cohort versus the CL cohort (p < 0.05). Shoulder tip discomfort was reported by 17% of vNOTES patients, in contrast to 83% of CL patients (p < 0.05). Hospital stay duration was markedly shorter for vNOTES recipients (36 ± 13 hours) compared to CL patients (55 ± 14 hours, p < 0.01). Pelvic drains were needed in 8 out of 12 CL cases, but none were required in the vNOTES group (p < 0.01). Neither group experienced intraoperative complications or required conversion to laparotomy. This single-center, retrospective study has limitations due to its small sample size (n = 24), limited generalizability, and reduced statistical power to detect rare complications.

Conclusions: In this cohort, vNOTES demonstrated shorter operative times, reduced insufflation pressures, and enhanced postoperative recovery compared with conventional laparoscopy. The results indicate that vNOTES could serve as a promising surgical alternative for selected patients presenting with ruptured ectopic pregnancy. Future multicenter investigations involving larger populations and extended follow-up periods-including assessments of fertility and quality of life-will be crucial to validate these findings.

Objective: To identify clinical, laboratory, radiologic, and operative factors associated with intraoperative complications during surgical management of tubo-ovarian abscess (TOA), and to describe evolving surgical trends over a 10-year period.

Methods: This retrospective cohort study included 177 women who underwent operative treatment for TOA between January 2015 and June 2025 at a tertiary referral center. Demographic variables, laboratory parameters, radiologic findings, operative details, and postoperative outcomes were extracted from institutional records. Patients were grouped as uncomplicated or complicated according to the presence of bowel, bladder, or ureteral injury. Groups were compared using appropriate statistical tests.

Results: Of 177 patients, 9 (5.1%) experienced intraoperative organ injury. Complicated cases were significantly older (49 vs 42 years, P = .006) and exhibited higher C-reactive protein (CRP) levels (299 vs 188 mg/L, P = .004), higher platelet counts (544,000 vs 351,000/µL, P = .002), elevated platelet-to-lymphocyte ratio (PLR) (240.9 vs 186.8, P = .010), and lower mean platelet volume (MPV) (7.80 vs 8.70 fL, P = .019). Abscess size and bilaterality were not associated with complications. Extensive surgery was more frequently performed in the complicated group. A pronounced shift toward minimally invasive surgery was observed, with laparoscopy becoming the predominant approach after 2023 and all cases in early 2025 performed laparoscopically. Complicated surgeries were associated with longer operative times, greater postoperative hemoglobin decline, prolonged hospitalization, and markedly higher reoperation rates.

Conclusion: Older age, elevated inflammatory markers, and altered platelet indices may help identify patients at increased risk of operative difficulty. The growing use of laparoscopy supports its role as a feasible and increasingly preferred surgical approach in the management of TOA.

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.