No consensus exists on the optimal surgical strategy for small bowel obstruction (SBO). Therefore, we assessed the feasibility of laparoscopic surgery (LS) for SBO by comparing LS and open surgery (OS) outcomes.
Methods
We retrospectively analyzed 303 patients who underwent surgery for SBO. The characteristics of 233 patients who underwent exploratory LS, including 43 who underwent open conversion surgery (OCS) and 70 who underwent OS, were propensity score-matched to compare surgical outcomes. Risk factors and a predictive model for OCS were also investigated.
Results
After matching, patients who underwent LS had smaller hemorrhage volumes, fewer severe postoperative complications, and shorter postoperative hospital stays than those who underwent OS. Furthermore, the recurrence rates were comparable. The surgical outcomes of patients who underwent OCS were generally inferior to those of patients who completed LS and were almost equivalent to those of patients who underwent OS. A history of abdominal surgery, serum albumin level ≤ 3.8 g/dL, platelet count ≤ 15 × 104/μL, and neutrophil-to-lymphocyte ratio ≥ 6.7 were identified as independent risk factors for OCS. The OCS risk was significantly higher when the predictive model for conversion to OS was derived from risk factors scoring ≥ 10.
Conclusion
Overall, LS for SBO yields better outcomes than OS. Even in patients with a high predicted risk of conversion to OS, exploratory laparoscopy should be the primary surgical procedure for treating SBO.
{"title":"Is Exploratory Laparoscopy the Optimal Surgical Strategy for Small Bowel Obstruction? A Single-Center Retrospective Cohort Study With Propensity Score-Matched Analysis","authors":"Shotaro Furukawa, Kentaro Kato, Yuta Susa, Takumi Yamabuki, Minoru Takada, Yoshihiro Kinoshita, Yoshiyasu Anbo, Fumitaka Nakamura, Satoshi Hirano","doi":"10.1111/ases.70056","DOIUrl":"https://doi.org/10.1111/ases.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>No consensus exists on the optimal surgical strategy for small bowel obstruction (SBO). Therefore, we assessed the feasibility of laparoscopic surgery (LS) for SBO by comparing LS and open surgery (OS) outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 303 patients who underwent surgery for SBO. The characteristics of 233 patients who underwent exploratory LS, including 43 who underwent open conversion surgery (OCS) and 70 who underwent OS, were propensity score-matched to compare surgical outcomes. Risk factors and a predictive model for OCS were also investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, patients who underwent LS had smaller hemorrhage volumes, fewer severe postoperative complications, and shorter postoperative hospital stays than those who underwent OS. Furthermore, the recurrence rates were comparable. The surgical outcomes of patients who underwent OCS were generally inferior to those of patients who completed LS and were almost equivalent to those of patients who underwent OS. A history of abdominal surgery, serum albumin level ≤ 3.8 g/dL, platelet count ≤ 15 × 10<sup>4</sup>/μL, and neutrophil-to-lymphocyte ratio ≥ 6.7 were identified as independent risk factors for OCS. The OCS risk was significantly higher when the predictive model for conversion to OS was derived from risk factors scoring ≥ 10.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Overall, LS for SBO yields better outcomes than OS. Even in patients with a high predicted risk of conversion to OS, exploratory laparoscopy should be the primary surgical procedure for treating SBO.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A bronchogenic cyst is a congenital malformation with a rare esophageal origin. Occasionally, it is discovered incidentally, and excision is the only treatment. A 43-year-old patient was referred to our hospital for treatment of a cystic tumor in the left posterior mediastinum. We suspected the tumor was a bronchogenic cyst by imaging findings; therefore, we performed video-assisted thoracoscopic resection. The patient was discharged 9 days postoperatively. The tumor origin was found to be the esophageal wall. This report presents a rare case in which the esophageal wall was the origin of the bronchogenic cyst.
