Surgical Endoscopy And Other Interventional Techniques最新文献

Background: Bariatric surgery patients with body mass index (BMI) ≥ 60 kg/m2 present unique technical and perioperative challenges. While robotic-assisted bariatric surgery is thought to offer potential technical advantages, direct comparisons between robotic and laparoscopic approaches (R-BS and L-BS) in this population remains limited.

Methods: An analysis of the 2020-2023 MBSAQIP database was conducted and all patients with BMI ≥ 60 kg/m2 who underwent primary laparoscopic or robotic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were included. Baseline demographics, operative characteristics, and 30-day postoperative outcomes were compared. Multivariable logistic regression identified independent predictors of serious complications.

Results: Of 32,295 patients, 22,211 (68.8%) were L-BS and 10,084 (31.2%) were R-BS. Significant baseline differences existed between groups, including higher rates of gastroesophageal reflux disease (28.6% vs. 26.1%, p < 0.001), and hypertension (54.7% vs. 52.8%, p = 0.001) in the R-BS group. From 2020 to 2023, the proportion of R-BS doubled from 20.4% to 41.3%, whereas the proportion of L-BS declined slightly from 79.6% to 58.7%. There was no significant difference in robotic versus laparoscopic utilization for RYGB. (27.4% vs 26.4%, p = 0.059) and operative time was significantly longer in R-BS (106.5 ± 51.4 min vs. 83.5 ± 47.0 min, p < 0.001). Rates of individual 30-day complications, including leaks, bleeding, reoperation, and readmission, were low with no significant difference between cohorts. Independent predictors of serious complications included older age, hypertension, gastroesophageal reflux disease, prior myocardial infarction, therapeutic anticoagulation, longer operative time and RYGB. The robotic approach was neither independently associated with nor protective against serious complications.

Conclusions: In patients with a BMI ≥ 60 kg/m2 undergoing elective bariatric surgery, there were no significant differences in 30-day postoperative outcomes between laparoscopic and robotic approaches despite baseline patient differences between groups. Although operative times were 27% longer for the robotic approach, its utilization increased substantially over the study period. These findings suggest that perioperative outcomes in this high-risk population are primarily determined by patient comorbidities and procedural factors rather than surgical approach, and that neither approach demonstrates superior short-term safety.

Background: Laparoscopy-assisted transgastric rendezvous ERCP (LAERCP) is a perioperative treatment option for common bile duct stones (CBDS) in Roux-en-Y gastric bypass (RYGB) patients. Although rendezvous ERCP (RV-ERCP) is a safe treatment for CBDS, comparative data with LAERCP in larger cohorts are lacking. This study compares outcomes of laparoscopic cholecystectomy (LC) and LAERCP in RYGB patients with LC and rendezvous ERCP (RV-ERCP) in patients with unaltered anatomy, using an extensive validated national registry.

Methods: A retrospective study on prospectively collected nationwide cohort data from the Swedish Registry of Gallstone Surgery and ERCP (GallRiks), including all patients from September 2016 to June 2021 who underwent LC with same-day rendezvous ERCP. Patients with prior RYGB (RYGB group) were compared to those without previous upper abdominal surgery (non-RYGB group). Outcome measures was therapeutic success, peri- and postoperative adverse events, procedural time and readmissions.

Results: Seventy RYGB and 4342 non-RYGB patients were identified. CBDS were detected in 60 and 3067 patients, respectively. Therapeutic success was 100% in the RYGB group versus 91.4% in the non-RYGB group (p = 0.018). Perioperative adverse events occurred in 8.8% and 2.3% of cases (p < 0.001), but none in the RYGB group had postoperative consequences. Postoperative adverse events, antibiotic use and readmissions were similar. Median procedural time (180 vs. 131 min, p < 0.001) and hospital stay (2 vs. 1 days, p < 0.001) were longer for the RYGB group. No mortality occurred in either group.

Conclusions: Concomitant rendezvous LAERCP during LC is a safe and effective method for managing CBDS after RYGB. Despite a higher rate of perioperative events, outcomes were favorable relative to previously published data for non-concomitant LAERCP. These findings support LAERCP with rendezvous technique as the standard of care for RYGB patients in Sweden and provide registry-based evidence to inform future international guidelines.

Background: The European Association for Endoscopic Surgery (EAES) three-month Fellowship Programme was established in 2014 to promote educational mobility, training, and international collaboration in minimally invasive surgery. A five-year analysis of the programme demonstrated educational and professional advantages. This study presents a ten-year update and an assessment of long-term outcomes, fellows' perspectives, and the implementation of previous recommendations.

