Surgical Endoscopy And Other Interventional Techniques最新文献

Objective: While laparoendoscopic single-site surgery (LESS) theoretically improves cosmesis through a single umbilical incision, evidence on patient-reported cosmetic satisfaction remains equivocal. Technical challenges in umbilical incision closure and reliance on costly disposable devices further limit its adoption in resource-constrained settings. The transumbilical single-site dual-incision (SSDI) approach circumvents these challenges through strategic dual umbilical incision placement. This design enables surgeons to apply conventional instruments and umbilical incision suturing techniques which are comparable to multiport laparoscopy. This study aimed to compare surgical outcomes and cosmetic satisfaction between transumbilical SSDI laparoscopic surgery using conventional instruments and standard LESS for benign adnexal diseases.

Methods: A total of 116 patients with benign adnexal diseases underwent transumbilical SSDI laparoscopic surgery using conventional laparoscopic instruments (n = 52) or standard LESS (n = 64) were retrospectively analyzed.

Results: Both procedures were successfully performed in all patients. SSDI technique preserved the integrity of the base of umbilical fossa in 88.5% (46/52) of cases, obviating the need for complex umbilical reconstruction. Compared to the LESS group, the SSDI group demonstrated significantly shorter total operation time (44.6 ± 18.9 vs. 56.8 ± 14.9 min, P < 0.001) and incision suturing time (3.6 ± 4.4 vs. 15.4 ± 2.5 min, P < 0.001). Additionally, hospital costs were significantly lower in the SSDI group (9,137.4 ± 891.3 vs. 11,920.2 ± 924.5 RMB, P < 0.001). No significant differences were observed between the two groups in terms of estimated blood loss, delayed discharge, wound infection, trocar-site hernia, or cosmetic satisfaction. At the 3-month postoperative follow-up, the majority of patients in both groups reported great satisfaction with cosmetic outcomes.

Conclusion: Transumbilical SSDI laparoscopic surgery using conventional instruments represents a technically feasible and economically advantageous alternative to standard LESS for benign adnexal diseases. This "back-to-basics" approach may enhance the accessibility of single-site laparoscopy, particularly in resource-limited settings.

Introduction: Dumping Syndrome (DS) and Reactive Hypoglycaemia (RH) are common occurrences post bariatric surgery, particularly post Roux-En-Y Gastric Bypass (RYGB). We present our initial results using Transoral Outlet Reduction Endoscopy (TORE) in the management of patients who failed to respond to dietary and medical treatment for DS.

Methods: All patients identified to have symptoms consisting with DS were discussed in the complex bariatric MDT and assessed for suitability of TORE via an upper gastro-intestinal endoscopy to assess the length of the pouch, size of the gastro-jejunostomy and the presence of alternative pathologies.

Results: Since the onset of our TORE services in January 2025, we identified 17 patients for treatment with TORE. The median age was 45yrs (IQR 36-55). Sixteen patients (94%) were women and all patients scored ≥ 7 on the Sigstad scoring questionnaire. Two patients had previously undergone conversion of gastric sleeve to a RYGB whilst all others had a primary RYGB. 2 patients were found to have unfavourable anatomy and was not safe to proceed with the procedure whilst one patient was followed up privately hence no data were available for review. The data showed a complete response to treatment at 2 years for 66% of patients. Four patients did not respond to treatment with TORE and are being considered for surgical intervention.

Conclusions: TORE is an effective treatment for patients with DS not responsive to medical and dietary therapy. We believe it is an effective non-surgical treatment method prior to considering reversal of the original surgery (RYGB) with its associated weight regain. Further work is planned to assess its outcomes in larger groups of patients.

Background: The epidemiological shift toward non-B non-C hepatocellular carcinoma (NBNC-HCC) highlights the need for identifying prognostic markers in this population. While microvascular invasion (MVI) has been established in hepatitis virus-related HCC (HV-HCC), its role in NBNC-HCC remains unclear.

Methods: This multicenter retrospective study analyzed 3308 patients with HCC undergoing curative resection (2012-2023). Risk factors for MVI were identified using logistic regression in the overall cohort. From this cohort, 439 patients with NBNC-HCC were stratified based on the MVI status and balanced using propensity score matching (PSM). Cox regression models and Kaplan-Meier analysis with log-rank test were employed to compare recurrence-free survival (RFS) and overall survival (OS) between MVI-positive and MVI-negative subgroups.

