Asian Journal of Endoscopic Surgery最新文献

Background

Esophageal squamous cell carcinoma (ESCC) and squamous cell carcinoma of the head and neck (HN) often occur simultaneously. Total esophagectomy with pharyngolaryngectomy (TE-TPL) is a highly invasive surgery associated with significant mortality. In thoracic esophagectomy, minimally invasive esophagectomy (MIE) has gained widespread acceptance. This study evaluates the efficacy of MIE in TE-TPL.

Methods

We retrospectively analyzed patients who underwent TE-TPL between January 2007 and December 2022 at the National Cancer Center Hospital in Tokyo, Japan. A total of 33 patients were enrolled, with 19 undergoing minimally invasive esophagectomy (MIE group) and 14 undergoing conventional esophagectomy (Open group).

Results

MIE was associated with a significantly shorter operative time (532 min vs. 687 min, p = 0.028), less intraoperative bleeding (371 mL vs. 840 mL, p < 0.01), shorter hospital stays (21 days vs. 34 days, p < 0.01), and a lower reoperation rate (11% vs. 29%, p = 0.036) compared to the Open group. The 3-year overall survival (OS) and progression-free survival (PFS) rates were not significantly different between the two groups (OS: 47.4% vs. 50.0%, p = 0.72; PFS: 34.0% vs. 47.1%, p = 0.41).

Conclusion

MIE may be a more feasible and efficient option than the conventional approach for TE-TPL.

Introduction

Gallbladder bed detachment (GBB-D) in laparoscopic cholecystectomy (LC) lacks a standardized technique. We developed butterfly traction (BT) to perform optimal GBB-D. This study evaluates its effectiveness and potential for standardization.

Methods

BT aligns the dissection axis with the surgeon's dominant hand by positioning the gallbladder upright and using a left-sided lateral approach. This improves right-side mobility, enabling horizontal traction and avoiding axis interference. BT has been adopted in all LCs at our institution since July 2023. Among 118 LCs performed from 2019 to 2024, three open conversion cases and 13 bailout cases were excluded. Operative outcomes in the remaining patients were compared between the BT group (n = 50) and the nonstandardized (NS) group (n = 52).

Results

No significant differences were observed in age, gender, comorbidities, or preoperative gallbladder drainage between groups. However, the BT group had more surgeons with ≤ 5 years of experience (52% vs. 29%, p = 0.017). Operative times were comparable (p = 0.363), but bile contamination due to gallbladder perforation during GBB-D was significantly lower in the BT group (4% vs. 17%, p = 0.030), as was blood loss (0 vs. 1 g, p = 0.003). BT was particularly effective in higher difficulty cases (Grade B/C from Tokyo Guidelines 2018), with shorter operative times (95 vs. 116 min, p = 0.095), less blood loss (0 vs. 2 g, p < 0.001), and fewer perforations (6% vs. 24%, p = 0.046).

Conclusions

BT improved surgical outcomes and minimized bile contamination, even when performed by less experienced surgeons. It shows strong potential as a standard technique for GBB-D in LC.

Introduction

In pediatric surgery, declining case volumes and restrictions on working hours have intensified the need for efficient training strategies. The operating room remains a central educational environment, yet the nature of intraoperative teaching is unclear. We examined the educational role of intraoperative verbal communication and identified opportunities for improvement.

Methods

We retrospectively analyzed data of unilateral single-incision laparoscopic percutaneous extraperitoneal closure procedures performed between December 2024 and June 2025 with complete audio and video recordings. Verbal statements were transcribed verbatim, classified by type and content, and analyzed for overall distribution, phase-specific frequency, composition of attending-to-operating surgeon communication, and intraoperative debriefing occurrence during the wound closure.

Results

Nineteen cases were included, yielding 7374 statements. The most common content category was General (39.6%), followed by Instrument handling (19.1%), Anatomy (14.9%), and Operation method (14.8%). The proportion for Instrument handling increased to 27.1% during laparoscopic manipulation; that for Private talk rose to 18.5% during wound closure. Communication from attending to operating surgeons was most frequent in the laparoscopic manipulation phase (median, 3.4; interquartile range, 2.6–4.7, per minute), with higher proportions of Commanding (11.8%) and Advising (14.9%) statements. Intraoperative debriefing on the preceding laparoscopic phase occurred in only two cases (10.5%).

Conclusion

Intraoperative communication during single-incision laparoscopic percutaneous extraperitoneal closure demonstrates distinct phase-specific patterns, with heightened directive teaching during the laparoscopic manipulation phase but infrequent reflective debriefing. These findings suggest that systematically incorporating debriefing into the wound closure phase could foster reflective learning, complement real-time coaching, and enhance the overall educational impact of intraoperative experiences.

Objective

This study aims to compare perioperative outcomes and recovery parameters between vaginal natural orifice transluminal endoscopic surgery (vNOTES) and total laparoscopic hysterectomy (TLH) in obese patients undergoing hysterectomy for benign indications.

Methods

A retrospective cohort study was conducted including 112 patients with a body mass index (BMI) ≥ 30 kg/m² who underwent hysterectomy between June 2022 and May 2025. Fifty-three patients underwent vNOTES and 59 underwent TLH. Demographic data, intraoperative parameters, postoperative recovery metrics, pain scores, and complications were recorded and statistically compared.

