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}
Historically, live pigs have been utilized for technical exploration in developing the transoral endoscopic thyroidectomy vestibular approach (TOETVA). This study aims to design a TOETVA training model using porcine subjects for junior doctors.
Methods
Trainees from hospitals across China were invited to participate in a TOETVA training workshop. We documented the duration of each procedural step, surgical complications, and specific details, which were then compared to the initial human TOETVA procedures conducted by specialists from our institution. After the workshop, participants completed online questionnaires using a 1–5 Likert Scale to assess their subjective experiences of each step in comparison to human procedures.
Results
The study involved 17 trainees and seven mentors from institutions in four Chinese cities, using five pigs for the workshop. All five surgeries were successfully completed, although there was a loss of recurrent laryngeal nerve (RLN) signal in one case. Remarkably, one trainee successfully performed their first human TOETVA 3 days after the workshop. The overall complication rates were comparable between the porcine TOETVAs and human procedures (20.0% vs. 11.4%, p > 0.999). Participants rated the training on assistance in performing human TOETVA between 3.54 ± 1.18 and 4.29 ± 0.55 on the Likert Scale. In terms of similarity to human TOETVA, steps such as establishing working space, identifying RLNs, and dissecting central lymph nodes were rated above 3.
Conclusion
This study is the first to confirm the feasibility of a porcine TOETVA training model. Despite anatomical differences, the porcine TOETVA effectively simulates human procedures.
背景：历史上，生猪被用于开发经口内窥镜甲状腺切除术前庭入路（TOETVA）的技术探索。本研究旨在设计以猪为主体的初级医师TOETVA训练模型。方法：邀请来自全国各医院的受训者参加TOETVA培训工作坊。我们记录了每个手术步骤的持续时间、手术并发症和具体细节，然后与我们机构的专家进行的最初的人类TOETVA手术进行比较。研讨会结束后，参与者使用1-5李克特量表完成在线问卷，以评估他们对每个步骤的主观体验，并将其与人类程序进行比较。结果：该研究涉及来自中国4个城市的机构的17名学员和7名导师，使用5头猪进行工作坊。所有五例手术均成功完成，尽管有一例喉返神经（RLN）信号丢失。值得注意的是，一名学员在培训3天后成功地完成了他们的第一次人体TOETVA。猪TOETVAs和人手术的总并发症发生率相当（20.0% vs. 11.4%, p < 0 0.999）。在李克特量表上，参与者对协助执行人类TOETVA的培训的评分在3.54±1.18和4.29±0.55之间。在与人类TOETVA的相似度方面，建立工作空间、识别RLNs、解剖中央淋巴结等步骤被评为3级以上。结论：本研究首次证实了猪TOETVA训练模型的可行性。尽管解剖学上存在差异，但猪的TOETVA有效地模拟了人类的手术过程。
{"title":"A Porcine Model for Training Novices in Transoral Endoscopic Thyroidectomy Vestibular Approach","authors":"Lei Min, Yujing Weng, Yanhong Miao, Zhiheng Huang","doi":"10.1111/ases.70232","DOIUrl":"10.1111/ases.70232","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Historically, live pigs have been utilized for technical exploration in developing the transoral endoscopic thyroidectomy vestibular approach (TOETVA). This study aims to design a TOETVA training model using porcine subjects for junior doctors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Trainees from hospitals across China were invited to participate in a TOETVA training workshop. We documented the duration of each procedural step, surgical complications, and specific details, which were then compared to the initial human TOETVA procedures conducted by specialists from our institution. After the workshop, participants completed online questionnaires using a 1–5 Likert Scale to assess their subjective experiences of each step in comparison to human procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study involved 17 trainees and seven mentors from institutions in four Chinese cities, using five pigs for the workshop. All five surgeries were successfully completed, although there was a loss of recurrent laryngeal nerve (RLN) signal in one case. Remarkably, one trainee successfully performed their first human TOETVA 3 days after the workshop. The overall complication rates were comparable between the porcine TOETVAs and human procedures (20.0% vs. 11.4%, <i>p</i> > 0.999). Participants rated the training on assistance in performing human TOETVA between 3.54 ± 1.18 and 4.29 ± 0.55 on the Likert Scale. In terms of similarity to human TOETVA, steps such as establishing working space, identifying RLNs, and dissecting central lymph nodes were rated above 3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study is the first to confirm the feasibility of a porcine TOETVA training model. Despite anatomical differences, the porcine TOETVA effectively simulates human procedures.</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":"145960429","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}
Tubal ligation is a common permanent contraception method. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) offers a scarless alternative to laparoscopy, but comparative evidence for interval tubal ligation is limited.
