Asian Journal of Endoscopic Surgery最新文献_第6页

Robot-Assisted Partial Nephrectomy for Upper Versus Lower Pole Renal Tumors: Perioperative Outcomes and Technical Insights Incorporating the da Vinci and Hinotori Systems 机器人辅助肾部分切除术治疗上极与下极肾肿瘤：结合达芬奇和Hinotori系统的围手术期结果和技术见解。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-19 DOI: 10.1111/ases.70217

Daisuke Motoyama, Kyohei Watanabe, Yuto Matsushita, Hiromitsu Watanabe, Keita Tamura, Hideaki Miyake, Teruo Inamoto

Introduction

Upper pole renal tumors, despite the unique surgical techniques and preparations necessitated by their anatomical location, are assigned the same numerical complexity as lower pole tumors by the RENAL nephrometry score. Consequently, this study aimed to compare the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) for upper versus lower pole renal tumors.

Methods

Out of 484 consecutive patients who underwent RAPN at our institution, this retrospective study included 186 patients with renal polar tumors. Upper and lower pole tumors were defined as those with a RENAL nephrometry score L component of 1, indicating polar tumors not overlapping the superior or inferior polar lines. RAPN procedures were performed using either the da Vinci Xi or the hinotori system, a newly developed robotic platform in Japan. For upper pole tumor excision in a transperitoneal approach, a 30° down-angle robotic camera was inserted via a camera port previously positioned approximately 3 cm more superolaterally than the standard placement, alongside two robotic arms, irrespective of the robotic platform.

Results

The study population was divided into lower (n = 109) and upper (n = 77) pole tumor groups; tumors located centrally, including hilar tumors, were entirely excluded. No significant differences were observed in baseline patient characteristics between the two groups. Following surgery, significant differences were found in operative time (165 vs. 179 min, p = 0.010) and robotic time (98 vs. 116 min, p = 0.004) between the lower and upper pole groups, respectively. However, other major perioperative outcomes, including the Trifecta achievement rate (94.5% vs. 98.7%, p = 0.24), showed no significant differences. Uni- and multivariate analyses identified sex, tumor size, and tumor polar location as independent factors for prolonged robotic time; however, robotic platform type was not.

Conclusions

With proper technical preparation, RAPN for upper pole tumors can achieve comparable perioperative outcomes to that for lower pole tumors, despite requiring longer operative and robotic times.

导言：上极肾肿瘤，尽管其解剖位置需要独特的手术技术和准备，但根据肾肾测量评分，其数值复杂性与下极肿瘤相同。因此，本研究旨在比较机器人辅助部分肾切除术（RAPN）治疗上、下极肾肿瘤的围手术期结果。方法：在我院连续接受RAPN的484例患者中，这项回顾性研究包括186例肾极性肿瘤患者。上极和下极肿瘤定义为肾肾测量评分L分量为1的肿瘤，表明极性肿瘤不重叠上极线或下极线。RAPN手术使用达芬奇Xi或hinotori系统（日本新开发的机器人平台）进行。对于经腹膜入路的上极肿瘤切除，无论机器人平台如何，通过先前定位于比标准位置多约3cm的相机端口插入一个30°向下角度的机器人摄像机，并与两个机械臂一起插入。结果：研究人群分为下极肿瘤组（n = 109）和上极肿瘤组（n = 77）；位于中心的肿瘤，包括肺门肿瘤，完全排除。两组患者的基线特征无显著差异。手术后，下极组和上极组的手术时间（165 vs. 179 min, p = 0.010）和机器人时间（98 vs. 116 min, p = 0.004）分别有显著差异。然而，其他主要围手术期结局，包括三氟乙酸的成功率（94.5%对98.7%,p = 0.24），无显著差异。单因素和多因素分析表明，性别、肿瘤大小和肿瘤极性位置是延长机器人使用时间的独立因素；然而，机器人平台类型不是。结论：通过适当的技术准备，上极肿瘤的RAPN可以达到与下极肿瘤相当的围手术期结果，尽管需要更长的手术时间和机器人时间。

