A 79-year-old Japanese man developed a low abdominal mass. Contrast-enhanced computed tomography revealed a left-sided pelvic kidney measuring 60 mm, suggestive of renal cell carcinoma. Abnormal vascular anatomy was also noted, including three renal arteries arising from the abdominal aorta, umbilical artery, and inferior mesenteric artery, respectively. On the basis of these findings, we performed robot-assisted radical nephrectomy with placement of fluorescent ureteral stents to facilitate intraoperative identification of both ureters. The patient was positioned in steep Trendelenburg, and the pelvic kidney was removed safely. The console time was 156 min, and the estimated blood loss was 20 mL. To our knowledge, this is the first case of robot-assisted radical nephrectomy for renal cell carcinoma arising in a pelvic kidney. Steep Trendelenburg positioning and placement of fluorescent ureteral stents were key to achieving a favorable surgical outcome.
{"title":"Robot-Assisted Radical Nephrectomy for Renal Cell Carcinoma in a Pelvic Kidney: Case Report","authors":"Daiki Kawashima, Kojiro Ohba, Masaharu Oki, Tsuyoshi Matsuda, Kensuke Mitsunari, Tomohiro Matsuo, Ryoichi Imamura","doi":"10.1111/ases.70265","DOIUrl":"10.1111/ases.70265","url":null,"abstract":"<p>A 79-year-old Japanese man developed a low abdominal mass. Contrast-enhanced computed tomography revealed a left-sided pelvic kidney measuring 60 mm, suggestive of renal cell carcinoma. Abnormal vascular anatomy was also noted, including three renal arteries arising from the abdominal aorta, umbilical artery, and inferior mesenteric artery, respectively. On the basis of these findings, we performed robot-assisted radical nephrectomy with placement of fluorescent ureteral stents to facilitate intraoperative identification of both ureters. The patient was positioned in steep Trendelenburg, and the pelvic kidney was removed safely. The console time was 156 min, and the estimated blood loss was 20 mL. To our knowledge, this is the first case of robot-assisted radical nephrectomy for renal cell carcinoma arising in a pelvic kidney. Steep Trendelenburg positioning and placement of fluorescent ureteral stents were key to achieving a favorable surgical outcome.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12925690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272429","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}
While minimally invasive pancreaticoduodenectomy (MIPD) has become increasingly common, biliary reconstruction remains a formidable technical hurdle. Ensuring the reproducibility of hepaticojejunostomy, particularly when performed by procedure-naïve surgeons, is a critical challenge.
Methods
We retrospectively analyzed consecutive patients who underwent MIPD with laparoscopic hepaticojejunostomy using a standardized technique employing a handmade double-armed suture. All procedures were performed by a procedure-naïve U40 surgeon under expert supervision. The anastomotic safety and reconstruction time were evaluated to assess reproducibility.
Results
A total of 23 patients were included. No bile leakage was observed, and anastomotic stricture occurred in 1 patient. The reconstruction time showed minimal variability throughout the series, indicating stable procedural performance from the early phase.
Conclusion
A standardized laparoscopic hepaticojejunostomy technique can be safely and reproducibly performed by a procedure-naïve surgeon with sufficient foundational experience under structured supervision. Technique-based standardization may complement existing training strategies and facilitate sustainable dissemination of MIPD.
