The adoption of robot-assisted surgery (RAS) in Japan has progressed significantly since its initial approval in 2009. RAS gradually expanded into various surgical fields with 35 procedures now covered under Japan's national health insurance. This study provides an inaugural assessment of RAS outcomes for seven digestive procedures introduced in 2018.
Methods
The Japanese Society for Endoscopic Surgery working group established an RAS registry integrating data from the National Clinical Database and additional RAS-specific records. The analysis focused on three major gastrointestinal fields: the esophagus, stomach, and rectum.
Results
In 2019, 530 esophagectomies, 2295 gastrectomies, and 3269 proctectomies were performed. RAS for these procedures was characterized by relatively long operative times, low intraoperative blood loss, and very low conversion rates to open surgery (< 1%). Postoperative morbidity rates Grade IIIa or higher were 23.2% for esophagectomy, 4.9% for gastrectomy, and 9.4% for proctectomy. Length of postoperative hospital stay correlated with morbidity, though readmission (1.3%–3.1%) and postoperative mortality rates (0.3%–0.6%) remained low. The early nationwide implementation of RAS in Japan was marked by a high surgeon qualification rate (98.9%) and meticulous case selection; the DVSS Xi model accounted for 66.3% of robotic platforms used.
Conclusion
These findings underscore the need for ongoing surveillance and data-driven evaluation to ensure safe and effective implementation of RAS. Future longitudinal analyses will refine surgical quality, optimize resource allocation, and advance minimally invasive techniques. This study highlights the transformative potential of RAS in Japanese surgical practice and its alignment with global trends.
{"title":"First Annual Report for Robot-Assisted Surgery Based on the National Clinical Database 2019 in Japan: Report on Three Major Gastrointestinal Fields","authors":"Ichiro Takemasa, Hiroyuki Yamamoto, Tatsuto Nishigori, Takeo Fujita, Tomoki Makino, Yusuke Taniyama, Masanori Terashima, Masanori Tokunaga, Takatoshi Matsuyama, Tomohiro Yamaguchi, Noriko Iwata, Hidetoshi Katsuno, Koichi Suda, Yusuke Kinugasa, Kazutaka Obama, Takashi Kamei, Ichiro Uyama, Masahiko Watanabe, Yoshiharu Sakai, Yuko Kitagawa","doi":"10.1111/ases.70220","DOIUrl":"https://doi.org/10.1111/ases.70220","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The adoption of robot-assisted surgery (RAS) in Japan has progressed significantly since its initial approval in 2009. RAS gradually expanded into various surgical fields with 35 procedures now covered under Japan's national health insurance. This study provides an inaugural assessment of RAS outcomes for seven digestive procedures introduced in 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Japanese Society for Endoscopic Surgery working group established an RAS registry integrating data from the National Clinical Database and additional RAS-specific records. The analysis focused on three major gastrointestinal fields: the esophagus, stomach, and rectum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2019, 530 esophagectomies, 2295 gastrectomies, and 3269 proctectomies were performed. RAS for these procedures was characterized by relatively long operative times, low intraoperative blood loss, and very low conversion rates to open surgery (< 1%). Postoperative morbidity rates Grade IIIa or higher were 23.2% for esophagectomy, 4.9% for gastrectomy, and 9.4% for proctectomy. Length of postoperative hospital stay correlated with morbidity, though readmission (1.3%–3.1%) and postoperative mortality rates (0.3%–0.6%) remained low. The early nationwide implementation of RAS in Japan was marked by a high surgeon qualification rate (98.9%) and meticulous case selection; the DVSS Xi model accounted for 66.3% of robotic platforms used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings underscore the need for ongoing surveillance and data-driven evaluation to ensure safe and effective implementation of RAS. Future longitudinal analyses will refine surgical quality, optimize resource allocation, and advance minimally invasive techniques. This study highlights the transformative potential of RAS in Japanese surgical practice and its alignment with global trends.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146057738","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}
Roux-en-Y duodenojejunal bypass with sleeve gastrectomy (RY-DJB-SG) generally yields better operative outcomes regarding weight loss and glycemic control compared with SG. However, the requirement of two anastomoses limits its adoption as a primary metabolic bariatric surgery in Japan. To reduce the complexity of RY-DJB-SG, we introduced loop reconstruction for DJB-SG (L-DJB-SG) with a single anastomosis in 2022. This study aimed to assess the feasibility and short-term operative outcomes of L-DJB-SG and RY-DJB-SG.