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引用次数: 0

Biliary Dilatation While Awaiting Surgery for a Congenital Hiatal Hernia: A Case Report 先天性裂孔疝等待手术时胆道扩张一例报告。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-17 DOI: 10.1111/ases.70212

Ryuta Masuya, Jun Kuwabara, Katsuya Watanabe, Satoshi Ieiri, Taro Oshikiri

Giant congenital hiatal hernias that cause biliary dilatation are uncommon. We present the case of a female neonate with a massive hiatal hernia involving the entire stomach, which was located in the mediastinum, who developed cholestasis presenting with elevated bilirubin and grayish stools, along with dilatation of the intrahepatic and common hepatic ducts by 90 days of age. The common bile duct remained undilated and no pancreatic herniation was evident. A laparoscopic hernia repair was performed at 141 days. Intraoperative cholangiography suggested that hernia-induced common bile duct kinking caused the stasis; consequently, no biliary surgery was performed. Postoperatively, the liver function and bilirubin levels normalized, although MRI at 2 months revealed residual ductal dilatation. Neonatal hiatal hernias can induce biliary dilatation through mechanical kinking, even without pancreatic prolapse. While hernia repair may resolve cholestasis, persistent ductal alterations require long-term monitoring.

巨大先天性裂孔疝引起胆道扩张并不常见。我们报告一例女性新生儿，其位于纵隔的大面积裂孔疝累及整个胃，在90日龄时出现胆汁淤积，表现为胆红素升高，大便呈灰色，并伴有肝内管和肝总管扩张。胆总管未扩张，无明显胰疝。第141天行腹腔镜疝修补术。术中胆管造影提示：疝致胆总管扭结引起瘀血；因此，没有胆道手术。术后，肝功能和胆红素水平恢复正常，尽管2个月MRI显示残余导管扩张。新生儿裂孔疝可以通过机械扭结诱导胆道扩张，即使没有胰腺脱垂。虽然疝修补可以解决胆汁淤积，但持续性的导管改变需要长期监测。

引用次数: 0

Comment on “Intraoperative Verbal Communication in Pediatric Single-Incision Laparoscopic Percutaneous Extraperitoneal Closure: A Comprehensive Analysis and Educational Implications” 评论“儿科单切口腹腔镜经皮腹腔外缝合术中言语交流：综合分析及教育意义”。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-17 DOI: 10.1111/ases.70218

Kamran Hussain, Abida Nawab, Isha Khawar

引用次数: 0

Consensus Statements on Minimally Invasive Surgery for Congenital Biliary Dilatation 先天性胆道扩张微创手术的共识声明。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-15 DOI: 10.1111/ases.70203

So Nakamura, Takahisa Tainaka, Yoshitaka Kiya, Toshiharu Matsuura, Toshiya Abe, Kenoki Ohuchida, Kohei Nakata, Hiroyuki Koga, Takao Ohtsuka, Hiroki Ishibashi, Yuichi Nagakawa, Tatsuro Tajiri, Hiroo Uchida, Yuko Kitagawa, Masafumi Nakamura

Introduction

Minimally invasive surgery for congenital biliary dilatation (MICBD), including both laparoscopic and robotic approaches, is gaining increasing popularity. However, the evidence remains limited, especially across both adult and pediatric populations.

Methods

Consensus statements on MICBD were formulated during a multidisciplinary consensus meeting, addressing two clinical questions focused on the use of MICBD in Todani classification types I and IV-A. A comprehensive literature review and expert survey were performed. Consensus was achieved through a Delphi voting process, with statements approved when ≥ 75% agreement was reached.

Results

The literature review revealed that although MICBD was associated with prolonged operative times, the approach resulted in reduced blood loss and shorter hospital stays, with complication rates comparable to those observed in open surgery. In the expert survey, MICBD was supported by 81% of respondents for type I and 64% for type IV-A. The following consensus statement was developed: “MICBD for both Todani classification type I and type IV-A can be considered; however, it is preferable for the procedure to be performed by a team experience in minimally invasive surgery.” This statement achieved unanimous agreement in the Delphi vote.

