Incarcerated groin hernia is a challenging emergency, and the optimal surgical approach—particularly regarding mesh use when bowel resection is required—remains controversial.
Operative Technique
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.
Discussion
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.
{"title":"One-Stage Totally Extraperitoneal Mesh Repair for Incarcerated Groin Hernias With Separated Operative Fields","authors":"Mamoru Miyasaka, Yo Kawarada, Yuki Okawa, Sho Sekiya, Toshihiro Kushibiki, Daisuke Saikawa, Koichi Teramura, Satoshi Hayashi, Yoshinori Suzuki, Masaya Kawada, Shuji Kitashiro, Kichizo Kaga, Shunichi Okushiba, 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}
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.
Methods
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.
Results
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.
Conclusion
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.
{"title":"Favorable Impact of Cost-Conscious Robotic Colectomy on Hospital Gross Profit: A Retrospective Cohort Study","authors":"Susumu Inamoto, Tsutomu Morishita, Tomoaki Okada, Akinari Nomura, 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}
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.
Patient and Surgical Technique
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.
Discussion
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.
{"title":"Reverse Needle Driving via Umbilical Trocar: An Effective Technique for Treating Recto-Bulbar Urethral Fistula in Laparoscopically Assisted Anorectoplasty","authors":"Toshio Harumatsu, Koshiro Sugita, Masakazu Murakami, Ayaka Nagano, Yumiko Tabata, Yumiko Iwamoto, Lynne Takada, Nanako Nishida, Chihiro Kedoin, Yudai Tsuruno, Keisuke Yano, Shun Onishi, Koji Yamada, Waka Yamada, Takafumi Kawano, 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}
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.
{"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, Nanako Jonai, Minami Oshikiri, Kazuyuki Murakami, Sho Sato, Yoshitaka Kaido, Hiroki Onoue, Masahiro Kagabu, Tadahiro Shoji, 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}
Renal pelvic hematoma is an uncommon but important complication after robot-assisted pyeloplasty (RAP), with few reports in the literature. Here, we report two cases of renal pelvic hematoma following RAP: A 9-year-old girl (Case 1) and a 25-year-old man (Case 2), both diagnosed with left ureteropelvic junction obstruction. Both underwent transperitoneal Anderson–Hynes pyeloplasty using 5-0 absorbable monofilament sutures. Postoperative imaging revealed renal pelvic hematoma in each case. Both patients remained hemodynamically stable and were managed conservatively. In Case 1, the hematoma and urine were aspirated through a 6 Fr ureteral catheter, whereas in Case 2, symptoms resolved spontaneously. Follow-up imaging demonstrated preserved renal function and improvement of hydronephrosis in both cases. Renal pelvic hematoma after RAP is rare but can be managed conservatively in stable patients. Careful intraoperative hemostasis and awareness of this complication are essential to ensure favorable outcomes.
{"title":"Renal Pelvic Hematoma Following Robot-Assisted Pyeloplasty: Two Case Reports","authors":"Saki Kobayashi, Yutaro Sasaki, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshito Kusuhara, Kunihisa Yamaguchi, Tomoya Fukawa, Yasuyo Yamamoto, Junya Furukawa","doi":"10.1111/ases.70234","DOIUrl":"10.1111/ases.70234","url":null,"abstract":"<div>\u0000 \u0000 <p>Renal pelvic hematoma is an uncommon but important complication after robot-assisted pyeloplasty (RAP), with few reports in the literature. Here, we report two cases of renal pelvic hematoma following RAP: A 9-year-old girl (Case 1) and a 25-year-old man (Case 2), both diagnosed with left ureteropelvic junction obstruction. Both underwent transperitoneal Anderson–Hynes pyeloplasty using 5-0 absorbable monofilament sutures. Postoperative imaging revealed renal pelvic hematoma in each case. Both patients remained hemodynamically stable and were managed conservatively. In Case 1, the hematoma and urine were aspirated through a 6 Fr ureteral catheter, whereas in Case 2, symptoms resolved spontaneously. Follow-up imaging demonstrated preserved renal function and improvement of hydronephrosis in both cases. Renal pelvic hematoma after RAP is rare but can be managed conservatively in stable patients. Careful intraoperative hemostasis and awareness of this complication are essential to ensure favorable outcomes.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919053","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}
Precise spatial understanding of the bronchovascular tree is essential for anatomical lung resection. Three-dimensional (3D) reconstruction and extended-reality (XR) technologies have emerged as tools for preoperative planning, navigation, and education. We aimed to assess the current use and efficacy of 3D and XR technologies in thoracic surgery in Japan and develop expert recommendations.