Methods
Electronic medical records of 13 and 26 patients who underwent L-DJB-SG and RY-DJB-SG, respectively, between May 2012 and November 2023 at our institute were retrospectively analyzed. Patients' demographic characteristics and glycemic and operative outcomes were statistically compared between the two groups.
Results
No significant differences in demographic data were observed between the groups. L-DJB-SG exhibited a shorter operation time (221 [206–268] vs. 304 [283–332.3] min, p < 0.01) and required fewer staplers (2 [1.5–2] vs. 5 [3–5], p < 0.01) for bypass procedures compared with RY-DJB-SG, whereas other operative outcomes were comparable. No significant differences in weight loss or glycemic parameters were noted 1 year after surgery.
Conclusion
L-DJB-SG is a feasible and effective procedure that may serve as an alternative DJB option for Japanese patients with obesity and diabetes mellitus.
{"title":"Short-Term Operative Outcomes of Loop Reconstruction for Duodenojejunal Bypass With Sleeve Gastrectomy: A Retrospective Study From a Single Japanese Academic Hospital","authors":"Taiki Nabekura, Takashi Oshiro, Kotaro Wakamatsu, Natsumi Kitahara, Yuki Moriyama, Kengo Kadoya, Ayami Sato, Yu Sato, Masaru Tsuchiya","doi":"10.1111/ases.70245","DOIUrl":"10.1111/ases.70245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Roux-en-Y duodenojejunal bypass with sleeve gastrectomy (RY-DJB-SG) generally yields better operative outcomes regarding weight loss and glycemic control compared with SG. However, the requirement of two anastomoses limits its adoption as a primary metabolic bariatric surgery in Japan. To reduce the complexity of RY-DJB-SG, we introduced loop reconstruction for DJB-SG (L-DJB-SG) with a single anastomosis in 2022. This study aimed to assess the feasibility and short-term operative outcomes of L-DJB-SG and RY-DJB-SG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Electronic medical records of 13 and 26 patients who underwent L-DJB-SG and RY-DJB-SG, respectively, between May 2012 and November 2023 at our institute were retrospectively analyzed. Patients' demographic characteristics and glycemic and operative outcomes were statistically compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences in demographic data were observed between the groups. L-DJB-SG exhibited a shorter operation time (221 [206–268] vs. 304 [283–332.3] min, <i>p</i> < 0.01) and required fewer staplers (2 [1.5–2] vs. 5 [3–5], <i>p</i> < 0.01) for bypass procedures compared with RY-DJB-SG, whereas other operative outcomes were comparable. No significant differences in weight loss or glycemic parameters were noted 1 year after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>L-DJB-SG is a feasible and effective procedure that may serve as an alternative DJB option for Japanese patients with obesity and diabetes mellitus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031284","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}
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.
{"title":"Antegrade Jejunal Intussusception at the Bilopancreatic Limb Jejunojejunostomy After Laparoscopic Distal Gastrectomy With Roux-en-Y Reconstruction: A Case Report","authors":"Kotaro Kimura, Kentaro Kato, Zen Naito, Hiroyuki Yamamoto, Tomohiro Suzuki, Noriaki Kyogoku, Takumi Yamabuki, Minoru Takada, Yoshiyasu Ambo, Satoshi Hirano","doi":"10.1111/ases.70222","DOIUrl":"10.1111/ases.70222","url":null,"abstract":"<div>\u0000 \u0000 <p>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.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991389","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}
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.