Objective
To compare surgical outcomes and recovery between vNOTES and conventional laparoscopic tubal ligation.
Methods
Retrospective cohort at a tertiary center (August 2024–May 2025). Women aged 30–50 seeking permanent contraception with ASA ≤ 3 were included. Exclusions: prior pelvic surgery or known pelvic pathology, salpingectomy or non-contraceptive indications (e.g., hydrosalpinx), concomitant procedures, incomplete records. Patients were grouped by technique: vNOTES (n = 20) or laparoscopy (n = 27). Outcomes: operative time, hospital stay, time to mobilization, analgesia use, Δhemoglobin/Δhematocrit, complications. Tests: t-test/Mann–Whitney, Chi-square/Fisher; effect sizes (Cohen's d) and 95% CIs reported (α = 0.05).
Results
Baseline demographics were comparable. Operative time did not differ (mean difference −3.77 min, 95% CI −9.70 to 2.15; p = 0.199; d = −0.32). vNOTES was associated with shorter hospitalization (−3.40 h, 95% CI −6.51 to −0.29; p = 0.033; d = 0.47), earlier mobilization (−0.80 h, 95% CI −1.27 to −0.33; p < 0.001; d = 0.94), and lower postoperative analgesia use (−1.05 doses, 95% CI −1.48 to −0.63; p < 0.001; d = 1.55). Changes in hemoglobin and hematocrit were similar (both p > 0.40). One vNOTES case required conversion to laparoscopy due to adhesions; no conversions occurred in the laparoscopy group.
Conclusions
vNOTES and laparoscopy are both safe for interval tubal ligation. vNOTES confers clinically meaningful recovery advantages—shorter hospitalization, faster mobilization, and reduced analgesic need—while maintaining comparable operative time and blood loss surrogates. These findings support vNOTES as a promising, patient-centered alternative.
背景：输卵管结扎是一种常见的永久性避孕方法。阴道自然孔腔内窥镜手术（vNOTES）提供了一种无疤痕的腹腔镜手术，但间隔输卵管结扎的比较证据有限。目的：比较vNOTES与传统腹腔镜输卵管结扎术的手术效果和恢复情况。方法：回顾性队列在三级中心（2024年8月- 2025年5月）。纳入ASA≤3、寻求永久避孕的30-50岁女性。排除：既往盆腔手术或已知盆腔病理，输卵管切除术或非避孕指征（如输卵管积水），伴随手术，记录不完整。患者按技术分组：vNOTES （n = 20）或腹腔镜（n = 27）。结果：手术时间、住院时间、活动时间、镇痛使用、Δhemoglobin/Δhematocrit、并发症。检验：t检验/Mann-Whitney、卡方检验/Fisher；效应量（Cohen’s d）和95% ci报告（α = 0.05）。结果：基线人口统计学具有可比性。手术时间无差异（平均差-3.77 min, 95% CI -9.70 ~ 2.15; p = 0.199; d = -0.32）。vNOTES与较短的住院时间（-3.40 h, 95% CI -6.51至-0.29;p = 0.033; d = 0.47）和较早的活动（-0.80 h, 95% CI -1.27至-0.33;p = 0.40）相关。1例vNOTES病例因粘连需要转为腹腔镜检查；腹腔镜组未发生转换。结论：vNOTES和腹腔镜在间歇输卵管结扎中均是安全的。vNOTES具有临床意义的恢复优势-更短的住院时间，更快的活动，减少镇痛需求-同时保持相当的手术时间和出血量。这些发现支持vNOTES作为一个有希望的、以患者为中心的替代方案。
{"title":"Scarless Sterilization? A Comparative Study of Vaginal Notes and Laparoscopic Tubal Ligation","authors":"Ayşe Betül Albayrak Denizli, Eralp Bulutlar, Gizem Boz İzceyhan, Narin Ece Rol, Sadık Şahin","doi":"10.1111/ases.70236","DOIUrl":"10.1111/ases.70236","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tubal ligation is a common permanent contraception method. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) offers a scarless alternative to laparoscopy, but comparative evidence for interval tubal ligation is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare surgical outcomes and recovery between vNOTES and conventional laparoscopic tubal ligation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort at a tertiary center (August 2024–May 2025). Women aged 30–50 seeking permanent contraception with ASA ≤ 3 were included. Exclusions: prior pelvic surgery or known pelvic pathology, salpingectomy or non-contraceptive indications (e.g., hydrosalpinx), concomitant procedures, incomplete records. Patients were grouped by technique: vNOTES (<i>n</i> = 20) or laparoscopy (<i>n</i> = 27). Outcomes: operative time, hospital