Asian Journal of Endoscopic Surgery最新文献

Objective: To evaluate the feasibility, safety, and short-term effectiveness of a society-led, proctor-guided Equivalent Certificate program designed to support the supervised initiation of robot-assisted gynecologic surgery in Japan.

Methods: A multicenter pilot program was conducted across four academic institutions. Fourteen surgeons without prior da Vinci console experience were enrolled. The training pathway included: (1) manufacturer-provided e-learning, on-site system training, and written assessment; (2) institution-based, proctor-supervised training with mandatory simulator proficiency (≥ 80 points across 10 tasks) and at least five bedside assistant cases; (3) standardized proctor evaluation of technical readiness using a 5-point Likert scale; and (4) post-case assessment following each surgeon's first console case. Upon completion of all requirements, participants received an equivalency-based Certificate of da Vinci System Training issued by Intuitive Surgical.

Results: Eleven surgeons completed the full program and performed at least one robotic procedure. No intraoperative complications or proctor takeovers occurred. Proctor evaluations demonstrated satisfactory performance across all assessed skill domains, with mean scores ranging from 3.09 to 4.55 out of 5. Instrument insertion and exchange received the highest ratings (mean 4.55), while third-arm control showed relatively lower scores (mean 3.09), consistent with known early learning challenges. The overall composite score was 3.79, indicating performance approaching a "well done" level under supervised conditions.

Conclusion: This feasibility study suggests that a structured, society-led Equivalent Certificate program is a feasible and safe approach for the supervised introduction of robot-assisted gynecologic surgery. By integrating manufacturer-aligned education with institution-based proctor supervision and objective performance benchmarks, this framework may serve as a complementary training pathway as robotic surgery education continues to evolve in Japan.

Lymphocele is a frequent complication of renal transplantation and can be difficult to manage. Surgical intervention requires precise identification of the ureter owing to anatomical variability in the urinary tract after transplantation. We herein report a 61-year-old obese man (body mass index 33.4 kg/m²) who developed pelvic lymphocele after living donor renal transplantation. Initial conservative observation was followed by percutaneous drainage due to progressive leg edema, hydronephrosis, and elevated serum creatinine levels (3.3 mg/dL). Although drainage improved renal function and reduced edema, persistent high-output drainage of 500 mL/day necessitated laparoscopic fenestration. Given the anticipated difficulty in identifying the ureter due to obesity, a near-infrared fluorescent ureteral catheter was inserted preoperatively. Intraoperative near-infrared imaging enables visualization of the ureter, facilitating fenestration at a safe distance. Furthermore, observing fluorescence within the lymphocele allowed for clearer identification of the ureteral location.

Introduction: The global burden of inguinal hernia (IH) has significantly increased. Mesh with self-fixating technology helps provide superior tissue integration, reducing the need for additional fixation compared to conventional mesh. Benefits include shorter operative time, reduced hospital stay, lower recurrence rates, and improved quality of life. However, variability remains in its adoption and application. To address this, a panel of Asian hernia experts convened to develop a consensus and formulate recommendations on self-fixating mesh (SFM) use in IH repair.

Method: A panel of 13 hernia experts participated in the consensus discussion and manuscript development. A comprehensive literature review was conducted using PubMed, Embase, and Google Scholar to identify relevant articles and formulate statements. Consensus was assessed using a modified three-step Delphi method, with an acceptance level of > 80%.

Results: In phase 1 of consensus development, 11 statements were reviewed, with 9 reaching consensus and 1 facing disagreement. Five additional statements were introduced based on expert input. Phase 2 reviewed all 16 statements, with one failing to reach consensus. In phase 3, an online reassessment of the revised version of the failed statement in the previous round was conducted via Microsoft Forms, leading to consensus on all 16 statements.

Conclusion: SFM offers significant advantages over conventional sutured meshes in IH repair. However, further research and multicenter trials are recommended to refine surgical protocols. Based on expert recommendations, SFM may be preferred in IH repair, and structured training can enhance its adoption, improving patient outcomes.

Vein-guided resection using the cranio-ventral approach (CVA) prevents split injuries during laparoscopic anatomical liver resection, but its utility in robot-assisted surgery remains unreported. A 74-year-old woman with hepatocellular carcinoma underwent robotic segmentectomy 8 using the da Vinci Xi system. We evaluated the safety and feasibility of robotic segmentectomy 8 using the CVA approach with port hopping. After caudal liver mobilization, port hopping enabled access to the roots of the middle hepatic vein and right hepatic vein, allowing parenchymal transection with the CVA. The operative time was 583 min with 30 mL blood loss. Recovery was uneventful with discharge on postoperative day 14. Robotic CVA with port hopping demonstrates feasibility for anatomical liver resection.

Introduction: To determine optimal port placement for retroperitoneal robot-assisted radical nephroureterectomy (RANU) using the Hugo robot-assisted surgery system (HRS) and to compare perioperative outcomes and arm interference between transperitoneal and retroperitoneal approaches.

Methods: We retrospectively analyzed 21 patients who underwent RANU for upper tract urothelial carcinoma with HRS at our institution between 2023 and 2025 via a transperitoneal (n = 13) or retroperitoneal (n = 8) approach. For clinical retroperitoneal RANU, four robotic ports were placed 3 cm lateral to the erector spinae and spaced 8 cm medially. We compared patient demographics, perioperative metrics, and the rates of arm interference and system-caused errors from log data. Continuous variables were analyzed using the Mann-Whitney U test, whereas categorical variables were analyzed using the chi-squared test or Fisher's exact test.

Results: Total operative, console, and dissection times; blood loss; and transfusion and complication rates were comparable between approaches. One transperitoneal case required conversion to da Vinci because of HRS malfunction. The median number of removed lymph nodes was significantly lower in the retroperitoneal group (p = 0.049). The time from incision to roll-in was shorter in the transperitoneal group (p = 0.015), whereas the time from roll-in to console start favored the retroperitoneal approach (p = 0.045). Arm-interference errors were significantly less common for the retroperitoneal approach (p = 0.011), whereas the frequency of system-caused errors did not differ between the groups.

Conclusion: Retroperitoneal HRS-RANU was feasible in our cohort and may reduce arm interference; larger studies are needed to confirm this.