Conclusion

Due to a lack of high-level evidence, formal recommendations for MICBD remain premature. Expert consensus supports MICBD for both types I and IV-A cases, provided that the procedures are performed by experienced surgical teams. Further high-quality studies and long-term outcome assessments are essential to establish safety and efficacy.

导读：微创手术治疗先天性胆道扩张（MICBD），包括腹腔镜和机器人方法，越来越受欢迎。然而，证据仍然有限，特别是在成人和儿科人群中。方法：在多学科共识会议期间制定了关于MICBD的共识声明，解决了两个临床问题，重点是MICBD在Todani分类I型和IV-A型中的应用。进行了全面的文献综述和专家调查。通过德尔菲投票程序达成共识，当达成≥75%的一致意见时，声明被批准。结果：文献综述显示，尽管MICBD与延长手术时间有关，但该方法减少了出血量，缩短了住院时间，并发症发生率与开放手术相当。在专家调查中，81%的ⅰ型受访者和64%的IV-A型受访者支持MICBD。达成了以下共识声明：“MICBD对于Todani分类I型和IV-A型都可以考虑；然而，最好是由有微创手术经验的团队来进行手术。”这一声明在德尔菲投票中获得了一致同意。结论：由于缺乏高水平的证据，MICBD的正式推荐仍不成熟。专家一致支持MICBD治疗I型和IV-A型病例，前提是手术由经验丰富的外科团队进行。进一步的高质量研究和长期结果评估对于确定安全性和有效性至关重要。

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引用次数: 0

Lateral Segment Thickness of the Liver Is a Risk Factor for Elevated Liver Enzymes After Laparoscopic Gastrectomy Using the Nathanson Liver Retractor 肝外侧段厚度是使用Nathanson肝牵开器腹腔镜胃切除术后肝酶升高的危险因素。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-15 DOI: 10.1111/ases.70214

Michihisa Iida, Yusaku Watanabe, Chiyo Nakashima, Mitsuo Nishiyama, Hiroto Matsui, Yoshitaro Shindo, Yukio Tokumitsu, Shinobu Tomochika, Yuki Nakagami, Hidenori Takahashi, Hiroaki Nagano

Introduction

Liver transaminase levels may be elevated following gastrectomy using the Nathanson liver retractor, which is widely used in laparoscopic gastrectomy. However, risk factors for developing liver dysfunction associated with this procedure remain unclear.

Methods

Overall, 258 consecutive patients who underwent laparoscopic gastrectomy for gastric cancer using a Nathanson retractor between 2015 and 2022 were categorized into groups with and without Common Terminology Criteria for Adverse Event grade 3 or higher elevation in transaminases. Factors associated with transaminase elevation after laparoscopic gastrectomy were analyzed.

Results

Grade 3 or higher transaminase elevation was observed in 62 (24.0%) patients. Male sex, preoperative transaminase elevation, fatty liver, high body mass index, thickness of the lateral segment of the liver, D2 lymph node dissection, long operative duration, and high amount of blood loss were significantly associated with elevated transaminase levels in the univariable analysis. In the multivariable analysis, lateral segment thickness of the liver and operative duration were independent risk factors for postoperative elevation in transaminase levels.

Conclusion

Lateral segment thickness of the liver and operative duration were independent risk factors for transaminase elevation after laparoscopic gastrectomy using a Nathanson retractor. Although it is an easy and useful liver retractor, alternative methods of liver elevation should be considered in patients at risk of elevated postoperative liver enzyme levels.