{"title":"A Rare Coexistence of Gastric Fundal False Diverticulum and Sliding Hiatal Hernia: Technical Considerations and Literature Review","authors":"Sze Li Siow, Jing Hui Fu, Amirah Lotfi Hanis, Sidi Nurazim","doi":"10.1111/ases.70244","DOIUrl":"10.1111/ases.70244","url":null,"abstract":"<div>\u0000 \u0000 <p>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.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991373","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}
Robotic surgery has become increasingly widespread; however, device-related complications specific to robotic platforms are rarely reported. We describe a case of rectal cancer treated with robotic-assisted abdominoperineal resection using the da Vinci Surgical System. At the end of the procedure, the tip cover of the robotic scissors detached and was inadvertently retained within the abdominal wall. It was invisible on plain radiography but was detected on postoperative computed tomography as a cylindrical structure beneath the rectus abdominis muscle. The patient underwent reoperation to retrieve the tip cover and recovered uneventfully, being discharged without further complications. This case highlights a rare but important complication of robotic surgery—detachment and retention of the tip cover of robotic scissors in the abdominal wall. Because tip covers may not be reliably detected on plain radiography, computed tomography is crucial for their identification. Strict counting protocols and heightened awareness are essential to prevent such events.
{"title":"Retention of a Detached Robotic Scissors Tip Cover in the Abdominal Wall: A Case Report","authors":"Masatsugu Kojima, Toru Miyake, Soichiro Tani, Keiji Muramoto, Yusuke Nishina, Sachiko Kaida, Katsushi Takebayashi, Hiromitsu Maehira, Reiko Otake, Haruki Mori, Nobuhito Nitta, Miyuki Kimura, Noritoshi Ushio, Tomoharu Shimizu, Masaji Tani","doi":"10.1111/ases.70242","DOIUrl":"https://doi.org/10.1111/ases.70242","url":null,"abstract":"<p>Robotic surgery has become increasingly widespread; however, device-related complications specific to robotic platforms are rarely reported. We describe a case of rectal cancer treated with robotic-assisted abdominoperineal resection using the da Vinci Surgical System. At the end of the procedure, the tip cover of the robotic scissors detached and was inadvertently retained within the abdominal wall. It was invisible on plain radiography but was detected on postoperative computed tomography as a cylindrical structure beneath the rectus abdominis muscle. The patient underwent reoperation to retrieve the tip cover and recovered uneventfully, being discharged without further complications. This case highlights a rare but important complication of robotic surgery—detachment and retention of the tip cover of robotic scissors in the abdominal wall. Because tip covers may not be reliably detected on plain radiography, computed tomography is crucial for their identification. Strict counting protocols and heightened awareness are essential to prevent such events.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70242","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146007566","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}
The Hugo RAS System received regulatory approval for gastroenterological surgery in Japan in May 2023. Beyond standard robotic advantages—three-dimensional high-definition imaging, articulated instruments with tremor filtration, and motion scaling—it features an open console that enhances team communication and four independent arm carts for flexible positioning. We report Japan's first case of robot-assisted distal pancreatectomy performed using the Hugo RAS System. The patient was a 78-year-old woman with a branch-duct intraductal papillary mucinous neoplasm in the left pancreas exhibiting high-risk stigmata. Four ports were placed laterally at the umbilical level, with an assistant port in the right subcostal region. Arm cart 1 was positioned on the patient's right caudal side, and the remaining three on the left cranial side. After division of the splenic artery via the supragastric approach, the pancreas and spleen were mobilized, and transection was performed at the pancreatic neck for specimen retrieval.