{"title":"Reproducible Laparoscopic Hepaticojejunostomy Using a Double-Armed Suture Technique Performed by a Procedure-Naïve Surgeon","authors":"Mampei Kawashima, Yoshiharu Nakamura, Akira Matsushita, Akira Hamaguchi, Takashi Ono, Takahiro Haruna, Daigo Yoshimori, Toshiyuki Irie, Ryo Ga, Yuto Aoki, Yukio Oshiro, Hiroshi Yoshida","doi":"10.1111/ases.70267","DOIUrl":"10.1111/ases.70267","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While minimally invasive pancreaticoduodenectomy (MIPD) has become increasingly common, biliary reconstruction remains a formidable technical hurdle. Ensuring the reproducibility of hepaticojejunostomy, particularly when performed by procedure-naïve surgeons, is a critical challenge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed consecutive patients who underwent MIPD with laparoscopic hepaticojejunostomy using a standardized technique employing a handmade double-armed suture. All procedures were performed by a procedure-naïve U40 surgeon under expert supervision. The anastomotic safety and reconstruction time were evaluated to assess reproducibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 23 patients were included. No bile leakage was observed, and anastomotic stricture occurred in 1 patient. The reconstruction time showed minimal variability throughout the series, indicating stable procedural performance from the early phase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A standardized laparoscopic hepaticojejunostomy technique can be safely and reproducibly performed by a procedure-naïve surgeon with sufficient foundational experience under structured supervision. Technique-based standardization may complement existing training strategies and facilitate sustainable dissemination of MIPD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12916228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221521","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}
Yuta Ushida, Ken Hayashi, Goshi Fujimoto, Akinari Miyazaki, Hiroshi Kusanagi
Vein-guided resection using the cranio-ventral approach (CVA) prevents split injuries during laparoscopic anatomical liver resection, but its utility in robot-assisted surgery remains unreported. A 74-year-old woman with hepatocellular carcinoma underwent robotic segmentectomy 8 using the da Vinci Xi system. We evaluated the safety and feasibility of robotic segmentectomy 8 using the CVA approach with port hopping. After caudal liver mobilization, port hopping enabled access to the roots of the middle hepatic vein and right hepatic vein, allowing parenchymal transection with the CVA. The operative time was 583 min with 30 mL blood loss. Recovery was uneventful with discharge on postoperative day 14. Robotic CVA with port hopping demonstrates feasibility for anatomical liver resection.
{"title":"Robotic Segmentectomy 8 Using a Cranio-Ventral Approach (With Video)","authors":"Yuta Ushida, Ken Hayashi, Goshi Fujimoto, Akinari Miyazaki, Hiroshi Kusanagi","doi":"10.1111/ases.70264","DOIUrl":"10.1111/ases.70264","url":null,"abstract":"<div>\u0000 \u0000 <p>Vein-guided resection using the cranio-ventral approach (CVA) prevents split injuries during laparoscopic anatomical liver resection, but its utility in robot-assisted surgery remains unreported. A 74-year-old woman with hepatocellular carcinoma underwent robotic segmentectomy 8 using the da Vinci Xi system. We evaluated the safety and feasibility of robotic segmentectomy 8 using the CVA approach with port hopping. After caudal liver mobilization, port hopping enabled access to the roots of the middle hepatic vein and right hepatic vein, allowing parenchymal transection with the CVA. The operative time was 583 min with 30 mL blood loss. Recovery was uneventful with discharge on postoperative day 14. Robotic CVA with port hopping demonstrates feasibility for anatomical liver resection.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214559","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}
To evaluate the feasibility, safety, and short-term effectiveness of a society-led, proctor-guided Equivalent Certificate program designed to support the supervised initiation of robot-assisted gynecologic surgery in Japan.
Methods
A multicenter pilot program was conducted across four academic institutions. Fourteen surgeons without prior da Vinci console experience were enrolled. The training pathway included: (1) manufacturer-provided e-learning, on-site system training, and written assessment; (2) institution-based, proctor-supervised training with mandatory simulator proficiency (≥ 80 points across 10 tasks) and at least five bedside assistant cases; (3) standardized proctor evaluation of technical readiness using a 5-point Likert scale; and (4) post-case assessment following each surgeon's first console case. Upon completion of all requirements, participants received an equivalency-based Certificate of da Vinci System Training issued by Intuitive Surgical.
Results
Eleven surgeons completed the full program and performed at least one robotic procedure. No intraoperative complications or proctor takeovers occurred. Proctor evaluations demonstrated satisfactory performance across all assessed skill domains, with mean scores ranging from 3.09 to 4.55 out of 5. Instrument insertion and exchange received the highest ratings (mean 4.55), while third-arm control showed relatively lower scores (mean 3.09), consistent with known early learning challenges. The overall composite score was 3.79, indicating performance approaching a “well done” level under supervised conditions.