Methods: A cross-sectional survey was conducted and is reported according to the Checklist for Reporting of Survey Studies (CROSS). A 54-item questionnaire (multiple-choice, five-point Likert scale, and short open-ended questions) was distributed by e-mail to all surgeons who participated in the Fellowship between 2014 and 2024. Questions explored participants' demographics; surgical and endoscopic activities; academic and educational activities; the perceived impact of the Fellowship on personal, surgical, and scientific growth; and the practical aspects and overall feedback on the Fellowship experience.

Results: Seventy-one of the 81 eligible Fellows completed the survey (87.7%). At the time of the Fellowship, the mean age was 36 ± 3.3 years, and 62 participants (87.3%) held a consultant position. Sixty-six Fellows (93%) completed the entire Fellowship period. During the Fellowship, 53 participants (74.6%) did not operate as first surgeons, whereas 58 Fellows (81.7%) assisted during surgical procedures. In collaboration with their Host Institutions, 21 Fellows (29.6%) presented oral communications, 16 (22.5%) presented posters, and 27 (38%) published articles. Participants strongly agreed that the Fellowship contributed to their personal (mean 4.7 ± 0.6) and surgical (mean 4.6 ± 0.8) growth. Forty-five Fellows (63.4%) continued research after the programme and 44 (62%) reported changes in their clinical practice. Fellowship was considered adequate in funding and duration (mean 4.1 ± 0.8 and 4 ± 1.1, respectively).

Conclusions: After ten years, the EAES Fellowship Programme continues to play a pivotal role in advancing minimally invasive surgical education, professional networking, and research, confirming and expanding the positive outcomes observed in the five-year evaluation.

Aim: To assess the clinical effectiveness, safety, technical feasibility, and challenges of remote robotic surgery in general surgery, gynecology, orthopedics, and urology, focusing on issues like communication technology, ethics, and cost.

Methods: Relevant reports on remote robotic surgery were retrieved from databases such as PubMed, EMbase, Web of Science, Cochrane Library, VIP, CNKI, and Wanfang (2001-2025). Literature quality was evaluated using tools from the Joanna Briggs Institute (JBI).

Results: A total of 26 articles were included (13 in Chinese, 13 in English) covering general surgery, gynecology, orthopedics, urology, and thyroid surgery. The results showed that the average operation time was slightly longer than that of traditional methods (about 10-30 min), but the safety was good. Most studies had communications backup plans, such as backup networks or local physician take-overs, to deal with the risk of disruption. Tele-robotic surgery has a high success rate and accuracy with controllable network latency, showing the potential to expand access to medical resources, especially in remote areas. However, it still faces challenges such as network stability, equipment cost, operation accuracy, data privacy, and ethical issues. Most of the included studies reported successful cases, and there was a lack of in-depth analysis of failure cases or adverse outcomes of patients, which may have publication bias.

Conclusion: Despite challenges, remote robotic surgery shows promise in overcoming geographical and resource limitations. The quality of current evidence is low, with serious methodological limitations and reporting bias. The establishment of international mandatory registration systems, standardized safety protocols, and transnational collaboration networks are urgent to promote this field from "proof of concept" to "clinical practice". But, with continuous technological advancements, it is expected to play an increasingly significant role in global healthcare.

Background: Iatrogenic colonic perforation is a rare but potentially catastrophic complication of colonoscopy (0.016-0.2% diagnostic; 0.15-5% therapeutic) with reported mortality of 15-25%. Rates may increase with expanding colonoscopy volume and advanced therapeutic interventions. Endoscopic closure is increasingly used, yet comparative outcomes remain uncertain.

Methods: Registered in PROSPERO (CRD420251233077). We searched six databases from inception to November 2025 for adult observational cohorts comparing endoscopic closure versus surgery. Outcomes included treatment success, mortality, major morbidity, reoperation, length of stay, and fasting duration. Two reviewers independently screened studies, extracted data, and assessed bias using ROBINS-I. Random-effects models pooled risk ratios (RR) and mean differences (MD); GRADE rated certainty. Sensitivity and geographic subgroup analyses assessed robustness and effect modification.

