Surgical Endoscopy And Other Interventional Techniques最新文献

Introduction: In off-clamp single-port robot-assisted partial nephrectomy (ocSP-RAPN), the factors guiding retroperitoneal versus transperitoneal access remain undefined. We sought to identify the preoperative and anatomical determinants influencing route selection during early ocSP-RAPN integration at a high-volume centre.

Methods: All patients undergoing ocSP-RAPN between May 2024 and October 2025 (n = 78) were retrospectively reviewed. Clinical, anatomical and perioperative variables were compared by access route (retroperitoneal n = 42; transperitoneal n = 36). Tumour complexity was graded using the RENAL score; renal function was evaluated through serial CKD-EPI eGFR measurements. Predictors of retroperitoneal access were analysed using Firth-corrected logistic regression, with covariate entry based on univariable p < 0.20 or biological plausibility. Model calibration, discrimination and collinearity were assessed. Complete-case analysis yielded a final multivariable cohort of 71 patients.

Results: Baseline characteristics were comparable (each each p ≥ 0.23). Tumour size (median 2.5 cm; p = 0.57), preoperative eGFR (p = 0.39) and RENAL complexity (21.6% vs 11.8% high-complexity; p = 0.43) showed no significant differences. Perioperative outcomes were favourable: hospital stay remained 2 days (p = 0.67), complications were uncommon in both groups (≤ 10%; p = 0.82) and all margins were negative. Early renal function was preserved in both cohorts (median ΔeGFR 98.4%; p = 0.61). At multivariable analysis, the RENAL score was the only independent determinant of retroperitoneal access (OR 0.58; 95% CI 0.33-0.97; p = 0.039). The predicted probability of retroperitoneal use decreased from approximately 65% (RENAL ≤ 5) to ~ 20% (RENAL ≥ 9).

Conclusions: In ocSP-RAPN, access selection is shaped predominantly by anatomical complexity, with patient-level variables exerting no measurable influence. When tailored to tumour anatomy, both retroperitoneal and transperitoneal routes ensured safe resection and preserved early renal function. Larger, standardised multicentre cohorts will be required to verify whether these patterns persist beyond specialised environments.

Background and aim: Accurate preoperative assessment of lesion size is crucial for selecting the appropriate endoscopic resection technique. However, the current assessment of lesion size still mainly relies on visual estimation, lacking objective measurement methods. To develop and validate an Endoscopic Virtual Ruler (EVR) based on image detection technology for objective measurement of lesion size before endoscopic treatment.

Methods: Using computer image recognition technology and laser spot imaging principle, EVR was formed to detect the size of lesions. In vitro animal and human experiments were carried out to verify the accuracy and safety of EVR by comparing its measurement results with the actual size and the visual inspection results of endoscopists.

Results: In 30 in vitro tests, the measurement error of EVR was 0.08 ± 0.17 cm (95% CI 0.01-0.14), and the relative accuracy of the measurement was 92.80% ± 5.50%( 95% CI 90.75-94.85%). In 58 clinical lesions, the mean error for visual estimation was 0.16 ± 0.66 cm (95% CI- 0.01 to 0.33), while EVR showed 0.12 ± 0.32 cm (95% CI 0.04-0.21). EVR was significantly more accurate (85.68% ± 15.25%) than visual estimation (67.08% ± 22.59%, p < 0.001). EVR was more effective [48 (82.8%) vs 31 (46.6%), p = 0.001]. In the multivariable model, EVR-assisted measurement was independently associated with achieving clinically acceptable accuracy (OR  4.38, 95% CI 1.84-10.43, p = 0.001). EVR also demonstrated higher consistency in lesion size classification (Kappa = 0.764 vs. 0.522, p < 0.001). For lesions < 1 cm, EVR misclassified only 12.5% as 1-2 cm, significantly less than the 50% misclassification rate with visual estimation (p = 0.034). There was no laser damage side effect.

Conclusion: EVR offers an accurate, safe, and objective measurement tool, which is helpful for the formulation of appropriate treatment decisions.

Chinese clinical trial registry: ChiCTR2400085998.

Introduction: Exploratory laparotomy has been the main method for surgical interventions in penetrating abdominal trauma (PAT). Minimally invasive surgery (MIS) has been utilized in the treatment of selected trauma patients as an alternative to laparotomy. This study aimed to investigate the utilization of MIS and open approaches in patients with PAT.

Methods: Patients who underwent surgical treatment for PAT were included in this study using the National Inpatient Sample 2016-2020. Patients who underwent diagnostic laparoscopy or other laparoscopic or robotic procedures during admission were categorized as MIS.

Results: A total of 94,280 patients with PAT were analyzed (open: 82,745 (87.8%), MIS: 8,630 (9.2%), and conversion to open: 2,905 (3.1%)). The trend of using a MIS approach remained stable between 2016 and 2020 (8.6-9.7%). Independent predictors of using MIS were younger age, female gender, higher median income of residence area, and urban nonteaching hospitals. Independent factors associated with less MIS intervention were Midwest and South locations, Black race, firearm mechanism, and a higher Charlson Comorbidity Index score or Injury Severity Score. MIS approach had significantly lower hospitalization cost median and interquartile range ($16,822 [11,764-26,489] vs $32,913 [20,270-63,016]) and shorter length of stay (4 [2-7] vs 8 [5-14] days) compared to open approach. The complication rate was lower in the MIS group.