Results: The incidence of MVI was lower in the NBNC-HCC group compared to the HV-HCC group (31.44% vs. 38.06%, P = 0.007), but viral hepatitis was not an independent risk factor for MVI (OR = 1.20, 95% CI 0.95-1.51, P = 0.118). After PSM, patients with MVI-positive NBNC-HCC had significantly worse RFS (median 30.0 vs. 47.0 months) and OS (median 41.0 months vs. not reached) compared to MVI-negative patients (both P < 0.01). MVI independently predicted postoperative recurrence (HR = 2.07, 95% CI 1.46-2.94) and mortality (HR = 2.17, 95% CI 1.45-3.26). MVI-positive cases also demonstrated adverse recurrence patterns, characterized by higher rates of simultaneous intrahepatic and extrahepatic recurrence (17.0% vs. 11.4%) and more frequent recurrence beyond the Milan criteria (39.8% vs. 22.9%).

Conclusion: MVI independently predicts adverse outcomes in NBNC-HCC, associated with adverse recurrence and reduced survival. The prognostic value of MVI is independent of viral hepatitis, supporting its importance for risk stratification in this population.

Background: Debate regarding whether additional surgery should be the preferred treatment option for patients with early gastric cancer who have undergone noncurative endoscopic resection is ongoing.

Objectives: This meta-analysis aims to provide clarity for clinicians and patients to facilitate better informed treatment decisions.

Methods: Our meta-analysis involved searches of PubMed, Embase, and Web of Science databases. We analyzed the following prognosis-related indicators in groups receiving additional surgical or nonsurgical treatment: 5-year overall survival (OS), 8-year overall survival (OS), 5-year disease-specific survival (DSS), 5-year disease-free survival (DFS), 5-year recurrence-free survival (RFS), 5-year cancer-specific survival (CSS), and clinicopathological data.

Results: After applying strict inclusion and exclusion criteria, 26 studies published in English through May 2024 were included, comprising data from 9177 patients with early-stage gastric tumors following noncurative endoscopic resection. These patients were categorized into additional surgery (n = 4903) and nonsurgical (n = 4274) groups. The following outcomes were significantly better in the additional surgery group: 5-year OS (odds ratio [OR] = 3.37, 95% confidence interval [CI] = 2.91-3.91, p < 0.00001; hazard ratio [HR] = 0.51, 95% CI = 0.41-0.64, p < 0.00001), 8-year OS (OR = 1.96, 95% CI = 1.22-3.16, p = 0.005), 5-year DSS (OR = 3.08, 95% CI = 2.08-4.55, p < 0.00001), 5-year DFS (OR = 4.17, 95% CI = 1.53-11.4, p = 0.005), 5-year RFS (OR = 9.14, 95% CI = 3.63-23.01, p < 0.00001), and 5-year CSS (OR = 2.54, 95% CI = 1.32-4.9, p = 0.005). Additionally, subgroup analysis revealed that patients over 70 years old benefitted more from surgery (OR = 3.09, 95% CI = 2.37-4.02, p < 0.00001). The results of the analysis were significant, with minimal heterogeneity.

Conclusions: Our review revealed that the prognostic indicators of patients in the additional surgery group were greater and cannot be ignored.

Objective: To compare the long-term safety and efficacy of endoscopic radiofrequency ablation (ERFA) versus endoscopic band ligation (EBL) in the treatment of gastroesophageal reflux disease (GERD).

Methods: A retrospective analysis was conducted on the clinical data of 139 patients who underwent endoscopic treatment for GERD. According to the treatment modality, patients were divided into an ERFA group (n = 50) and an EBL group (n = 89). Primary outcome measures included the DeMeester score, GerdQ score, symptom relief rate, and complication rate.

Results: No significant differences were found in baseline characteristics (all P > 0.05). Key results include (1) Intraoperative blood loss was 1.04 ± 0.20 mL (ERFA) vs. 1.10 ± 0.75 mL (EBL). (2) Both groups showed reduced DeMeester scores: ERFA from 28.16 ± 20.01 to 6.77 ± 3.95 and EBL from 26.18 ± 13.39 to 6.26 ± 4.33 (both P < 0.001). (3) GERD-Q scores improved: ERFA from 11.84 ± 2.92 to 3.58 ± 2.75 and EBL from 12.13 ± 2.70 to 3.54 ± 3.05 (both P < 0.001). (4) Symptom relief was 48.0% (ERFA) vs. 58.4% (EBL). (5) Complications were low: 2 cases (4.0%) bleeding in ERFA; 3 cases (3.4%) bleeding; and 1 case (1.1%) perforation in EBL, with no significant difference between groups (P = 0.677). (6) Complete drug discontinuation rates were 72.0% (ERFA) and 73.0% (EBL). (7) Mean LES pressure was 15.15 ± 5.99 mmHg (ERFA) vs. 14.81 ± 6.76 mmHg (EBL).

Conclusion: Both ERFA and EBL are safe and efficacious treatments for GERD. Three-year follow-up data indicate comparable efficacy between the two approaches in symptom control.

