Asian Journal of Endoscopic Surgery最新文献

{"title":"Magnetic Sphincter Augmentation for Gastroesophageal Reflux Following Sleeve Gastrectomy: A Scoping Review and First Asian Case Series","authors":"Marcus Yeow,&nbsp;Jimmy Bok Yan So,&nbsp;Javis Fung,&nbsp;Daryl Kai Ann Chia,&nbsp;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}

{"title":"A Porcine Model for Training Novices in Transoral Endoscopic Thyroidectomy Vestibular Approach","authors":"Lei Min,&nbsp;Yujing Weng,&nbsp;Yanhong Miao,&nbsp;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> &gt; 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}

{"title":"Scarless Sterilization? A Comparative Study of Vaginal Notes and Laparoscopic Tubal Ligation","authors":"Ayşe Betül Albayrak Denizli,&nbsp;Eralp Bulutlar,&nbsp;Gizem Boz İzceyhan,&nbsp;Narin Ece Rol,&nbsp;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> &lt; 0.001; d = 0.94), and lower postoperative analgesia use (−1.05 doses, 95% CI −1.48 to −0.63; <i>p</i> &lt; 0.001; d = 1.55). Changes in hemoglobin and hematocrit were similar (both <i>p</i> &gt; 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}

{"title":"Comments on: Clinical Impacts of Minimally Invasive Transperineal Abdominoperineal Resection in Crohn's Disease","authors":"Nabil Mohammad Azmi,&nbsp;Mohd Firdaus Mohd Hayati,&nbsp;Zairul Azwan Mohd Azman,&nbsp;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}

{"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,&nbsp;Hiroki Mori,&nbsp;Tetsuya Idichi,&nbsp;Takahisa Tainaka,&nbsp;So Nakamura,&nbsp;Yuichiro Miyake,&nbsp;Go Miyano,&nbsp;Atsuyuki Yamataka,&nbsp;Yoshitaka Kiya,&nbsp;Toshiharu Matsuura,&nbsp;Toshiya Abe,&nbsp;Kenoki Ohuchida,&nbsp;Kohei Nakata,&nbsp;Takao Ohtsuka,&nbsp;Hiroki Ishibashi,&nbsp;Hiroyuki Koga,&nbsp;Yuichi Nagakawa,&nbsp;Tatsuro Tajiri,&nbsp;Masafumi Nakamura,&nbsp;Yuko Kitagawa,&nbsp;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}

{"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,&nbsp;Toshio Takayama,&nbsp;Saya Chiba,&nbsp;Toshiya Abe,&nbsp;Kenoki Ouchida,&nbsp;Shunji Endo,&nbsp;Noboru Ideno,&nbsp;Katsuyuki Hoshina,&nbsp;Hidenori Haruta,&nbsp;Masaharu Higashida,&nbsp;Naoki Ikenaga,&nbsp;Yasunaru Sakuma,&nbsp;Masafumi Nakamura,&nbsp;Yuko Kitagawa,&nbsp;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}