Methods
Two clinical survey questions on the usefulness of 3D imaging in thoracic surgery and that of VR, AR, and MR were sent to 125 certified thoracic surgical centers. PubMed searches targeted thoracic 3D and XR studies, including English-language randomized, prospective, and retrospective studies, systematic reviews, and meta-analyses. Draft statements were refined at the Anatomy on the Border Expert Consensus Meeting (Japan Society for Endoscopic Surgery 2024).
Results
Fifty of the 125 institutions (40%) responded. 3D imaging was used by 96% of the institutions, and 72% used it in all cases. “Very” or “moderately” useful was reported by 94% of the institutions. Main purposes for using 3D imaging were preoperative simulation (84%) and anatomical understanding (86%); 52% of the institutions used 3D imaging for intraoperative reference. For XR, awareness was moderate, but adoption remained limited (8%). Among respondents, 74% rated its usefulness as uncertain, while only a small proportion found it clearly useful for preoperative simulation, intraoperative localization, and education. Literature search showed that 3D-planning reduces blood loss, operative time, and complications in segmentectomy, whereas XR studies demonstrated improved nodule localization and workflow efficiency.
Conclusions
3D imaging should be the standard for complex thoracic resections, particularly segmentectomy. XR is a promising tool, with broader deployment expected as its usability improves and cost decreases.
{"title":"Three-Dimensional Reconstruction and Extended Reality in Thoracic Surgery: Japanese Expert Recommendations From the Anatomy on the Border Expert Consensus Meeting","authors":"Yujin Kudo, Daisuke Asano, Satoshi Kobayashi, Kentato Miura, Toshiya Abe, Kenoki Ohuchida, Mingyon Mun, Kimihiro Shimizu, Hisashi Iwata, Keiichi Akahoshi, Go Wakabayashi, Tomoharu Yoshizumi, Atsushi Takenaka, Tomonori Habuchi, Masafumi Nakamura, Yuko Kitagawa, Masatoshi Eto, Minoru Tanabe, Norihiko Ikeda","doi":"10.1111/ases.70196","DOIUrl":"10.1111/ases.70196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Precise spatial understanding of the bronchovascular tree is essential for anatomical lung resection. Three-dimensional (3D) reconstruction and extended-reality (XR) technologies have emerged as tools for preoperative planning, navigation, and education. We aimed to assess the current use and efficacy of 3D and XR technologies in thoracic surgery in Japan and develop expert recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two clinical survey questions on the usefulness of 3D imaging in thoracic surgery and that of VR, AR, and MR were sent to 125 certified thoracic surgical centers. PubMed searches targeted thoracic 3D and XR studies, including English-language randomized, prospective, and retrospective studies, systematic reviews, and meta-analyses. Draft statements were refined at the Anatomy on the Border Expert Consensus Meeting (Japan Society for Endoscopic Surgery 2024).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty of the 125 institutions (40%) responded. 3D imaging was used by 96% of the institutions, and 72% used it in all cases. “Very” or “moderately” useful was reported by 94% of the institutions. Main purposes for using 3D imaging were preoperative simulation (84%) and anatomical understanding (86%); 52% of the institutions used 3D imaging for intraoperative reference. For XR, awareness was moderate, but adoption remained limited (8%). Among respondents, 74% rated its usefulness as uncertain, while only a small proportion found it clearly useful for preoperative simulation, intraoperative localization, and education. Literature search showed that 3D-planning reduces blood loss, operative time, and complications in segmentectomy, whereas XR studies demonstrated improved nodule localization and workflow efficiency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>3D imaging should be the standard for complex thoracic resections, particularly segmentectomy. XR is a promising tool, with broader deployment expected as its usability improves and cost decreases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12770078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906977","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}
Robotic liver resection (RLR) has seen rapidly expanding indications, with its utility widely reported. However, a major limitation is the restricted view due to the rigid endoscope. This study aimed to evaluate the effectiveness of the scope-transition technique in optimizing the surgical field during RLR.
Methods
We retrospectively analyzed 73 consecutive patients who underwent RLR at our institution between October 2022 and September 2024, focusing on scope transition. Two standardized port configurations were used based on the side of the liver resected. When optimal visualization was difficult during resection, the scope was relocated to an alternate port to improve the field. Parenchymal transection was primarily performed using the clamp-crushing method under the Pringle maneuver, with adjunctive use of an assistant-controlled CUSA when the transection plane was extensive.
Results
Scope transition was used 41 times in 23 patients (32%), primarily for transection plane visualization (56%), liver mobilization (29%), and multiple-lesion resection (15%). The median transition duration was 80 s (range: 23–217). No intraoperative complications or conversions to open surgery occurred. The median operative time was 211 min, and median blood loss was 40 mL. Clavien–Dindo grade II complications occurred in 7 patients (10%), with no grade III or higher complications. The median hospital stay was 7 days. All resections achieved R0 status.
Conclusion
Scope transition is a safe and effective method to enhance visualization and surgical feasibility during RLR.