{"title":"A Case of Intramural Esophageal Bronchogenic Cyst","authors":"Mototsugu Watanabe, Noriaki Shiraha, Toshio Shiotani","doi":"10.1111/ases.70055","DOIUrl":"https://doi.org/10.1111/ases.70055","url":null,"abstract":"<div>\u0000 \u0000 <p>A bronchogenic cyst is a congenital malformation with a rare esophageal origin. Occasionally, it is discovered incidentally, and excision is the only treatment. A 43-year-old patient was referred to our hospital for treatment of a cystic tumor in the left posterior mediastinum. We suspected the tumor was a bronchogenic cyst by imaging findings; therefore, we performed video-assisted thoracoscopic resection. The patient was discharged 9 days postoperatively. The tumor origin was found to be the esophageal wall. This report presents a rare case in which the esophageal wall was the origin of the bronchogenic cyst.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study highlights the effectiveness of using silicone plates to manage intrauterine adhesions (IUAs) in an enlarged uterine cavity caused by multiple fibroids. A 42-year-old woman developed Asherman syndrome following fibroid resection surgery, and despite initial attempts to prevent recurrence with an intrauterine device (IUD), IUAs reappeared. After successful hysteroscopic adhesiolysis, a customized silicone plate was introduced, preventing further IUAs for 1 month. The patient was then deemed suitable for fertility treatment. This case underscores the importance of innovative approaches in complex Asherman syndrome, particularly when standard treatments fail. Silicone plates prove useful for addressing enlarged or deformed uterine cavities caused by fibroids, expanding existing strategies for managing post-hysteroscopic complications.
{"title":"The Efficacy of a Silicone Plate for the Prevention of Re-Adhesions in Asherman Syndrome: A Case Study","authors":"Yuya Makino, Kaoru Tejima, Yuko Ikemoto, Saki Nagai, Juichiro Saito","doi":"10.1111/ases.70053","DOIUrl":"https://doi.org/10.1111/ases.70053","url":null,"abstract":"<div>\u0000 \u0000 <p>This study highlights the effectiveness of using silicone plates to manage intrauterine adhesions (IUAs) in an enlarged uterine cavity caused by multiple fibroids. A 42-year-old woman developed Asherman syndrome following fibroid resection surgery, and despite initial attempts to prevent recurrence with an intrauterine device (IUD), IUAs reappeared. After successful hysteroscopic adhesiolysis, a customized silicone plate was introduced, preventing further IUAs for 1 month. The patient was then deemed suitable for fertility treatment. This case underscores the importance of innovative approaches in complex Asherman syndrome, particularly when standard treatments fail. Silicone plates prove useful for addressing enlarged or deformed uterine cavities caused by fibroids, expanding existing strategies for managing post-hysteroscopic complications.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Razan Dankar, Toni Habib, Mira Tfaily, Dina Makkouk, Salim Barakat, Bruno Habib, Chris Kaspar, Ali Khalil
Background and Objectives
Current treatment options for obesity typically involve a combination of lifestyle changes, medications, and bariatric surgeries. This study aimed to assess the safety profile of the endoscopic sleeve gastroplasty (ESG), which is a novel non-invasive approach, as compared to laparoscopic sleeve gastrectomy (LSG) and to correlate their weight loss effectiveness and complication risk in Lebanese patients.
Subjects and Methods
This is a retrospective study, including 70 patients who underwent ESG at Fouad Khoury Hospital and 70 patients who underwent LSG at Trad Hospital, between September 2021 and March 2023. Data collection targeted the patients' medical records and included their demographic characteristics (age, sex, weight, height, BMI), comorbidities, and post-procedural information. Weight and BMI (pre-op, 6-months post-op, and 1-year post-op) were collected. Total body weight loss was calculated, and analysis was performed using SPSS version 25.
Results
Patients who underwent ESG were distributed between 43 (61.4%) females and 27 (38.6%) males, with an average age of 38.07 ± 10.78 years. Patients who underwent LSG were distributed between 42 (60%) females and 28 (40%) males, with an average age of 33.99 ± 10.55 years. Both ESG and LSG resulted in significant weight loss, but LSG achieved greater total body weight loss at 6 and 12 months. ESG was associated with significantly shorter hospital stays (9.14 h vs. 27.77 h, p < 0.001) and fewer adverse events (8.5% vs. 17.1%, p = 0.111). New-onset GERD was more frequent after LSG (20% vs. 4.3%, p = 0.004).