Conclusion: The MIS approach is utilized in a subgroup of patients with PAT with acceptable outcomes, shorter length of stay, and reduced costs. Further research is needed to develop strategies to increase the utilization of MIS in the management of patients with trauma.

Background: The transition from medical student to surgical resident involves a significant shift in responsibility, learning style, and hands-on training complexity. Navigating all these professional hurdles can be a challenge, and residents may struggle with various aspects of these throughout their training, which can lead to the need for remediation. Residency programs must facilitate efforts to identify and address both technical and non-technical deficiencies through targeted remediation.

Materials and methods: Members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Resident and Fellow Task Force (RAFT) Committee performed a review of technical and non-technical components of resident remediation.

Results: The two primary components of remediation in a residency program are technical and non-technical skill competencies. The role of the program director is essential to guiding and facilitating the remediation process for residents. Additionally, efforts to prevent remediation are important to implement within a residency program's structure. Current resources focus on technical and non-technical skills remediation. Program design and video-based assessments play crucial roles in technical skills remediation. For non-technical skills remediation, these address resident deficiencies in professionalism, interpersonal skills and communication.

Conclusion: Resident remediation is a complex yet essential responsibility for surgical training programs. It requires structured strategies tailored to both technical and non-technical skills, grounded in timely identification and consistent support. Effective remediation begins with early recognition of deficits and the development of clear, personalized improvement plans. These plans must outline specific goals, measurable outcomes, and mechanisms for progress assessment.

Background: The anchor-pronged clip has been widely adopted for closure of large defects, offering enhanced tensile strength and grasping ability. However, reported real-world device and patient adverse events are limited in literature. Our focus is to identify the most commonly reported adverse events, device issues, and their clinical implications.

Methods: The Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was analyzed from February 1, 2023 to December 31, 2024 to report post-marketing surveillance data on these anchor pronged clips.

Results: Approximately 135 reported cases with 187 device issues and 30 patient adverse events were examined. The most reported device problems were due to activation, position, or separation (53.5%). Common indications included defect closures after endoscopic submucosal dissection (ESD) (29.9%) and endoscopic mucosal resection (EMR) (23.9%). From the total reports analyzed, patient adverse events were noted in 21.1% (n  =  30) of cases which comprised of hemorrhage (43.3%; n  =  13), perforation (10.0%; n  =  3), abdominal pain (6.7%; n  =  2) among others.

Conclusions: Our analysis of the MAUDE database suggests that the MANTIS^™ clip demonstrates a favorable safety profile, particularly considering its intended use for closing large defects after advance tissue resections and ulcerations - procedures that inherently carry a higher risk of complications. This study provides valuable insight to help inform the risk/benefit discussions with patients and guide the development of future design iterations, ultimately enhancing patient outcomes and safety.

Background: Indocyanine green (ICG) fluorescence imaging is increasingly incorporated into robotic liver resections (RLR), yet clinical practice regarding timing, dosage, and staining techniques is divergent. This international expert survey aimed to characterize current practices for ICG in RLR.

Methods: Experts in RLR were invited to participate based on surgical volume (experience of $\ge$ 50 RLR and $\ge$ 30 annual RLR). A 74-item questionnaire was developed following a literature search and reviewed by a steering committee. The survey addressed indications, timing, dosage, imaging technology, benefits, limitations, training, and future directions of ICG use. Responses collected between September and October 2025 were analyzed.

Results: Seventy experts from 19 countries completed the survey, corresponding to an 88% response rate. Centers performed a median of 180 annual liver resections, including 55 RLR. Most experts used ICG (96%) during RLR. Anatomical demarcation (91%), tumor localization (60%), and biliary anatomy assessment (60%) were the most frequent indications. 60% of experts use preoperative ICG, while intraoperative ICG is mainly administered for demarcation (67%) and biliary tract visualization (40%). Considerable heterogeneity exists in dosage, timing, and staining techniques, particularly in cirrhotic livers and for tumor localization. 53% of the experts had standard operating procedures, whereas 64% expressed the need for a higher degree of standardization. Reported benefits of ICG use included improved anatomical orientation, margin assessment, lesion detection, and support during complex resections. Perceived limitations included background fluorescence, tissue penetration and variable staining in diseased parenchyma. 80% anticipated improved outcomes with combined ICG and three-dimensional image-guidance.

Conclusion: ICG fluorescence is widely used in RLR and is an important cornerstone for precision-guided robotic liver surgery. Standardized clinical practice guidelines, structured training, and technological improvements in imaging and navigation systems are claimed to optimize its clinical use.