Background: Quantifying learning in robotic pancreaticoduodenectomy (RPD) can be challenging because case selection and conversions complicate the interpretation of full-procedure metrics. MyIntuitive intraoperative telemetry provides objective, process-level signals that may help to capture proficiency gains.

Methods: We analysed 100 consecutive RPD attempts by a single surgeon (January 2022-August 2025). The primary outcome was Full-Case idle time from MyIntuitive telemetry among completed robotic cases. Key secondary telemetry outcomes included console time, active time, arm-specific activity, and instrument exchanges. As secondary corroboration on an intention-to-treat (ITT) basis, the probability of robotic completion (no conversion) was modelled across case order with risk-adjusted (RA)-CUSUM and spline logistic regression; conversions were characterised by timing and reason on video review.

Results: Telemetry demonstrated marked efficiency gains across the curve. Idle time fell from 42 to 32 min (P = 0.001), console time from 470 to 395 min (P < 0.001), and active time from 428 to 365 min (P < 0.001) between the initial (cases 1-60) and proficiency (> 60) phases; Arm-4 active time decreased from 40 to 17 min (P = 0.027). The RA-CUSUM of idle time showed a proficiency inflection near cases 50-60. Supportive resection-phase telemetry showed shorter time to complete mesopancreas dissection (from 323 to 215 min, P = 0.002). On ITT analysis, conversion occurred in 17% overall, declining from 23.3 to 7.5% after case 60 (P = 0.033); no emergency conversions occurred. Perioperative outcomes included POPF 29%, postpancreatectomy haemorrhage 8%, ≥ Clavien-Dindo III 22%, reoperation 9%, 90-day readmission 9%, 90-day mortality 2%, and median length of stay 16 days.

Conclusion: A telemetry-based primary endpoint (MyIntuitive idle time) sensitively tracks the RPD learning curve and, with risk-adjusted CUSUM, identifies a proficiency threshold around ~ 60 cases. Secondary ITT completion trends and conversion mapping corroborate the telemetry signal. This telemetry-first framework provides objective, phase-specific insight to guide coaching and programme maturation in complex robotic pancreatic surgery.

Background: Rectal gastrointestinal stromal tumours (GIST) are uncommon and technically challenging to treat due to the confined pelvic anatomy and proximity to the anal sphincter complex. The oncological goal of surgery is R0 resection, but radical procedures often compromise function. Transanal endoscopic microsurgery (TEM/TEO) provides stable exposure and precise full-thickness excision, offering the possibility of organ preservation. The role of tumour size and neoadjuvant imatinib in enabling local excision remains under investigation.

Methods: We conducted a retrospective single-centre study of all consecutive patients undergoing TEM/TEO for rectal GIST between January 2007 and May 2023. Clinicopathological data, operative outcomes, postoperative course, and follow-up were analysed. Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method.

Results: Thirteen patients were included. Median age was 55 years (IQR 48-69), 69.2% were male, and median BMI was 26.1 kg/m² (IQR 22.4-28.0). The median tumour distance from the anal verge was 6.0 cm (IQR 4.0-7.0), and the median pathological size was 5.0 cm (IQR 5.0-7.0). Two patients (15.4%) received neoadjuvant imatinib. Spinal anaesthesia was used in 69.2% of cases, with a median operative time of 80 min (IQR 60-110 min). Peritoneal opening occurred in one case (7.7%), which was repaired transanally. No conversions were required. Median hospital stay was 4 days (IQR 2-6), with no recorded postoperative complications; one patient (7.7%) required salvage reintervention. R0 resection was achieved in 92.3%. At a median follow-up of 60 months, two patients (15.4%) developed local recurrence and one patient (7.7%) died. The 12-month Kaplan-Meier estimates were 92.3% for DFS and 100.0% for OS.

Conclusion: TEM/TEO achieved a high rate of R0 resection with organ preservation in this small single-centre series of rectal GIST. Tumour size alone should not be considered an absolute contraindication when en-bloc excision without rupture and negative margins are technically achievable. Neoadjuvant imatinib may facilitate local excision in selected borderline cases, but our experience is limited and larger multicentre registries are required to better define selection criteria and long-term outcomes.

Background: Minimally invasive surgery (MIS) has transformed abdominal surgery by improving recovery times and maintaining comparable outcomes to open surgery. However, the loss of three-dimensional (3D) visualization remains a limitation. Robotic platforms have facilitated the adoption of 3D systems. Despite these developments, the advantages of 3D over two-dimensional (2D) visualization in MIS and robotic surgery remain controversial.

Methods: A systematic review was conducted including studies published between January 2015 and May 2024. Studies comparing 2D and 3D visualization in MIS and robotic surgery were included. Primary outcomes assessed were operative time, intraoperative blood loss, length of stay, conversion and complication rates.