Results: Four retrospective cohorts (n = 123; 52 endoscopic, 71 surgical) from Portugal, Korea, and Malaysia were included across care settings. Treatment success showed no clear difference (RR 1.00, 95% CI 0.94-1.06; I² = 0%; low certainty). Mortality was rare and imprecise (8 events; RR 0.26, 95% CI 0.06-1.16; I² = 0%; very low certainty). Hospital stay was shorter with endoscopic management (MD - 9.23 days, 95% CI - 13.74 to - 4.73; I² = 43%; low certainty). Fasting duration did not differ significantly and was heterogeneous. No geographic subgroup effect was detected (P = 0.95). Sensitivity analysis supported robustness, except for hospital-stay heterogeneity driven by referred cases in one study.

Conclusions: In observational cohorts, endoscopic closure was typically used for immediately recognized, smaller perforations in favorable clinical conditions, whereas surgery was preferentially used for delayed diagnosis, larger defects, or suspected contamination, introducing substantial confounding by indication. Accordingly, the pooled estimates should not be interpreted as evidence of equivalence. In carefully selected patients (immediate recognition, < 2 cm, no generalized peritonitis/instability), endoscopic closure appears to be a viable first-line strategy and may reduce length of stay. Prospective multicenter studies with standardized definitions and rigorous confounder adjustment are needed.

Background: Anastomotic leaks in colorectal surgery increase mortality, local cancer recurrence, and hospital readmission rate. The Echelon Circular Powered Stapler (PCS) is marketed to reduce anastomotic leaks by minimizing operator errors through powered systems. We reviewed current evidence on the use of PCS in left-sided colorectal anastomoses to determine if there is a reduction in anastomotic leak rates versus manual circular staplers (MCS).

Methods: This study followed PRISMA guidelines. MEDLINE, EMBASE, CINAHL, and OVID review databases were searched to January 2024. A broad search strategy for PCS versus MCS in colorectal surgery was used. Abstracts were reviewed for the primary outcome of anastomotic leaks, and data were extracted from full-text review. Statistical analysis was performed using RevMan 5.4 software.

Results: 109 articles were screened, 9 studies with 3110 patients were included. No randomized control trials (RCTs) were found. In pooled and sensitivity analysis excluding studies that used historic comparators, there was no significant difference in the rates of anastomotic leak (pooled RR 0.56, 95% CI [0.27-1.18], p = 0.13; sensitivity analysis RR 0.75, 95% CI [0.32-1.77], p = 0.52). Similarly, there was no significant difference in morbidity between PCS and MCS on pooled analysis (RR 0.84, 95% [CI 0.65-1.08], p = 0.17). However, on pooled analysis, there was a significantly lower rate of post-operative bleeding with the use of PCS (RR 0.2, 95% CI [0.08-0.51], p < 0.001).

Conclusion: The current systematic review and meta-analysis is unable to support the claim of lower leak rate with the use of PCS; however, there is preliminary evidence to indicate that powered staplers may decrease the rate of post-operative bleeding. Further evidence from RCTs investigating anastomotic leaks and bleeding rate with PCS and assessments of environmental impact should be conducted prior to the widespread use of powered staplers.

Background: Peroral Endoscopic Myotomy (POEM) has become the first-line minimally invasive treatment for achalasia. Its short-term and mid-term (1-5 years) efficacy has been consistently demonstrated, but long-term follow-up data (≥ 5 years) remain limited. This systematic review and meta-analysis aims to comprehensively evaluate the long-term (median follow-up ≥ 5 years) clinical efficacy and safety of POEM.

Methods: Using medical literature databases, we retrieved randomized controlled trials (RCTs) and non-randomized comparative studies from the inception of the databases through September 2025. Data were extracted using the Cochrane Risk of Bias 2.0 tool and the Newcastle-Ottawa Scale to assess risk of bias for RCTs and cohort studies, respectively. Meta-analyses were conducted using either fixed-effect or random-effects models.

Results: A total of 16 studies involving 2421 patients (50.4% male) were included, with a median follow-up duration of 72 months (range, 60-144 months). The pooled clinical success rate was 87.1% (95% CI 82.4-91.8%; I² = 84.2%). The pooled incidence of endoscopically detectable reflux esophagitis was 24.2% (95% CI 11.6-36.8%; I² = 85.4%), whereas symptomatic reflux was inconsistently reported, with a pooled incidence of 27.2% (95% CI 19.2-35.3%; I² = 83.6%). Long-term follow-up reported 2 cases of Barrett's esophagus and isolated cases of esophageal cancer.

Conclusion: POEM has demonstrated consistent long-term efficacy and safety. Postoperative symptomatic reflux is the most common long-term complication, while the risks of Barrett's esophagus and peptic stricture remain low. POEM represents a reliable first-line treatment option; however, further multicenter prospective studies are needed to validate its long-term efficacy and safety.