stay, time to mobilization, analgesia use, Δhemoglobin/Δhematocrit, complications. Tests: t-test/Mann–Whitney, Chi-square/Fisher; effect sizes (Cohen's d) and 95% CIs reported (<i>α</i> = 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline demographics were comparable. Operative time did not differ (mean difference −3.77 min, 95% CI −9.70 to 2.15; <i>p</i> = 0.199; d = −0.32). vNOTES was associated with shorter hospitalization (−3.40 h, 95% CI −6.51 to −0.29; <i>p</i> = 0.033; d = 0.47), earlier mobilization (−0.80 h, 95% CI −1.27 to −0.33; <i>p</i> < 0.001; d = 0.94), and lower postoperative analgesia use (−1.05 doses, 95% CI −1.48 to −0.63; <i>p</i> < 0.001; d = 1.55). Changes in hemoglobin and hematocrit were similar (both <i>p</i> > 0.40). One vNOTES case required conversion to laparoscopy due to adhesions; no conversions occurred in the laparoscopy group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>vNOTES and laparoscopy are both safe for interval tubal ligation. vNOTES confers clinically meaningful recovery advantages—shorter hospitalization, faster mobilization, and reduced analgesic need—while maintaining comparable operative time and blood loss surrogates. These findings support vNOTES as a promising, patient-centered alternative.</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":"145960411","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}
Nabil Mohammad Azmi, Mohd Firdaus Mohd Hayati, Zairul Azwan Mohd Azman, Ismail Sagap
{"title":"Comments on: Clinical Impacts of Minimally Invasive Transperineal Abdominoperineal Resection in Crohn's Disease","authors":"Nabil Mohammad Azmi, Mohd Firdaus Mohd Hayati, Zairul Azwan Mohd Azman, Ismail Sagap","doi":"10.1111/ases.70215","DOIUrl":"10.1111/ases.70215","url":null,"abstract":"","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":"145960498","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}
With the aim of facilitating cross-specialty discussion on detailed anatomical interpretations in congenital biliary dilatation surgery, the Japan Society for Endoscopic Surgery (JSES) and the Consensus Meeting of Anatomy on the Border (AOB) developed a series of consensus statements in 2024. This report focuses specifically on biliary reconstruction for intrahepatic bile duct strictures and the optimal jejunal limb length.
Methods
These statements were based on a comprehensive literature review and a nationwide questionnaire survey.
Results
For intrahepatic bile duct strictures, the need to tailor surgical approaches according to the location and underlying cause of the stricture has been recognized. When a stricture was located in the hilar or proximal intrahepatic bile ducts and direct surgical intervention was feasible, procedures such as stricture repair, membranous resection, or septal excision were commonly performed. In contrast, when the stricture was located more peripherally and direct intervention was difficult, alternative strategies, such as hepatectomy, endoscopic bile duct reconstruction, or additional hepaticojejunostomy to the upstream bile duct, were employed. For the optimal length of the jejunal limb, it is recommended that the jejunal limb length be adjusted according to body size in children under 5 years of age, and that the natural length be applied in children 5 years of age and older, as well as in adults.
Conclusion
The current evidence remains insufficient and further research is warranted to establish more definitive conclusions. This statement was finalized with the agreement of all expert panel members.