Hugo RAS系统于2023年5月在日本获得胃肠外科的监管批准。除了标准的机器人优势——三维高清成像、带有震颤过滤的铰接仪器和运动缩放——它还具有一个开放式控制台，可以增强团队沟通和四个独立的手臂推车，用于灵活定位。我们报告日本第一例使用Hugo RAS系统进行机器人辅助远端胰腺切除术的病例。患者是一名78岁的女性，左侧胰腺分支导管导管内乳头状粘液瘤，表现为高风险红斑。四个端口被放置在脐水平侧，一个辅助端口在右肋下区域。1号臂车放置于患者右侧尾侧，其余三台放置于左侧颅侧。经胃上入路分离脾动脉后，动员胰腺和脾脏，在胰颈处横切取标本。
{"title":"Robot-Assisted Distal Pancreatectomy Using the Hugo RAS System via the Supragastric Approach: First Nationwide Case Report (With Video)","authors":"Kazuyuki Nagai, Kei Yamane, Asahi Sato, Hiroto Nishino, Takahiro Nishio, Katsunori Sakamoto, Satoshi Ogiso, Yoichiro Uchida, Takashi Ito, Takamichi Ishii, Shigeo Hisamori, Kazutaka Obama, Etsuro Hatano","doi":"10.1111/ases.70239","DOIUrl":"10.1111/ases.70239","url":null,"abstract":"<p>The Hugo RAS System received regulatory approval for gastroenterological surgery in Japan in May 2023. Beyond standard robotic advantages—three-dimensional high-definition imaging, articulated instruments with tremor filtration, and motion scaling—it features an open console that enhances team communication and four independent arm carts for flexible positioning. We report Japan's first case of robot-assisted distal pancreatectomy performed using the Hugo RAS System. The patient was a 78-year-old woman with a branch-duct intraductal papillary mucinous neoplasm in the left pancreas exhibiting high-risk stigmata. Four ports were placed laterally at the umbilical level, with an assistant port in the right subcostal region. Arm cart 1 was positioned on the patient's right caudal side, and the remaining three on the left cranial side. After division of the splenic artery via the supragastric approach, the pancreas and spleen were mobilized, and transection was performed at the pancreatic neck for specimen retrieval.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12805036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971361","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}
Faisal A. Shaikh, Terrence Curran, Zoltan H. Nemeth
{"title":"Bile Exposure and Postoperative Cholangitis After Laparoscopic Resection of Choledochal Cysts: Clarifying Exposure, Controlling Confounding","authors":"Faisal A. Shaikh, Terrence Curran, Zoltan H. Nemeth","doi":"10.1111/ases.70226","DOIUrl":"10.1111/ases.70226","url":null,"abstract":"","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971337","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}
Taiki Sato, Tomoki Keiya, Makoto Tada, Hiroyuki Eguchi, Ryousuke Wakasa, Keisuke Ishimoto, Shuhei Yokoyama, Seiga Sasaya, Koki Kira, Hirofumi Uehara
Introduction
In Japan, efforts are being made to reduce the workload of physicians by delegating certain tasks to clinical engineers (CE) serving as scope operators (SO) in thoracoscopic lung resections.
Methods
To evaluate the safety and learning curve of clinical engineer scope operator (CESO) assistants, we analyzed their performance in thoracic surgeries conducted at our hospital from 2020 to 2023. Surgical data and postoperative complications associated with video-assisted thoracic surgery (VATS) lobectomy were assessed using scope clearance sustainability (SCS).
Results
The proportion of CESO-assisted procedures increased from 37% (55/150 cases) in 2020 to 53% (97/183 cases) in 2023, with the cumulative number of CESO-assisted surgery hours reaching approximately 697 in 2023. No significant differences were observed between the CESO-assisted and non-CESO groups regarding operating time, blood loss, postoperative hospital discharge days, or drain removal days. However, a chi-square test revealed that pulmonary air leakage lasting more than 7 days was significantly associated with postoperative complications. Multivariate analysis identified incomplete interlobar fissure as the only independent factor associated with incomplete fissure, with no significant differences attributable to CESO involvement. The stability of CESO-assisted surgeries was evaluated during the introductory period. At the beginning of this period, 28 cases were required to achieve a stable technique, whereas only 18 cases were necessary by the end. Experience with VATS demonstrated that stable outcomes could be consistently achieved with the right upper lobectomy procedures.