Background: Flexible endoscopic suturing tools are complex and may have a long learning curve. This porcine study evaluated the safety and performance of a simplified suturing system compared with a commercially available device for the repair of gastrointestinal mucosal defects.

Methods: This IACUC-approved study included four healthy swine. A total of ten defects (six in the stomach and four in the rectosigmoid colon) were created in each animal. Defects were randomly assigned to closure with either the novel or the commercially available system using a therapeutic gastroscope. Technical success was defined as mucosal closure of the defect with the inability to visualize any significant portion of the resection bed. Additional performance metrics included procedure time and device ease of use (assessed using the NASA Task Load Index [TLI]) and adverse events.

Results: No adverse events were reported post-procedurally for any of the test animals. The proportion of target resection sites achieving technical success was 100% in both treatment groups. The mean SimpleStitch NASA-TLI score was lower compared to the OverStitch device. Closure times were similar between the two devices. Histological assessment scores indicated expected healing response without evidence of perforation, leakage, or abscess formation.

Conclusion: A novel full-thickness suturing system safely and effectively closed mucosal defects. Lower NASA-TLI scores suggest that the novel suturing device may offer simpler, less demanding use compared to the predicate device, potentially reducing the learning curve for endoscopic suturing procedures.

Background: Safe establishment of pneumoperitoneum is essential in laparoscopic surgery because most access-related injuries occur during peritoneal entry. In Veress needle procedures, this step is performed blindly, and conventional verification tests are subjective and often unreliable. The negative pressure-based visualization (NPV) technique enables real-time confirmation of peritoneal entry using a saline column. We therefore developed a manometric modification (NPMV) and a four-forceps technique (NPMV4) to improve practicality and applicability in obese patients.

Methods: This retrospective study included two cohorts: a standard-weight cohort of 475 patients undergoing laparoscopic groin hernia repair (243 NPMV, 232 NPV) and an obese cohort of 53 patients undergoing laparoscopic sleeve gastrectomy (33 four-forceps, 20 two-forceps). In the NPMV, the Veress needle was connected to an insufflator with a manometric display, and peritoneal entry was confirmed at a pressure of minus 2 mmHg or lower. Primary outcomes were pneumoperitoneum success and access-related complications; secondary outcomes included access time and puncture attempts.

Results: In the standard-weight cohort, pneumoperitoneum success was 99% in both groups, with no differences in complications or puncture attempts. The NPMV group achieved a significantly shorter time to insufflation (median 1.0 vs 2.0 min, p < 0.001). In the obese cohort, the four-forceps group showed fewer failed entries (3% vs 15%) and significantly fewer puncture attempts (median 1.0 vs 3.5, p = 0.019), without increased gas-related complications.

Conclusion: Replacing the saline column with a manometric display did not increase access-related complications and improved procedural efficiency. The NPMV4 technique further improved the reliability of laparoscopic access in obese patients. These stepwise modifications provide a simple, reproducible, and reliable approach to Veress needle access across diverse surgical populations.

Background: Few studies have compared the invasiveness and safety of pure single-incision robotic surgery using the da Vinci SP system (SP) without an assistant port with those using the da Vinci Xi system (Xi) for right-sided colon cancer. Surgical invasiveness was assessed using the C-reactive protein/albumin (CRP/Alb) ratio and postoperative pain using the Numerical Rating Scale (NRS).

Methods: This single-center retrospective study included 163 patients who underwent robot-assisted surgery for right-sided colon cancer between October 2022 and August 2025 (SP = 60, Xi = 103). Confounding factors were adjusted using propensity score matching and stabilized inverse probability of treatment weighting based on body mass index (BMI) ≥ 25 kg/m², American Society of Anesthesiologists (ASA) ≥ III, tumor size ≥ 40 mm, surgical procedure, and preoperative CRP/Alb ratio ≥ 0.03; short-term outcomes were compared.

Results: After adjustment, baseline characteristics were well balanced. The SP approach was associated with a shorter incision length (3.0 vs 5.5 cm, p < 0.01) and lower postoperative pain on day 3 (NRS scores 2 vs. 3, p < 0.01). Operative time, postoperative inflammatory response assessed by CRP/Alb ratio, complications, and pathological outcomes were comparable between the groups.

Conclusions: Pure single-incision robotic surgery using the da Vinci SP system demonstrated comparable short-term safety and oncological adequacy to the Xi system, with modest advantages in incision length and postoperative pain. No clear benefit in systemic inflammatory response was observed, and further validation in larger, prospective, multicenter studies is warranted.