Conclusion
This feasibility study suggests that a structured, society-led Equivalent Certificate program is a feasible and safe approach for the supervised introduction of robot-assisted gynecologic surgery. By integrating manufacturer-aligned education with institution-based proctor supervision and objective performance benchmarks, this framework may serve as a complementary training pathway as robotic surgery education continues to evolve in Japan.
{"title":"Equivalent Certificate Training Program for Gynecologic Robotic Surgery: A Multicenter Feasibility Study","authors":"Hiroaki Komatsu, Masumi Sunada, Tsukasa Baba, Yoshito Terai, Yoshihito Yokoyama, Masaki Mandai, Hiroaki Kobayashi","doi":"10.1111/ases.70266","DOIUrl":"10.1111/ases.70266","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the feasibility, safety, and short-term effectiveness of a society-led, proctor-guided Equivalent Certificate program designed to support the supervised initiation of robot-assisted gynecologic surgery in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multicenter pilot program was conducted across four academic institutions. Fourteen surgeons without prior da Vinci console experience were enrolled. The training pathway included: (1) manufacturer-provided e-learning, on-site system training, and written assessment; (2) institution-based, proctor-supervised training with mandatory simulator proficiency (≥ 80 points across 10 tasks) and at least five bedside assistant cases; (3) standardized proctor evaluation of technical readiness using a 5-point Likert scale; and (4) post-case assessment following each surgeon's first console case. Upon completion of all requirements, participants received an equivalency-based Certificate of da Vinci System Training issued by Intuitive Surgical.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven surgeons completed the full program and performed at least one robotic procedure. No intraoperative complications or proctor takeovers occurred. Proctor evaluations demonstrated satisfactory performance across all assessed skill domains, with mean scores ranging from 3.09 to 4.55 out of 5. Instrument insertion and exchange received the highest ratings (mean 4.55), while third-arm control showed relatively lower scores (mean 3.09), consistent with known early learning challenges. The overall composite score was 3.79, indicating performance approaching a “well done” level under supervised conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This feasibility study suggests that a structured, society-led Equivalent Certificate program is a feasible and safe approach for the supervised introduction of robot-assisted gynecologic surgery. By integrating manufacturer-aligned education with institution-based proctor supervision and objective performance benchmarks, this framework may serve as a complementary training pathway as robotic surgery education continues to evolve in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208014","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}
{"title":"List of Reviewers","authors":"","doi":"10.1111/ases.70258","DOIUrl":"https://doi.org/10.1111/ases.70258","url":null,"abstract":"","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269024","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}
Sushma Narsing Katkuri, Varshini Vadhithala, Jeffrin Reneus Paul
{"title":"Learning Curves in Early Adoption of the Hugo Robotic System","authors":"Sushma Narsing Katkuri, Varshini Vadhithala, Jeffrin Reneus Paul","doi":"10.1111/ases.70263","DOIUrl":"https://doi.org/10.1111/ases.70263","url":null,"abstract":"","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269022","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}
To determine optimal port placement for retroperitoneal robot-assisted radical nephroureterectomy (RANU) using the Hugo robot-assisted surgery system (HRS) and to compare perioperative outcomes and arm interference between transperitoneal and retroperitoneal approaches.
Methods
We retrospectively analyzed 21 patients who underwent RANU for upper tract urothelial carcinoma with HRS at our institution between 2023 and 2025 via a transperitoneal (n = 13) or retroperitoneal (n = 8) approach. For clinical retroperitoneal RANU, four robotic ports were placed 3 cm lateral to the erector spinae and spaced 8 cm medially. We compared patient demographics, perioperative metrics, and the rates of arm interference and system-caused errors from log data. Continuous variables were analyzed using the Mann–Whitney U test, whereas categorical variables were analyzed using the chi-squared test or Fisher's exact test.
