This study aimed to explore the commonalities and differences in systematic lymph node dissection between lung and esophageal cancer surgeries.
Methods
A survey comprising 11 questions related to systematic lymph node dissection techniques for both lung and esophageal cancer was conducted across 265 facilities specializing in thoracic and esophageal surgeries. Additionally, a comprehensive search was performed using the MEDLINE database.
Results
Responses were received from 63 facilities specializing in thoracic surgery and 79 facilities specializing in esophageal surgery. Many facilities chose minimally invasive surgery for lung and esophageal cancer. Most thoracic and esophageal surgeons paid attention to the concepts of visceral and vascular sheaths. The results of the survey and literature review revealed the key anatomical structures that define the area of mediastinal lymph node dissection.
Conclusion
This survey and the literature review have clarified the current consensus among thoracic and esophageal surgeons regarding systematic mediastinal lymph node dissection.
{"title":"Consensus Meeting on the “Anatomy on the Border”: Systematic Thoracic Lymph Node Dissection Procedures for Lung and Esophageal Cancer","authors":"Junji Ichinose, Susumu Shibasaki, Koji Shindo, Yujin Kudo, Toshiya Abe, Kenoki Ohuchida, Hisashi Shinohara, Kazutaka Obama, Masato Watanabe, Kimihiro Shimizu, Hisashi Iwata, Hirokazu Noshiro, Norihiko Ikeda, Masafumi Nakamura, Yuko Kitagawa, Mingyon Mun, Ichiro Uyama, Koichi Suda","doi":"10.1111/ases.70186","DOIUrl":"10.1111/ases.70186","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to explore the commonalities and differences in systematic lymph node dissection between lung and esophageal cancer surgeries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A survey comprising 11 questions related to systematic lymph node dissection techniques for both lung and esophageal cancer was conducted across 265 facilities specializing in thoracic and esophageal surgeries. Additionally, a comprehensive search was performed using the MEDLINE database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Responses were received from 63 facilities specializing in thoracic surgery and 79 facilities specializing in esophageal surgery. Many facilities chose minimally invasive surgery for lung and esophageal cancer. Most thoracic and esophageal surgeons paid attention to the concepts of visceral and vascular sheaths. The results of the survey and literature review revealed the key anatomical structures that define the area of mediastinal lymph node dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This survey and the literature review have clarified the current consensus among thoracic and esophageal surgeons regarding systematic mediastinal lymph node dissection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606776","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}
The liver, lungs, and kidneys are all parenchymal organs and are useful targets for indocyanine green (ICG) fluorescence. We created a consensus statement on the appropriate use and precautions for ICG in liver, lung, and kidney surgery.
Methods
We conducted a comprehensive literature search and questionnaire survey for expert surgeons in each area.
Results
We extracted 11 articles related to the liver, 23 to the lung, and 8 to the kidney. A total of 86 facilities, 50 facilities, and 32 surgeons responded to the questionnaire survey for the liver, lung, kidney, respectively. ICG fluorescence is widely employed for segment delineation of the liver, lung, and kidney and has been reported to exhibit high efficacy. The dosage and timing greatly vary depending on the target organ and administration route. Tumor localization via ICG fluorescence is widely performed in the liver area, with numerous reports highlighting its high efficacy. Contrarily, in the lung and kidney, despite the existence of clinical studies, ICG fluorescence has not been generally performed in clinical practice. There have been no reported complications or adverse experiences related to the use of ICG agents, indicating their safety for clinical use.
Conclusion
This survey, along with a literature review, has elucidated the current consensus of liver, lung, and kidney surgeons regarding ICG fluorescence.
{"title":"Consensus Meeting of Anatomy on the Border, Appropriate Use and Precautions for ICG in Liver, Lung, and Renal Surgery","authors":"Junji Ichinose, Shinji Itoh, Shintaro Narita, Daisuke Asano, Yujin Kudo, Toshiya Abe, Kenoki Ohuchida, Keiichi Akahoshi, Go Wakabayashi, Kimihiro Shimizu, Hisashi Iwata, Atsushi Takeneka, Minoru Tanabe, Norihiko Ikeda, Masatoshi Eto, Masafumi Nakamura, Yuko Kitagawa, Tomoharu Yoshizumi, Tomonori Habuchi, Mingyon Mun","doi":"10.1111/ases.70175","DOIUrl":"10.1111/ases.70175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The liver, lungs, and kidneys are all parenchymal organs and are useful targets for indocyanine green (ICG) fluorescence. We created a consensus statement on the appropriate use and precautions for ICG in liver, lung, and kidney surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a comprehensive literature search and questionnaire survey for expert surgeons in each area.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We extracted 11 articles related to the liver, 23 to the lung, and 8 to the kidney. A total of 86 facilities, 50 facilities, and 32 surgeons responded to the questionnaire survey for the liver, lung, kidney, respectively. ICG fluorescence is widely employed for segment delineation of the liver, lung, and kidney and has been reported to exhibit high efficacy. The dosage and timing greatly vary depending on the target organ and administration route. Tumor localization via ICG fluorescence is widely performed in the liver area, with numerous reports highlighting its high efficacy. Contrarily, in the lung and kidney, despite the existence of clinical studies, ICG fluorescence has not been generally performed in clinical practice. There have been no reported complications or adverse experiences related to the use of ICG agents, indicating their safety for clinical use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This survey, along with a literature review, has elucidated the current consensus of liver, lung, and kidney surgeons regarding ICG fluorescence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606822","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}
There have been no nationwide surveys on the effectiveness of 3D images, virtual reality (VR), augmented reality (AR), and mixed reality (MR) in robotic-assisted surgery for urology. This study aimed to conduct a nationwide survey of techniques for laparoscopic and robotic 3D images, VR, AR, and MR in urology, and to propose a consensus on their effectiveness.