Conclusion
ESG offers a less invasive approach with a potentially more favorable short-term safety profile and faster recovery, while LSG yields greater total body weight loss. ESG may be a suitable alternative for patients with a higher BMI. Further research is needed to assess long-term outcomes and cost-effectiveness.
{"title":"Endoscopic Sleeve Gastroplasty Versus Laparoscopic Sleeve Gastrectomy: A Comparison in Effectiveness and Safety Profile","authors":"Razan Dankar, Toni Habib, Mira Tfaily, Dina Makkouk, Salim Barakat, Bruno Habib, Chris Kaspar, Ali Khalil","doi":"10.1111/ases.70050","DOIUrl":"https://doi.org/10.1111/ases.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Current treatment options for obesity typically involve a combination of lifestyle changes, medications, and bariatric surgeries. This study aimed to assess the safety profile of the endoscopic sleeve gastroplasty (ESG), which is a novel non-invasive approach, as compared to laparoscopic sleeve gastrectomy (LSG) and to correlate their weight loss effectiveness and complication risk in Lebanese patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects and Methods</h3>\u0000 \u0000 <p>This is a retrospective study, including 70 patients who underwent ESG at Fouad Khoury Hospital and 70 patients who underwent LSG at Trad Hospital, between September 2021 and March 2023. Data collection targeted the patients' medical records and included their demographic characteristics (age, sex, weight, height, BMI), comorbidities, and post-procedural information. Weight and BMI (pre-op, 6-months post-op, and 1-year post-op) were collected. Total body weight loss was calculated, and analysis was performed using SPSS version 25.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients who underwent ESG were distributed between 43 (61.4%) females and 27 (38.6%) males, with an average age of 38.07 ± 10.78 years. Patients who underwent LSG were distributed between 42 (60%) females and 28 (40%) males, with an average age of 33.99 ± 10.55 years. Both ESG and LSG resulted in significant weight loss, but LSG achieved greater total body weight loss at 6 and 12 months. ESG was associated with significantly shorter hospital stays (9.14 h vs. 27.77 h, <i>p</i> < 0.001) and fewer adverse events (8.5% vs. 17.1%, <i>p</i> = 0.111). New-onset GERD was more frequent after LSG (20% vs. 4.3%, <i>p</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ESG offers a less invasive approach with a potentially more favorable short-term safety profile and faster recovery, while LSG yields greater total body weight loss. ESG may be a suitable alternative for patients with a higher BMI. Further research is needed to assess long-term outcomes and cost-effectiveness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In high-risk patients undergoing surgery for colorectal cancer with organ invasion, a thorough evaluation of surgical indications and careful selection of optimal approaches is essential. We report a case of advanced transverse colon cancer with gastric invasion in a 58-year-old male with Child-Pugh grade B liver cirrhosis. The patient underwent laparoscopic transverse colectomy combined with gastric wedge resection. Intraoperative upper gastrointestinal endoscopy facilitated precise gastric resection. The primary tumor was excised with a clear margin, and the postoperative course was uneventful. This case highlights the feasibility of laparoscopic surgery for locally advanced colorectal cancer with organ invasion in high-risk cirrhotic patients, emphasizing the importance of meticulous operative planning and minimally invasive approaches to optimize outcomes.