Results
Total operative, console, and dissection times; blood loss; and transfusion and complication rates were comparable between approaches. One transperitoneal case required conversion to da Vinci because of HRS malfunction. The median number of removed lymph nodes was significantly lower in the retroperitoneal group (p = 0.049). The time from incision to roll-in was shorter in the transperitoneal group (p = 0.015), whereas the time from roll-in to console start favored the retroperitoneal approach (p = 0.045). Arm-interference errors were significantly less common for the retroperitoneal approach (p = 0.011), whereas the frequency of system-caused errors did not differ between the groups.
Conclusion
Retroperitoneal HRS-RANU was feasible in our cohort and may reduce arm interference; larger studies are needed to confirm this.
{"title":"Initial Experience With Robot-Assisted Nephroureterectomy Using the Hugo Robot-Assisted Surgery System via a Retroperitoneal Approach: Clinical Comparison With the Transperitoneal Approach","authors":"Shuichi Morizane, Atsushi Yamamoto, Hiroshi Yamane, Ryoma Nishikawa, Yusuke Kimura, Noriya Yamaguchi, Katsuya Hikita, Masaomi Ikeda, Ken-Ichi Tabata, Takao Mukuda, Toshiyuki Kaidoh, Atsushi Takenaka","doi":"10.1111/ases.70250","DOIUrl":"10.1111/ases.70250","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To determine optimal port placement for retroperitoneal robot-assisted radical nephroureterectomy (RANU) using the Hugo robot-assisted surgery system (HRS) and to compare perioperative outcomes and arm interference between transperitoneal and retroperitoneal approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 21 patients who underwent RANU for upper tract urothelial carcinoma with HRS at our institution between 2023 and 2025 via a transperitoneal (<i>n</i> = 13) or retroperitoneal (<i>n</i> = 8) approach. For clinical retroperitoneal RANU, four robotic ports were placed 3 cm lateral to the erector spinae and spaced 8 cm medially. We compared patient demographics, perioperative metrics, and the rates of arm interference and system-caused errors from log data. Continuous variables were analyzed using the Mann–Whitney <i>U</i> test, whereas categorical variables were analyzed using the chi-squared test or Fisher's exact test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total operative, console, and dissection times; blood loss; and transfusion and complication rates were comparable between approaches. One transperitoneal case required conversion to da Vinci because of HRS malfunction. The median number of removed lymph nodes was significantly lower in the retroperitoneal group (<i>p</i> = 0.049). The time from incision to roll-in was shorter in the transperitoneal group (<i>p</i> = 0.015), whereas the time from roll-in to console start favored the retroperitoneal approach (<i>p</i> = 0.045). Arm-interference errors were significantly less common for the retroperitoneal approach (<i>p</i> = 0.011), whereas the frequency of system-caused errors did not differ between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Retroperitoneal HRS-RANU was feasible in our cohort and may reduce arm interference; larger studies are needed to confirm this.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158697","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}
{"title":"Response to “Critical Evaluation of Safety Claims and Statistical Validity in Delayed Laparoscopic Cholecystectomy With Fluorescent Cholangiography”","authors":"Tsuyoshi Igami","doi":"10.1111/ases.70261","DOIUrl":"10.1111/ases.70261","url":null,"abstract":"","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158679","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}
Morgagni hernia (MH) is a rare diaphragmatic hernia caused by a parasternal defect. We report a case of MH that was successfully repaired using a laparoscopic transabdominal preperitoneal (L-TAPP) approach combined with a self-gripping mesh. A 76-year-old woman was incidentally diagn4osed with MH during a preoperative evaluation of an unrelated knee surgery. Computed tomography revealed herniation of the greater omentum through a diaphragmatic defect measuring ~5 cm × 5 cm. L-TAPP was performed, in which the hernia contents were reduced and wide peritoneal dissection enabled tension-free mesh placement in the extraperitoneal space using a self-gripping mesh. The postoperative course was uneventful, and the patient was discharged on postoperative Day 5, with no recurrence observed at 10 months of follow-up. The L-TAPP approach allows secure mesh placement without direct contact with the intra-abdominal organs, potentially reducing the risk of recurrence and intraperitoneal complications. L-TAPP combined with a self-gripping mesh may be a useful and minimally invasive treatment option for MH.