简介：广泛应用于腹腔镜胃切除术的Nathanson肝牵开器在胃切除术后，肝脏转氨酶水平可能升高。然而，与该手术相关的肝功能障碍的危险因素尚不清楚。方法：总体而言，在2015年至2022年期间，258例连续使用Nathanson牵开器接受腹腔镜胃癌切除术的患者被分为有和没有转氨酶3级或更高不良事件通用术语标准的组。分析腹腔镜胃切除术后转氨酶升高的相关因素。结果：62例（24.0%）患者出现3级或以上转氨酶升高。单变量分析中，男性、术前转氨酶升高、脂肪肝、体重指数高、肝外侧段厚度大、D2淋巴结清扫、手术时间长、出血量大与转氨酶升高有显著相关性。在多变量分析中，肝侧段厚度和手术时间是术后转氨酶水平升高的独立危险因素。结论：肝外侧段厚度和手术时间是Nathanson牵开器腹腔镜胃切除术后转氨酶升高的独立危险因素。虽然它是一种简单而有用的肝牵开器，但对于术后肝酶水平升高的患者，应考虑其他肝抬高方法。

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引用次数: 0

Trocarless Thoracic Surgery Using the Hinotori Surgical Robot System With a Wound Retractor 使用带伤口牵开器的Hinotori手术机器人系统进行无套管针胸外科手术。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-15 DOI: 10.1111/ases.70213

Akifumi Nakamura, Ayumi Kuroda, Masaki Hashimoto, Nobuyuki Kondo, Soichiro Funaki

Introduction

The hinotori Surgical Robot System, developed by Medicaroid Corporation, is Japan's first robotic surgical assistant. As of June 1, 2024, it has been approved to be covered by insurance in the field of thoracic surgery in Japan. One of its most notable features is the software-controlled pivot point, eliminating the need for docking between the robotic arms and ports.

Materials and Surgical Technique

To fully leverage this feature, we utilized wound retractors (Lap Protector Mini Mini) at all four port sites instead of inserting trocar sleeves when we introduced the hinotori on January 10, 2025. By July 31, 2025, a total of 14 cases had been successfully completed without any intraoperative complications. Implementing this approach, we confirmed improvements in the efficiency of the roll-in process and effectively controlled bleeding at the port sites. We also enhanced the operability of the stapler, which could be inserted from all ports.

Discussion

This approach streamlines the complex setup procedures of hinotori and facilitates surgical smoothing. Additional cases and comparative studies with the conventional trocar sleeve method will be necessary to validate its clinical utility.

简介：由Medicaroid公司开发的hinotori手术机器人系统是日本第一个机器人手术助手。截至2024年6月1日，它已被批准纳入日本胸外科领域的保险范围。其最显著的特点之一是软件控制的枢轴点，消除了机器人手臂和端口之间对接的需要。材料和手术技术：为了充分利用这一特点，我们在2025年1月10日引入hinotori时，在所有四个端口部位使用了伤口牵开器（Lap Protector Mini Mini），而不是插入套管。截至2025年7月31日，共成功完成14例，无术中并发症。实施该方法后，我们证实了滚入过程效率的提高，并有效地控制了港口现场的出血。我们还提高了订书机的可操作性，它可以从所有端口插入。讨论：该方法简化了复杂的hinotori设置程序，并促进了手术平滑。需要更多的病例和与常规套管套管方法的比较研究来验证其临床应用价值。

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引用次数: 0

Renal Function Outcomes After Soft-Coagulation Versus Robot-Assisted Partial Nephrectomy 软凝与机器人辅助部分肾切除术后的肾功能预后。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-15 DOI: 10.1111/ases.70216

Ryunosuke Nakagwa, Takahiro Nohara, Taiki Kamijima, Hiroshi Kano, Tomoyuki Makino, Renato Naito, Hiroaki Iwamoto, Hiroshi Yaegashi, Kazuyoshi Shigehara, Kouji Izumi, Atsushi Mizokami

Objective

We compared renal function outcomes between soft-coagulation-assisted open partial nephrectomy using an off-clamp technique and robot-assisted partial nephrectomy with temporary clamping for localized renal tumors.

Methods

A retrospective analysis was performed on 229 patients who underwent either soft-coagulation-assisted open partial nephrectomy (n = 47) or robot-assisted partial nephrectomy (n = 182). Renal function was evaluated by the percent change in estimated glomerular filtration rate at postoperative days 1 and 7, and months 1, 3, and 12. Multivariable linear regression was used to identify predictors of renal function decline.