{"title":"One-Stage Totally Extraperitoneal Mesh Repair for Incarcerated Groin Hernias With Separated Operative Fields","authors":"Mamoru Miyasaka,&nbsp;Yo Kawarada,&nbsp;Yuki Okawa,&nbsp;Sho Sekiya,&nbsp;Toshihiro Kushibiki,&nbsp;Daisuke Saikawa,&nbsp;Koichi Teramura,&nbsp;Satoshi Hayashi,&nbsp;Yoshinori Suzuki,&nbsp;Masaya Kawada,&nbsp;Shuji Kitashiro,&nbsp;Kichizo Kaga,&nbsp;Shunichi Okushiba,&nbsp;Satoshi Hirano","doi":"10.1111/ases.70233","DOIUrl":"10.1111/ases.70233","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Incarcerated groin hernia is a challenging emergency, and the optimal surgical approach—particularly regarding mesh use when bowel resection is required—remains controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Operative Technique</h3>\u0000 \u0000 <p>We retrospectively reviewed 13 patients who underwent emergency repair of incarcerated groin and obturator hernias using a standardized laparoscopy-assisted totally extraperitoneal (TEP) technique with separated operative fields. Diagnostic laparoscopy was used for inspection and reduction, followed by single-incision plus one-port TEP mesh repair, and re-laparoscopy for bowel assessment. When necessary, bowel resection was performed through an extended umbilical incision, maintaining field separation. Thirteen patients were treated with this approach, which allowed one-stage mesh repair even in cases requiring bowel resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This combined intraperitoneal and extraperitoneal approach enables safe one-stage mesh repair even when bowel resection is required by minimizing contamination risk through spatial separation. The technique may expand the applicability of TEP in emergency settings.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Favorable Impact of Cost-Conscious Robotic Colectomy on Hospital Gross Profit: A Retrospective Cohort Study","authors":"Susumu Inamoto,&nbsp;Tsutomu Morishita,&nbsp;Tomoaki Okada,&nbsp;Akinari Nomura,&nbsp;Yoshiharu Sakai","doi":"10.1111/ases.70235","DOIUrl":"10.1111/ases.70235","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In Japan, rising healthcare costs and hospital deficits require both systemic reforms and institutional efforts to reduce expenditure. Robotic surgery has been increasingly adopted owing to its precision and stability, and insurance coverage for colectomies began in April 2022. Nonetheless, the high cost and maintenance of robotic instruments have substantially reduced the hospital gross profit. We previously reported that robotic colectomy decreased the gross profit by approximately JPY 212 000 compared with laparoscopic colectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To address this issue, we implemented a hybrid robotic colectomy technique incorporating the double bipolar method and using laparoscopic coagulating shears instead of robotic advanced energy devices. Additionally, bowel transection and anastomosis were performed by an assistant using a laparoscopic stapler.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Standardization of the surgical procedure contributed to reduced operative time. Comparisons before and after the introduction of this strategy revealed no significant differences in clinical or oncological factors or short-term outcomes. However, the operative time was significantly reduced, and the gross profit improved by approximately JPY 120 000. This improvement resulted from lower material and labor costs, with the latter being due to the shorter operative time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our experience highlights that cost reduction in robotic colectomy can be safely achieved without compromising clinical outcomes. Continued efforts to optimize surgical efficiency and cost-effectiveness will benefit patients and healthcare institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reverse Needle Driving via Umbilical Trocar: An Effective Technique for Treating Recto-Bulbar Urethral Fistula in Laparoscopically Assisted Anorectoplasty","authors":"Toshio Harumatsu,&nbsp;Koshiro Sugita,&nbsp;Masakazu Murakami,&nbsp;Ayaka Nagano,&nbsp;Yumiko Tabata,&nbsp;Yumiko Iwamoto,&nbsp;Lynne Takada,&nbsp;Nanako Nishida,&nbsp;Chihiro Kedoin,&nbsp;Yudai Tsuruno,&nbsp;Keisuke Yano,&nbsp;Shun Onishi,&nbsp;Koji Yamada,&nbsp;Waka Yamada,&nbsp;Takafumi Kawano,&nbsp;Satoshi Ieiri","doi":"10.1111/ases.70231","DOIUrl":"10.1111/ases.70231","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Laparoscopically assisted anorectoplasty (LAARP) for recto-bulbar urethral fistula (RBUF) has not become standard practice because of the risk of urethral injury and incomplete fistula removal in the deep pelvic space. We herein report an effective technique for treating recto-bulbar fistula, called “Reverse needle driving via umbilical trocar” in LAARP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient and Surgical Technique</h3>\u0000 \u0000 <p>The patient was diagnosed with RUBF by distal colostogram, and LAARP was planned to be performed. A 5-mm trocar was inserted at the umbilicus and three additional trocars were inserted. The surgeon stands on the right side of the patient and performs anorectoplasty. The RUBF was ligated with a trans-fixing suture of 4–0 absorbable monofilament that passed through the fistula tract using reverse needle driving with the surgeon's left hand. Since the surgeon's left-hand forceps are inserted through the umbilical trocar, which is located in the midline, the suture could be reliably placed just below the urethra by performing reverse left needle driving in a straight line through the umbilical trocar, confirmed with a urethroscope. After transection of the fistula, the rectum was pulled through and the stump was sutured to the perineal skin to construct the neo-anus. Postoperative imaging revealed complete fistula closure, without complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This technique addresses the traditional challenges of urethral injury risk and incomplete fistula removal by utilizing strategic umbilical trocar positioning combined with flexible urethroscope confirmation. This robust RUBF technique represents an effective and safe approach for treating RUBF in LAARP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe Trocar Placement by Transvaginal Endoscopic Insertion in Robot-Assisted Surgery for Endometrial Cancer With Umbilical Incisional Hernia and Prior Mesh Repair: Two Case Reports","authors":"Takayuki Nagasawa,&nbsp;Nanako Jonai,&nbsp;Minami Oshikiri,&nbsp;Kazuyuki Murakami,&nbsp;Sho Sato,&nbsp;Yoshitaka Kaido,&nbsp;Hiroki Onoue,&nbsp;Masahiro Kagabu,&nbsp;Tadahiro Shoji,&nbsp;Tsukasa Baba","doi":"10.1111/ases.70237","DOIUrl":"10.1111/ases.70237","url":null,"abstract":"<div>\u0000 \u0000 <p>We report two cases of endometrial cancer with umbilical incisional hernia or prior mesh repair, in which robot-assisted surgery was safely performed using transvaginal laparoscope insertion. Both patients had prior abdominal surgeries, and preoperative imaging raised concerns about adhesions or mesh near the umbilicus, making conventional trocar insertion risky. A laparoscope was inserted via the posterior vaginal fornix, allowing real-time intra-abdominal visualization and safe port placement under direct vision. In one case, mesh and adhesions were confirmed at the umbilicus. In the other, no adhesions were found within the hernia sac despite being suspected preoperatively, whereas dense adhesions were identified at Palmer's point, which could not be fully characterized by imaging alone. These cases highlight the limitations of relying solely on imaging and underscore the utility of intraoperative visual assessment. Transvaginal scope insertion offers a simple, reproducible method to enhance trocar safety. To our knowledge, no previous reports have described this technique used solely for observation in robot-assisted surgery for endometrial cancer.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935545","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}