Results

No significant differences were found between groups in terms of BMI, uterine volume, or operative time. However, the vNOTES group exhibited significantly lower estimated blood loss (127.73 ± 88.93 mL vs. 300 ± 120 mL; p < 0.0001), shorter time to ambulation (5.86 ± 1.09 h vs. 6.47 ± 1.20 h; p = 0.006), shorter hospital stay (1.47 ± 0.54 days vs. 1.86 ± 0.43 days; p < 0.0001), and quicker return to daily activities (6.56 ± 1.15 vs. 8.01 ± 1.10 days; p < 0.0001). Postoperative pain scores were significantly lower in the vNOTES group at all measured time points. Complication rates were low in both groups, with no statistically significant difference.

Conclusion

vNOTES appears to be a safe and effective alternative to laparoscopy in obese patients, offering superior outcomes in terms of recovery time, pain, and blood loss. These findings support the broader adoption of vNOTES in high-risk populations, though further prospective studies are warranted.

Introduction

In hepatobiliary surgery, bile exposure (BE) may cause complications such as bile peritonitis, slow postoperative recovery, and peritoneal dissemination of cancer cells in adult patients. We investigated the effect of BE on postoperative recovery and complications in pediatric patients with choledochal cysts (CCs) who underwent laparoscopic treatment.

Methods

We reviewed the medical records of patients with CCs who underwent laparoscopic surgery at our institution and associated institutions between April 2016 and April 2024. Patients were divided into two groups according to the presence (BE group) or absence (control group) of BE during surgery.

Results

Forty-three patients were enrolled in this study (control group, n = 25; BE group, n = 18). Patient background characteristics, operative results, and postoperative complications were compared between the two groups. There were no significant differences in the patients' background characteristics and operative results between the two groups. The incidence of postoperative cholangitis was significantly higher in the BE group than in the control group (n = 1 [4.0%] vs. n = 6 [33.3%], p = 0.003). However, the incidence of stenosis at the anastomotic site and intrahepatic stones was not significantly different.

Conclusion

BE during surgery did not affect the postoperative recovery of patients with CCs treated by laparoscopic surgery. However, this did affect the rate of postoperative cholangitis. BE may be a factor contributing to the onset of postoperative cholangitis. Further investigations are necessary to clarify the mechanisms underlying the development of postoperative cholangitis in pediatric patients with CC.

Introduction

The present study examined factors preventing the achievement of pentafecta in patients who have already met trifecta criteria following robot-assisted partial nephrectomy (RAPN).

Methods

A retrospective observational study was conducted on 103 patients who underwent RAPN for localized renal tumors at Keio University Hospital between 2019 and 2023. Clinical characteristics, surgical parameters, and postoperative renal function were analyzed. Multivariate logistic regression analyses were performed to identify independent predictors of trifecta and pentafecta achievement.

Results

The achievement rates for trifecta and pentafecta were 88% and 27%, respectively. Independent predictors of trifecta achievement were tumor size ≤ 20 mm (OR = 5.496, p = 0.039) and estimated blood loss ≤ 50 cc (OR = 7.983, p = 0.011). Significant predictors of pentafecta achievement were age ≤ 63 years (OR = 3.753, p = 0.026) and tumor exophyticity ≥ 50% (OR = 4.054, p = 0.018). Independent predictors of pentafecta failure despite trifecta achievement were age > 63 years (OR = 0.223, 95% CI: 1.347–14.904, p = 0.014) and tumor exophyticity < 50% (OR = 0.205, 95% CI: 1.474–16.159, p = 0.009). The pentafecta failure rate was 95% in patients who achieved trifecta but had both risk factors, namely, older age and embedded tumors.

Conclusion

Older age and tumor exophyticity < 50% are significant predictors of pentafecta failure despite achieving trifecta. The consideration of these factors may help refine surgical planning and postoperative management.

Objective

The purpose of this study is to evaluate the reproductive outcomes, including pregnancy rates and modes of delivery, in women of reproductive age who previously underwent vaginal natural orifice transluminal endoscopic surgery (vNOTES).

Data Sources

A literature search was conducted using PubMed, Scopus, Web of Science, and EBSCO databases. The review used topic-specific keywords and MeSH terms such as (“transvaginal tissue removal” OR “Natural Orifice Transluminal Endoscopic Surgery” OR “transvaginal tissue extraction” OR “transvaginal specimen extraction” OR NOTES OR vNOTES) AND (delivery OR childbirth OR birth).

Method Study Selection

All English-language articles focusing on vNOTES in women of reproductive age (18–45), with a uterus, and desiring to conceive were included. Studies were excluded if they involved bowel or gynecological malignancies, prior total hysterectomy, nonuse of posterior colpotomy for tissue removal, animal studies, or were not in English.

Tabulation, Integration, and Results

The quality of included studies was assessed using the Nonrandomized Studies of Interventions (ROBINS-I) tool. Five studies out of 66 159 were included—four retrospective and one case series—encompassing 903 patients who underwent vNOTES for various procedures. These included laparoscopic and minimally invasive surgeries, such as cholecystectomy, appendectomy, gastric sleeve, intestinal operations, and gynecological procedures. Of these, 180 became pregnant: 12 had miscarriages, 47 had vaginal births, and 32 had C-sections (15 elective, five due to prior C-section). Fifty-eight used Assisted Reproductive Treatment (ART). No cases of sexual dysfunction, vaginal pain, laceration, or shortening were reported.

Conclusion

The findings suggest that vNOTES is a safe surgical approach for women wishing to conceive, as it does not negatively impact fertility or childbirth. Mode of delivery is influenced more by obstetric indications than by a history of vNOTES.

Trial Registration: Registered in PROSPERO (CRD420250644811)