Conclusion
VATS with CESO assistance is a safe and reliable technique, with stability achieved within 20–30 cases.
{"title":"Safety and Performance of Clinical Engineers as Thoracoscopic Scope Operators","authors":"Taiki Sato, Tomoki Keiya, Makoto Tada, Hiroyuki Eguchi, Ryousuke Wakasa, Keisuke Ishimoto, Shuhei Yokoyama, Seiga Sasaya, Koki Kira, Hirofumi Uehara","doi":"10.1111/ases.70243","DOIUrl":"10.1111/ases.70243","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In Japan, efforts are being made to reduce the workload of physicians by delegating certain tasks to clinical engineers (CE) serving as scope operators (SO) in thoracoscopic lung resections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To evaluate the safety and learning curve of clinical engineer scope operator (CESO) assistants, we analyzed their performance in thoracic surgeries conducted at our hospital from 2020 to 2023. Surgical data and postoperative complications associated with video-assisted thoracic surgery (VATS) lobectomy were assessed using scope clearance sustainability (SCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of CESO-assisted procedures increased from 37% (55/150 cases) in 2020 to 53% (97/183 cases) in 2023, with the cumulative number of CESO-assisted surgery hours reaching approximately 697 in 2023. No significant differences were observed between the CESO-assisted and non-CESO groups regarding operating time, blood loss, postoperative hospital discharge days, or drain removal days. However, a chi-square test revealed that pulmonary air leakage lasting more than 7 days was significantly associated with postoperative complications. Multivariate analysis identified incomplete interlobar fissure as the only independent factor associated with incomplete fissure, with no significant differences attributable to CESO involvement. The stability of CESO-assisted surgeries was evaluated during the introductory period. At the beginning of this period, 28 cases were required to achieve a stable technique, whereas only 18 cases were necessary by the end. Experience with VATS demonstrated that stable outcomes could be consistently achieved with the right upper lobectomy procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VATS with CESO assistance is a safe and reliable technique, with stability achieved within 20–30 cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971449","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}
Sinistral portal hypertension is caused by various pancreatic pathologies, including neoplasms. Bleeding from the collateral circulation due to sinistral portal hypertension obscures the operative field during laparoscopic distal pancreatectomy. A female patient in her 40s presented with a mucinous cystic neoplasm complicated by sinistral portal hypertension that was successfully managed with splenic arterial embolization followed by laparoscopic distal pancreatectomy. The intraoperative blood loss was minimal, and the patient did not require blood transfusions during the perioperative period. Preoperative splenic arterial embolization is feasible, safe, and effective in avoiding massive hemorrhage from the collateral circulation due to sinistral portal hypertension during laparoscopic distal pancreatectomy.
{"title":"Laparoscopic Distal Pancreatectomy Following Preoperative Splenic Arterial Embolization for Mucinous Cystic Neoplasm Associated With Sinistral Portal Hypertension: A Case Report","authors":"Yukiko Niwa, Akihiro Cho, Takeshi Ishita, Toshihiko Mori, Moe Tanemura, Atsushi Oda, Toshiya Sugishita, Ryota Higuchi, Masaho Ota, Satoshi Katagiri","doi":"10.1111/ases.70241","DOIUrl":"10.1111/ases.70241","url":null,"abstract":"<div>\u0000 \u0000 <p>Sinistral portal hypertension is caused by various pancreatic pathologies, including neoplasms. Bleeding from the collateral circulation due to sinistral portal hypertension obscures the operative field during laparoscopic distal pancreatectomy. A female patient in her 40s presented with a mucinous cystic neoplasm complicated by sinistral portal hypertension that was successfully managed with splenic arterial embolization followed by laparoscopic distal pancreatectomy. The intraoperative blood loss was minimal, and the patient did not require blood transfusions during the perioperative period. Preoperative splenic arterial embolization is feasible, safe, and effective in avoiding massive hemorrhage from the collateral circulation due to sinistral portal hypertension during laparoscopic distal pancreatectomy.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971342","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}
Marcus Yeow, Jimmy Bok Yan So, Javis Fung, Daryl Kai Ann Chia, Asim Shabbir
Introduction
Magnetic Sphincter Augmentation (MSA) has emerged as a possible surgical option in patients with gastroesophageal reflux following sleeve gastrectomy (SG). The published literature primarily originates from Western populations, with no reported cases outside the U.S. The purpose of this study was to review the current literature on the use of MSA for treating gastroesophageal reflux after SG and analyze our institution's experience.
