Asian Journal of Endoscopic Surgery最新文献

Anti-N-Methyl-D-Aspartate receptor encephalitis typically presents with neuropsychiatric symptoms, followed by autonomic dysregulation sometimes necessitating Intensive Care admission. It has a 15% mortality rate and when associated with ovarian teratoma, early surgical excision improves recovery rate by 25%. We describe the first two cases of vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) assisted vaginal adnexectomy for surgical treatment of ovarian teratoma associated anti-NMDA encephalitis and highlight the advantages of this novel approach. These include low insufflation pressures, shorter duration of surgery, avoidance of abdominal scarring, lower pain scores and more rapid recovery. While the outcomes in these two cases suggest that ovarian teratoma associated anti-NMDA encephalitis could be surgically managed through the vNOTES route rather than conventional laparoscopy, more randomized data still need to be available before this becomes standard approach.

Primary bladder neuroendocrine carcinoma (NEC) is rare and aggressive. We report the first case of bladder NEC with urethral invasion following radical retropubic prostatectomy (RRP) that was successfully managed by multimodal therapy. An 80-year-old man with a history of RRP presented with gross hematuria. Transurethral resection revealed mixed high-grade urothelial carcinoma and NEC; the clinical stage was at least cT1N0M0. After neoadjuvant chemotherapy with gemcitabine-cisplatin and etoposide-cisplatin, robot-assisted radical cystectomy (RARC) with transperineal urethrectomy and ileal conduit diversion was performed. Severe adhesions between the bladder and rectum due to prior RRP were safely dissected using a perineal-first approach aided by magnified robotic three-dimensional visualization. Complete resection was achieved without complications; pathological examination confirmed ypT0N0. No recurrence was observed after 1 year. This case demonstrated that RARC combined with transperineal urethrectomy was a feasible and safe option for bladder NEC after RRP when performed by an experienced urologist.

We report the first infant case of congenital biliary dilatation (CBD) treated using the da Vinci SP system. A 4-month-old boy (7.9 kg) with Todani type IV-A CBD underwent complete extrahepatic bile duct excision, hilar bile duct plasty, and hepaticojejunostomy through a 2.7-cm umbilical incision with an additional 3-mm assistant port. Operative time was 343 min with minimal blood loss. Recovery was uneventful, and the patient was discharged on postoperative day 7. This case demonstrates the feasibility of SP-assisted minimally invasive surgery in small infants.

Jejunal intussusception is a rare but potentially serious complication of gastric surgery, typically involving the gastrojejunostomy or alimentary limbs. A 75-year-old woman underwent laparoscopic distal gastrectomy with D1+ lymphadenectomy and Roux-en-Y reconstruction for early-stage gastric cancer. Postoperatively, she developed intermittent vomiting every 10 days without identifiable triggers and was managed conservatively. However, transient jejunal intussusception involving the bilopancreatic limb was later identified at the jejunojejunal site. Although the intussusception resolved spontaneously, her symptoms persisted. Laparoscopic reoperation revealed mild bulging at the jejunojejunostomy site and a bilopancreatic limb measuring approximately 40 cm, considerably longer than the intended 25 cm. The segment was resected and reconstructed in the antiperistaltic direction using a 25-cm limb. Postoperatively, the patient's symptoms resolved completely. Even minor intraoperative misjudgment of bilopancreatic limb length may lead to functional complications such as intussusception. Awareness of this rare complication can help guide surgical decision-making and postoperative management, ultimately improving patient outcomes.

Gastric fundal false diverticula are exceedingly rare, and to our knowledge, this is the first reported case occurring in association with a sliding hiatal hernia. We describe a 49-year-old woman who presented with persistent dysphagia, regurgitation, heartburn, and halitosis refractory to medical therapy. Imaging revealed a 5.0 × 3.6 × 4.7 cm false diverticulum at the posteromedial fundus and a sliding hiatal hernia. Esophageal manometry demonstrated normal motility with ineffective bolus clearance. Laparoscopic management was employed, combining intraoperative endoscopy for diverticulum localization and staple-line verification with laparoscopic dissection and repair. The procedure included diverticulum excision with an endoscopic stapler, posterior crural closure reinforced with pledgeted sutures, and anterior partial fundoplication. Histopathology confirmed a false diverticulum with complete absence of the muscularis propria layer and no malignancy. At the 1-year follow-up, the patient reported significant symptom resolution. This case highlights the laparoscopic management in complex gastric diverticula and provides a valuable surgical option for similar cases.