{"title":"Robotic Liver Resection With Scope Transition Technique: A Single-Center Experience","authors":"Hayato Baba, Yosuke Inoue, Kosuke Kobayashi, Atsushi Oba, Yoshihiro Ono, Takafumi Sato, Hiromichi Ito, Yu Takahashi","doi":"10.1111/ases.70230","DOIUrl":"10.1111/ases.70230","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Robotic liver resection (RLR) has seen rapidly expanding indications, with its utility widely reported. However, a major limitation is the restricted view due to the rigid endoscope. This study aimed to evaluate the effectiveness of the scope-transition technique in optimizing the surgical field during RLR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 73 consecutive patients who underwent RLR at our institution between October 2022 and September 2024, focusing on scope transition. Two standardized port configurations were used based on the side of the liver resected. When optimal visualization was difficult during resection, the scope was relocated to an alternate port to improve the field. Parenchymal transection was primarily performed using the clamp-crushing method under the Pringle maneuver, with adjunctive use of an assistant-controlled CUSA when the transection plane was extensive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Scope transition was used 41 times in 23 patients (32%), primarily for transection plane visualization (56%), liver mobilization (29%), and multiple-lesion resection (15%). The median transition duration was 80 s (range: 23–217). No intraoperative complications or conversions to open surgery occurred. The median operative time was 211 min, and median blood loss was 40 mL. Clavien–Dindo grade II complications occurred in 7 patients (10%), with no grade III or higher complications. The median hospital stay was 7 days. All resections achieved R0 status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Scope transition is a safe and effective method to enhance visualization and surgical feasibility during RLR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907027","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}
Division of the pancreatic arterial arcade during pancreaticoduodenectomy (PD) can precipitate visceral ischemia in patients with celiac artery stenosis (CAS). This study investigated optimal management of CAS for patients undergoing PD—particularly stenosis caused by median arcuate ligament (MAL) compression—through a systematic review and a nationwide survey.
Methods
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for studies indexed with the Medical Subject Headings terms celiac artery stenosis, median arcuate ligament syndrome, and pancreaticoduodenectomy. In parallel, a questionnaire on CAS management during PD was distributed to 67 major hepatobiliary and pancreatic surgery centers in Japan.
Results
Fifty-five studies met the inclusion criteria, comprising eight retrospective studies, and 47 case reports/series. Meta-analysis showed a prevalence of CAS in 6.1% of patients undergoing PD or total pancreatectomy, while preemptive MAL release was performed in only 2.2%. The risk of postoperative ischemic complications increased substantially when stenosis exceeded 80%. Among 108 patients with detailed postoperative data, those diagnosed with CAS preoperatively experienced significantly fewer ischemic events (5/85, 5.8%) compared with those diagnosed intraoperatively or postoperatively (8/22, 36%, p = 0.0006). Survey results indicated that the gastroduodenal artery (GDA) clamping test, supplemented with intraoperative Doppler ultrasonography in addition to visual inspection, was a common method to guide immediate MAL release. Repeated flow measurements after MAL release with GDA clamping were often required to confirm adequate visceral perfusion.
Conclusions
Accurate preoperative identification of CAS and deliberate surgical planning are essential when PD is anticipated. Intraoperative hemodynamic reassessment remains critical, with consideration of arterial reconstruction when MAL release alone fails to restore sufficient splanchnic perfusion.
{"title":"Management of Median Arcuate Ligament Compression in Patients Undergoing Pancreaticoduodenectomy: A Systematic Review and Consensus Statements","authors":"Noboru Ideno, Naoki Ikenaga, Yasunaru Sakuma, Saya Chiba, Tomotaka Ueno, Masaharu Higashida, Toshio Takayama, Hidenori Haruta, Shunji Endo, Katsuyuki Hoshina, Toshiya Abe, Kenoki Ohuchida, Akiko Umezawa, Yuko Kitagawa, Masafumi Nakamura","doi":"10.1111/ases.70206","DOIUrl":"10.1111/ases.70206","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Division of the pancreatic arterial arcade during pancreaticoduodenectomy (PD) can precipitate visceral ischemia in patients with celiac artery stenosis (CAS). This study investigated optimal management of CAS for patients undergoing PD—particularly stenosis caused by median arcuate ligament (MAL) compression—through a systematic review and a nationwide survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for studies indexed with the Medical Subject Headings terms <i>celiac artery stenosis</i>, <i>median arcuate ligament syndrome</i>, and <i>pancreaticoduodenectomy</i>. In parallel, a questionnaire on CAS management during PD was distributed to 67 major hepatobiliary and pancreatic surgery centers in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-five studies met the inclusion criteria, comprising eight retrospective studies, and 47 case reports/series. Meta-analysis showed a prevalence of CAS in 6.1% of patients undergoing PD or total pancreatectomy, while preemptive MAL release was performed in only 2.2%. The risk of postoperative ischemic complications increased substantially when stenosis exceeded 80%. Among 108 patients with detailed