Objective: Surgery remains the gold standard for non-metastatic esophageal cancer. Oncologic resection is considered adequate when 15 regional lymph nodes are sampled and specimen margins are negative. We hypothesize that racial and regional disparities exist in who receives an adequate oncologic resection.

Methods: The National Cancer Database (NCDB) was queried from 2010 to 2021 for patients who underwent esophagectomy for cancer. Exclusion criteria included stage IV disease and incomplete data. Adequate resection was defined as ≥ 15 lymph nodes removed and negative margins. A multivariable regression model identified factors associated with adequate resection, and survival was assessed using Kaplan-Meier curves.

Results: 11,451 patients were included. Of these, 5153 (45.0%) had an adequate oncologic resection. Black patients had increased odds of an inadequate resection compared to white patients (OR 1.490, 95%CI 1.227-1.809, p < 0.01). Patients treated at community or comprehensive cancer programs had higher odds of inadequate resection than those treated at academic programs. Medicaid patients had higher odds of an inadequate resection compared to those with private insurance (OR 1.397, 95%CI 1.172-1.664, p = < 0.01), while a minimally invasive esophagectomy (MIE) had 24.0% decreased odds of inadequate resection, and robotic-assisted esophagectomy (RAMIE) had 35.4% decreased odds compared to open surgery (95%CI 0.695-0.830, p < 0.01; 95%CI 0.567-0.735, p < 0.01). Controlling for stage, 5-year survival was higher for patients with an adequate resection. Resection adequacy improved from 38.5% in 2010 to 60.1% in 2021, with increases in MIE and RAMIE.

Conclusion: Disparities persist in who receives adequate resection for esophageal cancer, though overall resection adequacy has improved, these findings should be interpreted in the context of evolving practice patterns.

Background: Recurrent benign biliary strictures after failed hepaticojejunostomy remain a major surgical challenge, particularly in East Asia. This study aimed to evaluate the feasibility and mid-term outcomes of a structured, risk-adapted protocol for redo laparoscopic Roux-en-Y hepaticojejunostomy (RYHJ).

Methods: Between June 2019 and December 2024, 26 consecutive patients underwent redo laparoscopic RYHJ performed by a single surgeon. Patients were preoperatively stratified according to the Hobson adhesion grade (I-V) into low-risk (I-II), moderate-risk (III), and high-risk (IV-V) groups. In patients classified as high risk, a standardized intraoperative strategy incorporating indocyanine green (ICG) fluorescence cholangiography via pre-established percutaneous transhepatic cholangiodrainage and refined anastomotic techniques was applied. Key operative steps were prospectively video documented. Primary and secondary endpoints included technical success, perioperative outcomes, and biliary patency during follow-up.

Results: Redo laparoscopic reconstruction was successfully completed in all patients. The median operative time was 210 min (range 150-378) and median blood loss was 55 mL (range 10-200).Patients with higher Hobson grades demonstrated increased technical complexity and a higher incidence of early postoperative bile leakage. In the final six high-risk cases, no bile leaks or anastomotic strictures were observed during a median follow-up of 36 months, despite increased operative complexity.

Conclusions: Redo laparoscopic RYHJ using Hobson-guided protocols yielded durable mid-term outcomes with acceptble morbidity. In high-risk patients, the standardized use of ICG fluorescence and refined anastomotic techniques contributed to improved safety, representing a reproducible and clinically practical technical refinement for complex redo biliary surgery.

Background: Anal fistula is a common and challenging condition to manage, requiring a balance between achieving healing and preserving continence. Video-assisted anal fistula treatment (VAAFT) is a minimally invasive, endoscopic approach that allows direct visualisation and debridement of the fistula tract. Although short-term outcomes are promising, evidence regarding its long-term durability remains limited. This study provides one of the longest follow-up assessments of VAAFT outcomes to date.

Methods: This observational study utilises a prospectively maintained database of patients who underwent VAAFT between November 2014 and June 2016 at a single UK centre. All patients with a minimum of five years of follow-up were included. Data collected included sex, age, fistula type (simple vs. complex), comorbidities (inflammatory bowel disease and diabetes mellitus), smoking status, previous fistula surgery, and subsequent fistula-related procedures (if any). The primary outcome was healing, defined as the absence of fistula-related symptoms at review. Secondary outcomes were postoperative continence deterioration and complications.

Results: A total of 74 patients underwent VAAFT during the study period, and 48 patients (mean age 48 years, SD 13, 58.3% male) completed a minimum of 5 years' follow-up (median 79 months, IQR 67-82). The majority (77%) were complex-type fistula (versus simple). At their most recent follow-up appointment, 66.7% achieved healing and a further 27% reported partial symptomatic improvement. Only one reported worsened continence (loss of flatus control), and there was one self-resolving haematoma. Follow-up duration was comparable between healed and symptomatic groups. No significant association was found between healing and sex, age, fistula type, or surgical history.

Conclusion: VAAFT provides durable symptom relief for many patients and carries a low risk of complications or continence impairment. However, long-term complete healing rates appear modest, underscoring the importance of appropriate patient selection and counselling. Further prospective studies are warranted to refine indications and optimise long-term outcomes.