Results

Patients who underwent soft-coagulation-assisted open partial nephrectomy demonstrated significantly greater declines in renal function compared to those who underwent robot-assisted surgery at all evaluated time points. On postoperative day 1, the percent change in estimated glomerular filtration rate was −21.9% in the soft-coagulation group versus −11.9% in the robotic group (p = 0.0001). Similar trends were observed at postoperative day 7 (−10.2% vs. −5.4%, p = 0.027), month 1 (−12.7% vs. −5.0%, p = 0.0019), month 3 (−10.8% vs. −4.5%, p = 0.0025), and month 12 (−15.9% vs. −6.6%, p = 0.0007). Multivariable analysis revealed that robot-assisted surgery and younger age were independent predictors of better renal function preservation at 12 months.

Conclusion

Despite theoretical advantages in avoiding ischemia, soft-coagulation-assisted open partial nephrectomy resulted in greater renal function decline. Robot-assisted partial nephrectomy achieved superior preservation, likely due to enhanced surgical precision and minimized parenchymal injury.

目的：比较软凝辅助开放式非钳式肾部分切除术和机器人辅助临时钳式肾部分切除术治疗局部肾肿瘤的肾功能结局。方法：对229例行软凝辅助开放式肾部分切除术（n = 47）或机器人辅助部分切除术（n = 182）的患者进行回顾性分析。通过术后第1、7天和第1、3、12个月肾小球滤过率的百分比变化来评估肾功能。采用多变量线性回归确定肾功能下降的预测因素。结果：在所有评估时间点，接受软凝辅助开放式肾部分切除术的患者与接受机器人辅助手术的患者相比，肾功能明显下降。术后第1天，软凝组估计肾小球滤过率的百分比变化为-21.9%，而机器人组为-11.9% （p = 0.0001）。术后第7天（-10.2%比-5.4%,p = 0.027）、第1个月（-12.7%比-5.0%,p = 0.0019）、第3个月（-10.8%比-4.5%,p = 0.0025）和第12个月（-15.9%比-6.6%,p = 0.0007）也观察到类似的趋势。多变量分析显示，机器人辅助手术和年龄较小是12个月时肾功能保存较好的独立预测因素。结论：尽管软凝辅助开放式肾部分切除术在理论上具有避免缺血的优势，但其导致的肾功能下降更大。机器人辅助部分肾切除术获得了更好的保存，可能是由于提高了手术精度和最大限度地减少了实质损伤。

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引用次数: 0

Clinical Outcomes of Electrohydraulic Lithotripsy-Assisted Laparoscopic Bile Duct Stone Removal: A Retrospective Multi-Center Study From Vietnam 电液碎石辅助腹腔镜胆管结石取出的临床效果：一项来自越南的回顾性多中心研究

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-14 DOI: 10.1111/ases.70207

Pham Van Thuong, Tran Vuong The Vinh

Purposes

Managing complex bile duct stones, particularly those involving intrahepatic branches, remains a surgical challenge. Laparoscopic common bile duct exploration (LCBDE) with intraoperative flexible cholangioscopy and electrohydraulic lithotripsy (EHL) has emerged as a potential one-stage, minimally invasive alternative.

Methods

This retrospective multicenter cohort included 83 patients with choledocholithiasis or hepatolithiasis who underwent single-stage LCBDE with intraoperative cholangioscopy and EHL. The early postoperative stone-free rate was assessed by ultrasound performed within 48–72 h after surgery. For patients who underwent T-tube drainage (n = 28, 33.7%), findings from postoperative day 10–14 cholangiography were incorporated into the final analysis. Operative parameters, postoperative outcomes, and factors associated with residual stones were analyzed.

Results

The intraoperative stone clearance rate was 85.5%. Early imaging confirmed complete stone clearance in 75.9% of patients. Residual stones were most frequently associated with intrahepatic involvement (p = 0.004) and biliary duct abnormalities such as stricture or angulation (p < 0.001). The complication rate was 4.8%.