postoperative data, those diagnosed with CAS preoperatively experienced significantly fewer ischemic events (5/85, 5.8%) compared with those diagnosed intraoperatively or postoperatively (8/22, 36%, <i>p</i> = 0.0006). Survey results indicated that the gastroduodenal artery (GDA) clamping test, supplemented with intraoperative Doppler ultrasonography in addition to visual inspection, was a common method to guide immediate MAL release. Repeated flow measurements after MAL release with GDA clamping were often required to confirm adequate visceral perfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Accurate preoperative identification of CAS and deliberate surgical planning are essential when PD is anticipated. Intraoperative hemodynamic reassessment remains critical, with consideration of arterial reconstruction when MAL release alone fails to restore sufficient splanchnic perfusion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12770918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906932","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":"Response to Comment on “Intraoperative Verbal Communication in Pediatric Single-Incision Laparoscopic Percutaneous Extraperitoneal Closure: A Comprehensive Analysis and Educational Implications”","authors":"Yohei Sanmoto, Masanaga Matsumoto, Kouji Masumoto","doi":"10.1111/ases.70229","DOIUrl":"10.1111/ases.70229","url":null,"abstract":"","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901331","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}
Introduction: Open radical cystectomy is the current standard treatment for bladder cancer. However, it is associated with high morbidity and mortality, particularly in the elderly. Recently, robotic surgery has become a minimally invasive approach. To this end, we aimed to evaluate the safety and complications of robot-assisted radical cystectomy (RARC) in elderly patients with urothelial carcinoma.
Methods: We performed a retrospective single-center analysis of 103 patients who underwent RARC between May 2018 and May 2024. The patients were divided into an elderly group (age, ≥ 80 years; n = 24) and a younger group (n = 79).
Results: The American Society of Anesthesiologists Physical Status Classification System scores were significantly lower in the elderly group than in the younger group. No significant differences were observed between the two groups in terms of demography. Operative time was shorter in the elderly group than in the younger group. Conversely, the postoperative hospital stay was shorter in the younger group than in the elderly group. There were no significant differences in the frequency or severity of complications between the two groups; however, the incidence of ileus was significantly higher in the elderly group. In addition, higher age, ileus, and days to drain removal were identified as independent factors that prolonged hospitalization.
Conclusions: RARC is a safe treatment option for elderly patients with bladder cancer, with complication profiles comparable to those in younger patients. However, the increased risk of ileus and prolonged hospitalization in elderly patients highlights the need for cautious perioperative management to optimize outcomes in this growing population.
{"title":"Evaluation of the Safety of Robot-Assisted Radical Cystectomy for Bladder Cancer in Octogenarians.","authors":"Toshiharu Morikawa, Shuzo Hamamoto, Yoshihiko Tasaki, Daiki Ishikawa, Maria Aoki, Masakazu Gonda, Nobuhiko Shimizu, Takashi Nagai, Toshiki Etani, Taku Naiki, Ryosuke Ando, Kazuhiro Kanemoto, Atsushi Okada, Noriyasu Kawai, Tohru Mogami, Takahiro Yasui","doi":"10.1111/ases.70248","DOIUrl":"10.1111/ases.70248","url":null,"abstract":"<p><strong>Introduction: </strong>Open radical cystectomy is the current standard treatment for bladder cancer. However, it is associated with high morbidity and mortality, particularly in the elderly. Recently, robotic surgery has become a minimally invasive approach. To this end, we aimed to evaluate the safety and complications of robot-assisted radical cystectomy (RARC) in elderly patients with urothelial carcinoma.</p><p><strong>Methods: </strong>We performed a retrospective single-center analysis of 103 patients who underwent RARC between May 2018 and May 2024. The patients were divided into an elderly group (age, ≥ 80 years; n = 24) and a younger group (n = 79).</p><p><strong>Results: </strong>The American Society of Anesthesiologists Physical Status Classification System scores were significantly lower in the elderly group than in the younger group. No significant differences were observed between the two groups in terms of demography. Operative time was shorter in the elderly group than in the younger group. Conversely, the postoperative hospital stay was shorter in the younger group than in the elderly group. There were no significant differences in the frequency or severity of complications between the two groups; however, the incidence of ileus was significantly higher in the elderly group. In addition, higher age, ileus, and days to drain removal were identified as independent factors that prolonged hospitalization.</p><p><strong>Conclusions: </strong>RARC is a safe treatment option for elderly patients with bladder cancer, with complication profiles comparable to those in younger patients. However, the increased risk of ileus and prolonged hospitalization in elderly patients highlights the need for cautious perioperative management to optimize outcomes in this growing population.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"19 1","pages":"e70248"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094674","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}
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