{"title":"Laparoscopic Surgery for Advanced Transverse Colon Cancer With Gastric Invasion on a Child-Pugh Grade B Liver Cirrhosis Patient","authors":"Daisuke Tomita, Yudai Fukui, Jumpei Kashiwagi, Yasuhiro Takahashi, Kentoku Fujisawa, Yusuke Maeda, Kosuke Hiramatsu, Yu Ohkura, Yutaka Hanaoka, Shigeo Toda, Masaki Ueno, Shuichiro Matoba, Masashi Ueno, Hiroya Kuroyanagi","doi":"10.1111/ases.70051","DOIUrl":"https://doi.org/10.1111/ases.70051","url":null,"abstract":"<div>\u0000 \u0000 <p>In high-risk patients undergoing surgery for colorectal cancer with organ invasion, a thorough evaluation of surgical indications and careful selection of optimal approaches is essential. We report a case of advanced transverse colon cancer with gastric invasion in a 58-year-old male with Child-Pugh grade B liver cirrhosis. The patient underwent laparoscopic transverse colectomy combined with gastric wedge resection. Intraoperative upper gastrointestinal endoscopy facilitated precise gastric resection. The primary tumor was excised with a clear margin, and the postoperative course was uneventful. This case highlights the feasibility of laparoscopic surgery for locally advanced colorectal cancer with organ invasion in high-risk cirrhotic patients, emphasizing the importance of meticulous operative planning and minimally invasive approaches to optimize outcomes.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Effective liver retraction is crucial in minimally invasive upper gastrointestinal surgeries, including laparoscopic gastrectomy and robotic gastrectomy (RG) for gastric cancer, to ensure optimal visualization and sufficient working space. Various techniques have been developed to improve the surgical view, simplify procedures, and reduce complications. However, liver enzyme elevation has been a notable concern in these procedures. To address these challenges, we developed the subphrenic pulley (SP) method, a novel liver retraction technique, and evaluated its safety and feasibility in RG.
Methods
We retrospectively analyzed the initial 111 consecutive cases of RG for gastric cancer at a single center between January 2016 and September 2023. The SP method used a 2-0 polypropylene suture with a curved needle, which was placed in the left subphrenic peritoneum, the right side of the esophageal hiatus, and the right subphrenic peritoneum. The suture ends were pulled out from the left upper abdominal wall, achieving ventral and cranial retractions of both the lateral segment and round ligament of the liver.
Results
No case required re-retraction or additional methods, and no case of liver laceration was observed. The incidence of Grade ≥ 3 liver enzyme elevation was 12.6% (14/111) in all cases and 3.5% (3/86) in the subset of cases without aberrant left hepatic artery dissection. Additionally, no patient needed treatment for liver dysfunction.
Conclusion
The SP method is a valuable, simple, and safe liver retraction technique in minimally invasive upper gastrointestinal surgeries, ensuring effective retraction without requiring additional skin incisions.
{"title":"A Novel Liver Retraction Method Using a Polypropylene Suture in Robotic Gastrectomy for Gastric Cancer: The Subphrenic Pulley Method","authors":"Masashi Negita, Kazunari Misawa, Yuichi Ito, Seiji Ito, Tetsuya Abe, Koji Komori, Yasuhiro Shimizu","doi":"10.1111/ases.70047","DOIUrl":"https://doi.org/10.1111/ases.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Effective liver retraction is crucial in minimally invasive upper gastrointestinal surgeries, including laparoscopic gastrectomy and robotic gastrectomy (RG) for gastric cancer, to ensure optimal visualization and sufficient working space. Various techniques have been developed to improve the surgical view, simplify procedures, and reduce complications. However, liver enzyme elevation has been a notable concern in these procedures. To address these challenges, we developed the subphrenic pulley (SP) method, a novel liver retraction technique, and evaluated its safety and feasibility in RG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed the initial 111 consecutive cases of RG for gastric cancer at a single center between January 2016 and September 2023. The SP method used a 2-0 polypropylene suture with a curved needle, which was placed in the left subphrenic peritoneum, the right side of the esophageal hiatus, and the right subphrenic peritoneum. The suture ends were pulled out from the left upper abdominal wall, achieving ventral and cranial retractions of both the lateral segment and round ligament of the liver.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No case required re-retraction or additional methods, and no case of liver laceration was observed. The incidence of Grade ≥ 3 liver enzyme elevation was 12.6% (14/111) in all cases and 3.5% (3/86) in the subset of cases without aberrant left hepatic artery dissection. Additionally, no patient needed treatment for liver dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The SP method is a valuable, simple, and safe liver retraction technique in minimally invasive upper gastrointestinal surgeries, ensuring effective retraction without requiring additional skin incisions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Application of intracorporeal anastomosis is gradually becoming widespread; however, there are no detailed reports on its configuration. We aimed to create three-dimensional intracorporeal anastomosis models and compare their configurations in detail.