{"title":"Biliary Reconstruction for Intrahepatic Bile Duct Strictures and Optimal Jejunal Limb Length in Congenital Biliary Dilation Surgery: A Literature Review and Consensus Statements From the AOB Consensus Meeting","authors":"Masahiro Takeda, Hiroki Mori, Tetsuya Idichi, Takahisa Tainaka, So Nakamura, Yuichiro Miyake, Go Miyano, Atsuyuki Yamataka, Yoshitaka Kiya, Toshiharu Matsuura, Toshiya Abe, Kenoki Ohuchida, Kohei Nakata, Takao Ohtsuka, Hiroki Ishibashi, Hiroyuki Koga, Yuichi Nagakawa, Tatsuro Tajiri, Masafumi Nakamura, Yuko Kitagawa, Hiroo Uchida","doi":"10.1111/ases.70204","DOIUrl":"10.1111/ases.70204","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>With the aim of facilitating cross-specialty discussion on detailed anatomical interpretations in congenital biliary dilatation surgery, the Japan Society for Endoscopic Surgery (JSES) and the Consensus Meeting of Anatomy on the Border (AOB) developed a series of consensus statements in 2024. This report focuses specifically on biliary reconstruction for intrahepatic bile duct strictures and the optimal jejunal limb length.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>These statements were based on a comprehensive literature review and a nationwide questionnaire survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For intrahepatic bile duct strictures, the need to tailor surgical approaches according to the location and underlying cause of the stricture has been recognized. When a stricture was located in the hilar or proximal intrahepatic bile ducts and direct surgical intervention was feasible, procedures such as stricture repair, membranous resection, or septal excision were commonly performed. In contrast, when the stricture was located more peripherally and direct intervention was difficult, alternative strategies, such as hepatectomy, endoscopic bile duct reconstruction, or additional hepaticojejunostomy to the upstream bile duct, were employed. For the optimal length of the jejunal limb, it is recommended that the jejunal limb length be adjusted according to body size in children under 5 years of age, and that the natural length be applied in children 5 years of age and older, as well as in adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The current evidence remains insufficient and further research is warranted to establish more definitive conclusions. This statement was finalized with the agreement of all expert panel members.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12790982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953274","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}
Pancreaticoduodenal and gastroduodenal artery aneurysms (PDAA and GDAA) are rare but life-threatening vascular lesions. Many are associated with median arcuate ligament syndrome (MALS), a condition associated with increased retrograde collateral flow due to celiac artery compression. Although endovascular treatment is the first-line approach for PDAA and GDAA, the role and timing of median arcuate ligament (MAL) release remain unclear.
Methods
This consensus statement was developed through the Anatomy on the Border Expert Consensus Meeting, organized by the Japanese Society for Endoscopic Surgery. Among multiple clinical questions (CQs) addressed by the working group, this statement focuses on CQ3: the appropriate timing of MAL release in patients with PDAA or GDAA associated with MALS. Consensus statements were developed based on a literature review, a nationwide survey, expert panel discussions, and a modified Delphi voting process.
Results
Although evidence remains limited, MAL release may improve antegrade visceral perfusion, prevent ischemic complications, reduce retrograde hemodynamic stress and recurrence risk, and facilitate vascular access for future interventions. Based on current evidence and expert input, the committee developed and approved three consensus statements: MAL release could be considered before endovascular treatment in clinically stable cases; Endovascular treatment should be performed first in ruptured cases, with careful attention to end-organ ischemia; Elective MAL release is suggested after aneurysm treatment to reduce the risk of recurrence.
Conclusion
These consensus statements support individualized surgical decision-making for patients with PDAA or GDAA associated with MALS, where evidence is limited and clinical practice varies.
{"title":"Consensus Statement on the Timing of Median Arcuate Ligament Release in Patients With Pancreaticoduodenal or Gastroduodenal Artery Aneurysms Associated With Median Arcuate Ligament Syndrome","authors":"Tomotaka Ueno, Toshio Takayama, Saya Chiba, Toshiya Abe, Kenoki Ouchida, Shunji Endo, Noboru Ideno, Katsuyuki Hoshina, Hidenori Haruta, Masaharu Higashida, Naoki Ikenaga, Yasunaru Sakuma, Masafumi Nakamura, Yuko Kitagawa, Akiko Umezawa","doi":"10.1111/ases.70200","DOIUrl":"10.1111/ases.70200","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pancreaticoduodenal and gastroduodenal artery aneurysms (PDAA and GDAA) are rare but life-threatening vascular lesions. Many are associated with median arcuate ligament syndrome (MALS), a condition associated with increased retrograde collateral flow due to celiac artery compression. Although endovascular treatment is the first-line approach for PDAA and GDAA, the role and timing of median arcuate ligament (MAL) release remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This consensus statement was developed through the Anatomy on the Border Expert Consensus Meeting, organized by the Japanese Society for Endoscopic Surgery. Among multiple clinical questions (CQs) addressed by the working group, this statement focuses on CQ3: the appropriate timing of MAL release in patients with PDAA or GDAA associated with MALS. Consensus statements were developed based on a literature review, a nationwide survey, expert panel discussions, and a modified Delphi voting process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Although evidence remains limited, MAL release may improve antegrade visceral perfusion, prevent ischemic complications, reduce retrograde hemodynamic stress and recurrence risk, and facilitate vascular access for future interventions. Based on current evidence and expert input, the committee developed and approved three consensus statements: MAL release could be considered before endovascular treatment in clinically stable cases; Endovascular treatment should be performed first in ruptured cases, with careful attention to end-organ ischemia; Elective MAL release is suggested after aneurysm treatment to reduce the risk of recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These consensus statements support individualized surgical decision-making for patients with PDAA or GDAA associated with MALS, where evidence is limited and clinical practice varies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12790981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953247","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号