Methods
A literature search of PubMed, EMBASE, Cochrane, and Scopus was conducted from inception to 3 May 2025 to identify studies describing the use of MSA for gastroesophageal reflux following SG. Additionally, all consecutive patients who underwent MSA implantation for gastroesophageal reflux following SG between June 2019 and December 2023 were identified from our institution's database.
Results
The scoping review identified eight studies from the U.S., reporting on 108 patients. More than half of these patients no longer required daily PPI use after MSA implantation. Compared to pre-MSA GERD-HRQL scores, which ranged from 17.1 to 46.0, post-MSA scores were lower, ranging from 4.1 to 19.0. This first Asian case series included seven patients and found that, following MSA implantation, six out of seven continued to report daily proton pump inhibitor (PPI) use. The mean pre-MSA Gastroesophageal Reflux Disease–Health-Related Quality of Life (GERD-HRQL) score was 44.4, and the mean modified DeMeester symptom score was 4.1. These improved to 31.4 (p = 0.06) and 3.0 (p = 0.27), respectively, post-MSA. No MSA-related adverse events were recorded.
Conclusion
While the scoping review suggested that MSA may lead to symptomatic improvement in selected patients with gastroesophageal reflux following SG, this is based on low-level evidence. Our case series showed that only modest symptom improvements were observed following MSA for the treatment of reflux after SG in the Asian population.
{"title":"Magnetic Sphincter Augmentation for Gastroesophageal Reflux Following Sleeve Gastrectomy: A Scoping Review and First Asian Case Series","authors":"Marcus Yeow, Jimmy Bok Yan So, Javis Fung, Daryl Kai Ann Chia, Asim Shabbir","doi":"10.1111/ases.70238","DOIUrl":"10.1111/ases.70238","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Magnetic Sphincter Augmentation (MSA) has emerged as a possible surgical option in patients with gastroesophageal reflux following sleeve gastrectomy (SG). The published literature primarily originates from Western populations, with no reported cases outside the U.S. The purpose of this study was to review the current literature on the use of MSA for treating gastroesophageal reflux after SG and analyze our institution's experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A literature search of PubMed, EMBASE, Cochrane, and Scopus was conducted from inception to 3 May 2025 to identify studies describing the use of MSA for gastroesophageal reflux following SG. Additionally, all consecutive patients who underwent MSA implantation for gastroesophageal reflux following SG between June 2019 and December 2023 were identified from our institution's database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The scoping review identified eight studies from the U.S., reporting on 108 patients. More than half of these patients no longer required daily PPI use after MSA implantation. Compared to pre-MSA GERD-HRQL scores, which ranged from 17.1 to 46.0, post-MSA scores were lower, ranging from 4.1 to 19.0. This first Asian case series included seven patients and found that, following MSA implantation, six out of seven continued to report daily proton pump inhibitor (PPI) use. The mean pre-MSA Gastroesophageal Reflux Disease–Health-Related Quality of Life (GERD-HRQL) score was 44.4, and the mean modified DeMeester symptom score was 4.1. These improved to 31.4 (<i>p</i> = 0.06) and 3.0 (<i>p</i> = 0.27), respectively, post-MSA. No MSA-related adverse events were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While the scoping review suggested that MSA may lead to symptomatic improvement in selected patients with gastroesophageal reflux following SG, this is based on low-level evidence. Our case series showed that only modest symptom improvements were observed following MSA for the treatment of reflux after SG in the Asian population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960426","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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