Methods
Three types of intracorporeal anastomosis models were used: overlap anastomosis, delta-shaped anastomosis, and functional end-to-end anastomosis. In experiment 1, three-dimensional images of each anastomosis model were created. Additionally, the length of each staple line comprising the anastomotic site was measured. In experiment 2, the lengths of intestinal mobilization required for different anastomoses were compared.
Results
The circumference of the anastomosis in overlap anastomosis (141.5 ± 3.3 mm) was significantly greater than that in delta-shaped anastomosis (87.9 ± 0.9 mm; p < 0.001) and functional end-to-end anastomosis (89.6 ± 10 mm; p < 0.0001). The length of the intestinal tract after anastomosis in delta-shaped anastomosis (33 ± 6.9 mm) was significantly shorter than that in functional end-to-end anastomosis (76 ± 2 mm; p < 0.0001) and overlap anastomosis (60 ± 5 mm; p < 0.002).
Conclusions
We successfully constructed three-dimensional images of intracorporeal anastomosis models. These results suggest that overlap anastomosis led to the formation of the largest anastomotic site, while minimal bowel mobilization was required in the delta-shaped anastomosis.
{"title":"Optimal Intracorporeal Anastomosis for Colectomy: A Comparative Experimental Evaluation Using 3D Anastomosis Models","authors":"Yoshiaki Fujii, Seiya Yamamoto, Sho Kimura, Shogo Suzuki, Hirotaka Miyai, Hiroki Takahashi, Yoichi Matsuo, Kenji Kobayashi, Shuji Takiguchi","doi":"10.1111/ases.70048","DOIUrl":"https://doi.org/10.1111/ases.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Application of intracorporeal anastomosis is gradually becoming widespread; however, there are no detailed reports on its configuration. We aimed to create three-dimensional intracorporeal anastomosis models and compare their configurations in detail.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three types of intracorporeal anastomosis models were used: overlap anastomosis, delta-shaped anastomosis, and functional end-to-end anastomosis. In experiment 1, three-dimensional images of each anastomosis model were created. Additionally, the length of each staple line comprising the anastomotic site was measured. In experiment 2, the lengths of intestinal mobilization required for different anastomoses were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The circumference of the anastomosis in overlap anastomosis (141.5 ± 3.3 mm) was significantly greater than that in delta-shaped anastomosis (87.9 ± 0.9 mm; <i>p</i> < 0.001) and functional end-to-end anastomosis (89.6 ± 10 mm; <i>p</i> < 0.0001). The length of the intestinal tract after anastomosis in delta-shaped anastomosis (33 ± 6.9 mm) was significantly shorter than that in functional end-to-end anastomosis (76 ± 2 mm; <i>p</i> < 0.0001) and overlap anastomosis (60 ± 5 mm; <i>p</i> < 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We successfully constructed three-dimensional images of intracorporeal anastomosis models. These results suggest that overlap anastomosis led to the formation of the largest anastomotic site, while minimal bowel mobilization was required in the delta-shaped anastomosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robotic surgery is being rapidly implemented globally, and new robotic surgery techniques are being developed. The da Vinci SP surgical system, a new robotic surgery system using a single-port approach, was introduced for the first time in Japan, and its surgical results were compared with those of the conventional single-port plus one-port laparoscopic hysterectomy.
Methods
The study included 20 patients who underwent single-port robotic hysterectomy using the da Vinci SP surgical system (SP-RH) between March 2023 and December 2023, and 37 patients who underwent single-port plus one-port laparoscopic hysterectomy (SP + 1-LH) between March 2018 and December 2023. The surgical outcomes and complications were retrospectively compared.
Result
When the SP-RH group was compared with the SP + 1-LH group, intraoperative blood loss was observed to be significantly lower in the SP-RH group. However, no difference in the incidence of intraoperative complications between the two groups was observed. Furthermore, when comparing postoperative inflammatory responses, C-reactive protein levels were significantly lower in the SP + 1-LH group on the third day after surgery, but no other differences were observed.