{"title":"Successful Repair of a Morgagni Hernia Using the Laparoscopic Transabdominal Preperitoneal (TAPP) Approach: A Case Report","authors":"Yumeto Mikuni, Yuji Konishi, Haruna Nakamura, Hirotaka Shoji, Naotake Homma, Hideki Kawamura, Akinobu Taketomi","doi":"10.1111/ases.70259","DOIUrl":"10.1111/ases.70259","url":null,"abstract":"<div>\u0000 \u0000 <p>Morgagni hernia (MH) is a rare diaphragmatic hernia caused by a parasternal defect. We report a case of MH that was successfully repaired using a laparoscopic transabdominal preperitoneal (L-TAPP) approach combined with a self-gripping mesh. A 76-year-old woman was incidentally diagn4osed with MH during a preoperative evaluation of an unrelated knee surgery. Computed tomography revealed herniation of the greater omentum through a diaphragmatic defect measuring ~5 cm × 5 cm. L-TAPP was performed, in which the hernia contents were reduced and wide peritoneal dissection enabled tension-free mesh placement in the extraperitoneal space using a self-gripping mesh. The postoperative course was uneventful, and the patient was discharged on postoperative Day 5, with no recurrence observed at 10 months of follow-up. The L-TAPP approach allows secure mesh placement without direct contact with the intra-abdominal organs, potentially reducing the risk of recurrence and intraperitoneal complications. L-TAPP combined with a self-gripping mesh may be a useful and minimally invasive treatment option for MH.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158645","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}
Lymphocele is a frequent complication of renal transplantation and can be difficult to manage. Surgical intervention requires precise identification of the ureter owing to anatomical variability in the urinary tract after transplantation. We herein report a 61-year-old obese man (body mass index 33.4 kg/m2) who developed pelvic lymphocele after living donor renal transplantation. Initial conservative observation was followed by percutaneous drainage due to progressive leg edema, hydronephrosis, and elevated serum creatinine levels (3.3 mg/dL). Although drainage improved renal function and reduced edema, persistent high-output drainage of 500 mL/day necessitated laparoscopic fenestration. Given the anticipated difficulty in identifying the ureter due to obesity, a near-infrared fluorescent ureteral catheter was inserted preoperatively. Intraoperative near-infrared imaging enables visualization of the ureter, facilitating fenestration at a safe distance. Furthermore, observing fluorescence within the lymphocele allowed for clearer identification of the ureteral location.
{"title":"A Case of Lymphocele After Kidney Transplantation in a Severely Obese Patient Successfully and Safely Treated by Laparoscopic Fenestrated Resection With a Fluorescent Ureteral Stent","authors":"Takahito Endo, Yoji Hyodo, Satoshi Kitamura, Yuki Tashiro, Naoki Yokoyama, Koji Chiba, Hideaki Miyake","doi":"10.1111/ases.70260","DOIUrl":"10.1111/ases.70260","url":null,"abstract":"<div>\u0000 \u0000 <p>Lymphocele is a frequent complication of renal transplantation and can be difficult to manage. Surgical intervention requires precise identification of the ureter owing to anatomical variability in the urinary tract after transplantation. We herein report a 61-year-old obese man (body mass index 33.4 kg/m<sup>2</sup>) who developed pelvic lymphocele after living donor renal transplantation. Initial conservative observation was followed by percutaneous drainage due to progressive leg edema, hydronephrosis, and elevated serum creatinine levels (3.3 mg/dL). Although drainage improved renal function and reduced edema, persistent high-output drainage of 500 mL/day necessitated laparoscopic fenestration. Given the anticipated difficulty in identifying the ureter due to obesity, a near-infrared fluorescent ureteral catheter was inserted preoperatively. Intraoperative near-infrared imaging enables visualization of the ureter, facilitating fenestration at a safe distance. Furthermore, observing fluorescence within the lymphocele allowed for clearer identification of the ureteral location.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150971","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}
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