Results: Regarding MIS, three studies demonstrated a statistically significant reduction in blood loss favoring 3D visualization, with median reductions from 60 mL (IQR 20-60) to 20 mL (IQR 5-40) (p = 0.008). Operative time was significantly reduced in 15 studies, notably in hernia repairs, bariatric, gastric, and colorectal surgeries. Two studies reported marginally significant reductions in hospital stay. Complication rates showed isolated improvements. In robotic surgery, 14 studies showed 3D visualization enhanced task performance, with tasks completed up to 88% faster among novice surgeons.

Conclusion: 3D visualization consistently reduces operative time in selected MIS procedures and improves robotic task performance, whereas effects on blood loss, complications, and length of stay are inconsistent. Standardized, procedure-specific trials-especially against 2D-4K-and reporting of clinical outcomes in robotic surgery are needed.

Introduction: Necrotizing pancreatitis (NP), a severe form of acute pancreatitis (AP), is linked to lower survival rates. Treatment strategies have shifted towards less invasive, step-up approaches, favoring minimally invasive procedures. In this study, we report on the potential of combining the minimally invasive surgical approach with endoscopic necrosectomy as a novel treatment strategy, termed serial percutaneous endoscopic necrosectomy (SPEN), for patients with therapy-refractory NP.

Material and methods: A cohort of 19 patients suffering from therapy-refractory NP, defined as persistent necroses after drainage treatment and subsequent video-assisted retroperitoneal debridement (VARD), was treated with SPEN upon failure of the above stated. In contrast to surgery, SPEN does not require general anesthesia or an operating theater. The results were compared with the current data on alternative treatments.

Results: The investigated cohort consisted of severely ill patients as most patients experienced organ failure as well as severe disease progression in need of intensive-care unit admission. SPEN was performed 4.3 ± 3.8 times, ranging from 1 to 14 procedures per individual. According to the current Clavien-Dindo classification, only "mild" and no major SPEN procedure-associated complications can be observed.

Conclusion: In this report, we present our experience with a novel treatment approach combining surgery and endoscopic interventions for the treatment of NP. While sparing resources, SPEN was shown to be safe and effective. Favorable implications are implied owing to the combination of the best of two worlds: surgery, with its capacity for extensive necrosectomy and endoscopic necrosectomy, which is valued for its applicability as a flexible, low-grade invasive but effective tool that may be dynamically employed depending on individual disease progression.

Background: Peritoneal opening (PO) during transanal endoscopic microsurgery (TEM) can cause the pneumorectum to collapse and complicate the procedure. As indications expand to larger, more proximal rectal lesions, understanding the real-world frequency, predictors, and consequences of PO is clinically important.

Methods: We analysed a prospectively maintained single-centre database (January 1993-August 2025) of consecutive TEM/TEO resections. The primary exposure was PO; outcomes included abdominal conversion, complications, and length of stay (LOS). Multivariable logistic regression evaluated factors such as distal distance from the anal verge, maximal diameter, excision plane, and simplified lesion location (anterior, posterior, lateral, circumferential). The prone/supine position was examined overall and within the PO subgroup.

Results: Of 1077 resections, PO occurred in 81/1,077 (7.5%). PO was more common with increasing distance from the anal verge: distal edge < 7 cm 2.3% (13/570) versus ≥ 7 cm 13.5% (68/502). Independent predictors included greater distance (OR 1.49 per cm; 95%CI 1.35-1.65; p < 0.001), larger diameter (OR 1.19 per cm; 95%CI 1.03-1.38; p = 0.022), full-thickness compared to submucosal excision (OR 4.03; 95%CI 1.39-11.66; p = 0.010), and circumferential versus anterior location (OR 4.78; 95%CI 1.61-14.19; p = 0.0049). Posterior location was protective (OR 0.26; 95%CI 0.13-0.53; p = 0.0002). Conversion occurred more frequently with PO (6.2%, 5/81) than without (0.1%, 1/992). LOS was longer with PO (median 5 [IQR 4-6] days) compared to without PO (median 4 [3-5] days; p < 0.001). The rate of complications did not differ significantly (any Dindo ≥ 1: 11.1% vs 7.3%; p = 0.19). Position was prone in 560/1,077 (52.2%) and supine in 513/1,077 (47.8%); PO was more common in prone (11.1%) than in supine (3.7%; p < 0.0001). Within the PO group, conversion was higher in the supine position (4/19, 21.1%) versus prone (1/62, 1.6%; p = 0.007), and laparoscopic-only conversions showed a borderline excess in the supine position (2/19 vs 0/62; p = 0.049).

Conclusions: PO during TEM/TEO is infrequent, anatomically driven, and usually manageable with secure endoluminal repair. Careful surgical planning-considering distance, orientation, and size-and matching platform/position can reduce risk, with no evident increase in short-term morbidity.