Conclusion
This study demonstrated that single-port robotic hysterectomy using the da Vinci SP surgical system can be safely introduced and performed in clinical settings. The da Vinci SP surgical system, which uses a single-port platform, can be used in minimally invasive surgeries as a novel operational system.
{"title":"Comparison Between Robotic and Conventional Laparoscopic Hysterectomy Performed Using Single-Port Approach","authors":"Akiko Ohwaki, Kyohei Takada, Arata Kobayashi, Mayuko Ito, Ryoko Ichikawa, Hironori Miyamura, Haruki Nishizawa","doi":"10.1111/ases.70044","DOIUrl":"https://doi.org/10.1111/ases.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Robotic surgery is being rapidly implemented globally, and new robotic surgery techniques are being developed. The da Vinci SP surgical system, a new robotic surgery system using a single-port approach, was introduced for the first time in Japan, and its surgical results were compared with those of the conventional single-port plus one-port laparoscopic hysterectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included 20 patients who underwent single-port robotic hysterectomy using the da Vinci SP surgical system (SP-RH) between March 2023 and December 2023, and 37 patients who underwent single-port plus one-port laparoscopic hysterectomy (SP + 1-LH) between March 2018 and December 2023. The surgical outcomes and complications were retrospectively compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>When the SP-RH group was compared with the SP + 1-LH group, intraoperative blood loss was observed to be significantly lower in the SP-RH group. However, no difference in the incidence of intraoperative complications between the two groups was observed. Furthermore, when comparing postoperative inflammatory responses, C-reactive protein levels were significantly lower in the SP + 1-LH group on the third day after surgery, but no other differences were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrated that single-port robotic hysterectomy using the da Vinci SP surgical system can be safely introduced and performed in clinical settings. The da Vinci SP surgical system, which uses a single-port platform, can be used in minimally invasive surgeries as a novel operational system.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143632783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laparoscopic and robotic gastrectomies have become standard procedures for the treatment of gastric cancer. Among the reconstruction methods used following distal gastrectomy, the Billroth-I technique is often preferred owing to its low complication rates. Delta-shaped anastomosis, a method that eliminates the need for a mini-laparotomy, represents a significant advancement in minimally invasive surgeries. In this report, we aim to present a novel technique using bidirectional barbed sutures for temporary closure of the entry hole during delta-shaped anastomosis in laparoscopic and robotic gastrectomies.
Materials and Surgical Technique
The entry hole was closed using a bidirectional barbed suture, starting centrally to prevent overlapping of the gastric and duodenal staple lines. The suture length was meticulously adjusted to align with the stapler dimensions. All the procedures were successfully completed without any complications in both laparoscopic and robotic gastrectomies. Bidirectional barbed sutures enabled precise tissue alignment and prevented slippage, thereby facilitating secure, full-thickness closure of the entry hole while minimizing the risk of incomplete stapler firing.
Conclusion
Bidirectional barbed sutures offer a safe and feasible alternative option for the temporary closure of the entry hole during a stapled anastomotic technique in robotic and laparoscopic gastrectomies.