Conclusions

LCBDE with intraoperative cholangioscopy and electrohydraulic lithotripsy is a safe and effective single-stage treatment for complex bile duct stones in resource-limited settings. Broader application of this approach may reduce treatment burden and improve access to definitive biliary care.

目的处理复杂的胆管结石，特别是涉及肝内分支的胆管结石，仍然是一个外科挑战。腹腔镜胆总管探查（LCBDE）联合术中柔性胆管镜和电液碎石术（EHL）已成为一种潜在的一期微创替代方案。方法回顾性多中心队列研究纳入83例胆总管结石或肝内结石患者，均行单期LCBDE合并术中胆道镜检查和EHL。术后48 ~ 72 h超声检查术后早期结石清除率。对于行t管引流的患者（n = 28, 33.7%），术后10-14天的胆管造影结果纳入最终分析。我们分析了手术参数、术后结果和与残余结石相关的因素。结果术中结石清除率为85.5%。早期影像学证实75.9%的患者结石完全清除。残余结石最常与肝内受累（p = 0.004）和胆管异常（如狭窄或成角）相关（p < 0.001）。并发症发生率为4.8%。结论在资源有限的情况下，LCBDE联合术中胆管镜和电液碎石是一种安全有效的单期治疗复杂胆管结石的方法。广泛应用这种方法可以减轻治疗负担，提高获得最终胆道护理的机会。

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引用次数: 0

A First Case of Retroperitoneal Cavernous Hemangioma Resection With Senhance Digital Laparoscopy System 应用增强数字腹腔镜系统切除腹膜后海绵状血管瘤1例

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-14 DOI: 10.1111/ases.70210

Yoshiki Murase, Masayasu Aikawa, Yuichiro Watanabe, Taku Honma, Takuya Oba, Yumiko Kageyama, Kenichiro Takase, Yukihiro Watanabe, Hiroaki Ono, Katsuya Okada, Yasumitsu Hirano, Kojun Okamoto, Isamu Koyama

Senhance digital laparoscopy system (SDLS) is a surgical support robot featuring eye tracking control, haptic feedback, reusable instruments, and an open cockpit that has gradually gained widespread adoption in gastrointestinal surgery. However, there are no reports on the use of SDLS for retroperitoneal tumors. We present the first case of a retroperitoneal cavernous hemangioma that was successfully treated with the use of SDLS. A 61-year-old woman was referred to our hospital due to the detection of a heterogeneous 31 × 26 mm mass in the retroperitoneal area. The preoperative examination failed to confirm the diagnosis; therefore, surgical resection was performed using SDLS for definitive diagnosis and treatment. The tumor was located on the left renal vein and successfully resected without intraoperative complications. The operative time was 185 min, and the pathological examination confirmed the diagnosis of cavernous hemangioma. The SDLS enabled the safe and reliable resection of a retroperitoneal tumor.

增强数字腹腔镜系统（SDLS）是一种具有眼动跟踪控制、触觉反馈、可重复使用仪器和开放式驾驶舱的手术支持机器人，已逐渐在胃肠道手术中得到广泛采用。然而，尚无关于SDLS用于腹膜后肿瘤的报道。我们提出了第一例腹膜后海绵状血管瘤，成功地使用SDLS治疗。一名61岁女性因腹膜后区发现异质31 × 26 mm肿块而转诊至我院。术前检查未确诊；因此，手术切除使用SDLS明确诊断和治疗。肿瘤位于左肾静脉，成功切除，无术中并发症。手术时间185分钟，病理检查证实为海绵状血管瘤。SDLS能够安全可靠地切除腹膜后肿瘤。

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引用次数: 0

A Response to Commentary on the Clinical Impacts of Minimally Invasive Transperineal Abdominoperineal Resection in Crohn's Disease 微创经会阴腹会阴切除术治疗克罗恩病的临床疗效评论

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2025-12-14 DOI: 10.1111/ases.70199

Yoshitaka Kondo, Nobuhiko Kanaya, Toshiyoshi Fujiwara

引用次数: 0