{"title":"Usefulness of Bidirectional Barbed Sutures for Temporary Closure of Entry Hole for Delta-Shaped Anastomosis in Minimally Invasive Gastrectomy","authors":"Hironori Tsujimoto, Hiroyuki Horiguchi, Yoshihisa Yaguchi, Naoyuki Uehata, Risa Kariya, Asuma Ide, Keita Kouzu, Hideki Ueno","doi":"10.1111/ases.70046","DOIUrl":"https://doi.org/10.1111/ases.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Laparoscopic and robotic gastrectomies have become standard procedures for the treatment of gastric cancer. Among the reconstruction methods used following distal gastrectomy, the Billroth-I technique is often preferred owing to its low complication rates. Delta-shaped anastomosis, a method that eliminates the need for a mini-laparotomy, represents a significant advancement in minimally invasive surgeries. In this report, we aim to present a novel technique using bidirectional barbed sutures for temporary closure of the entry hole during delta-shaped anastomosis in laparoscopic and robotic gastrectomies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>The entry hole was closed using a bidirectional barbed suture, starting centrally to prevent overlapping of the gastric and duodenal staple lines. The suture length was meticulously adjusted to align with the stapler dimensions. All the procedures were successfully completed without any complications in both laparoscopic and robotic gastrectomies. Bidirectional barbed sutures enabled precise tissue alignment and prevented slippage, thereby facilitating secure, full-thickness closure of the entry hole while minimizing the risk of incomplete stapler firing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Bidirectional barbed sutures offer a safe and feasible alternative option for the temporary closure of the entry hole during a stapled anastomotic technique in robotic and laparoscopic gastrectomies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pure laparoscopy for living donor hepatectomy is gaining popularity due to its advantages. However, despite the long-standing application of laparoscopic donor left lateral sectionectomy, the dissection of the Glisson branch, portal vein, and biliary ducts, particularly those of the caudate lobe, remains insufficiently described. Although the Glissonean approach offers easy standardization for hilar dissection, clear landmarks for parenchymal transection, and reduces postoperative bile leakage, it has not been widely adopted in laparoscopic donor hepatectomy. Here, we introduce a modified Glissonean pedicle approach to address the movement restrictions in laparoscopic surgery.
Surgical Technique
After liver mobilization, the Glisson of Spiegel lobe (G1L) was divided, followed by encircling the left Glissonean pedicle. A tape for the liver hanging maneuver was placed from the right edge of the left Glissonean pedicle, along the Arantius plate, to the left edge of the left hepatic vein. When the parenchymal transection was completed, the left hepatic vein was automatically taped. The left hepatic artery and left portal vein were exposed, and some branches of P1 were divided to lengthen for anastomosis. The left hepatic duct was taped by removing the left hepatic artery and left hepatic vein from the left Glissonean pedicle. The left hepatic duct was divided under intraoperative cholangiography. Next, the left hepatic artery, left portal vein, and left hepatic vein were sequentially divided, and the graft liver was retrieved.
Discussion
Our Glissonean approach can help standardize donor left lateral sectionectomy, minimize the exposure of the left hepatic duct, and clarify B1 branch dissection.
{"title":"Laparoscopic Donor Left Lateral Sectionectomy Using the Glissonean Pedicle Approach: Technical Details With Video","authors":"Yasushi Hasegawa, Yuta Abe, Hideaki Obara, Yohei Yamada, Minoru Kitago, Akihiro Fujino, Yuko Kitagawa","doi":"10.1111/ases.70043","DOIUrl":"https://doi.org/10.1111/ases.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pure laparoscopy for living donor hepatectomy is gaining popularity due to its advantages. However, despite the long-standing application of laparoscopic donor left lateral sectionectomy, the dissection of the Glisson branch, portal vein, and biliary ducts, particularly those of the caudate lobe, remains insufficiently described. Although the Glissonean approach offers easy standardization for hilar dissection, clear landmarks for parenchymal transection, and reduces postoperative bile leakage, it has not been widely adopted in laparoscopic donor hepatectomy. Here, we introduce a modified Glissonean pedicle approach to address the movement restrictions in laparoscopic surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Surgical Technique</h3>\u0000 \u0000 <p>After liver mobilization, the Glisson of Spiegel lobe (G1L) was divided, followed by encircling the left Glissonean pedicle. A tape for the liver hanging maneuver was placed from the right edge of the left Glissonean pedicle, along the Arantius plate, to the left edge of the left hepatic vein. When the parenchymal transection was completed, the left hepatic vein was automatically taped. The left hepatic artery and left portal vein were exposed, and some branches of P1 were divided to lengthen for anastomosis. The left hepatic duct was taped by removing the left hepatic artery and left hepatic vein from the left Glissonean pedicle. The left hepatic duct was divided under intraoperative cholangiography. Next, the left hepatic artery, left portal vein, and left hepatic vein were sequentially divided, and the graft liver was retrieved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our Glissonean approach can help standardize donor left lateral sectionectomy, minimize the exposure of the left hepatic duct, and clarify B1 branch dissection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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