Material and Methods
In July 2024, the Japan Society for Endoscopic Surgery conducted an anonymous online survey to evaluate the effectiveness of 3D images, VR, AR, and MR among 44 certified laparoscopic technicians and qualified proctors in robotic surgery.
Results
Thirty-two urologists surveyed reported using 3D imaging for preoperative evaluation (84%) and to understand anatomy (75%), with 97% reporting clinical benefits and 85% indicating that it improved the quality of surgery. This widespread usage and the reported benefits of 3D imaging in urology should reassure the audience about the effectiveness of this technology. VR/AR/MR were primarily used for simulation (19%) and navigation (16%). While 63% expressed interest in these technologies, 51% reported never having used them. Among the barriers to adoption, 25% cited high cost, 24% cited the effort required for data processing, and 14% cited the difficulty of use.
Conclusion
3D images and VR/AR/MR technologies were expected to play a pivotal role in urological robotic surgery. These technologies have the potential to enhance precision and improve outcomes significantly. This study provided a comprehensive overview of the current usage status and challenges associated with these techniques.
{"title":"Clinical Practice and Survey of Three-Dimensional Images, Virtual Reality, Augmented Reality and Mixed Reality for Robotic-Assisted Surgery in Urology—“Anatomy on the Border” Expert Consensus Meeting","authors":"Satoshi Kobayashi, Daisuke Asano, Yujin Kudo, Shintaro Narita, Shuichi Morizane, Toshiya Abe, Kenoki Ohuchida, Tomonori Habuchi, Atsushi Takenaka, Go Wakabayashi, Tomoharu Yoshizumi, Keiichi Akahoshi, Norihiko Ikeda, Minoru Tanabe, Masafumi Nakamura, Yuko Kitagawa, Masatoshi Eto","doi":"10.1111/ases.70189","DOIUrl":"10.1111/ases.70189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>There have been no nationwide surveys on the effectiveness of 3D images, virtual reality (VR), augmented reality (AR), and mixed reality (MR) in robotic-assisted surgery for urology. This study aimed to conduct a nationwide survey of techniques for laparoscopic and robotic 3D images, VR, AR, and MR in urology, and to propose a consensus on their effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In July 2024, the Japan Society for Endoscopic Surgery conducted an anonymous online survey to evaluate the effectiveness of 3D images, VR, AR, and MR among 44 certified laparoscopic technicians and qualified proctors in robotic surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-two urologists surveyed reported using 3D imaging for preoperative evaluation (84%) and to understand anatomy (75%), with 97% reporting clinical benefits and 85% indicating that it improved the quality of surgery. This widespread usage and the reported benefits of 3D imaging in urology should reassure the audience about the effectiveness of this technology. VR/AR/MR were primarily used for simulation (19%) and navigation (16%). While 63% expressed interest in these technologies, 51% reported never having used them. Among the barriers to adoption, 25% cited high cost, 24% cited the effort required for data processing, and 14% cited the difficulty of use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>3D images and VR/AR/MR technologies were expected to play a pivotal role in urological robotic surgery. These technologies have the potential to enhance precision and improve outcomes significantly. This study provided a comprehensive overview of the current usage status and challenges associated with these techniques.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606838","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}
In recent years, the practical application of remote robotic surgery has become a reality, and is expected to be applied to difficult surgeries. The purpose of this study is to demonstrate whether the pancreaticojejunostomy in a pancreaticoduodenectomy, a difficult surgery, can be performed through a remote surgery-assisted robotic operation, as well as to verify the feasibility of remote surgery-assisted pancreaticojejunostomy.
Methods
Hirosaki city and Goshogawara city (about 30 km) were connected via a commercial communication line using the hinotori surgical robot, and five surgeons performed remote surgery on an artificial organ model for pancreaticojejunostomy. Four local surgeons were instructed remotely. Each procedure was repeated 3–5 times in sets of 8 min, and communication latency, Image Quality Score, System Usability Scale (mSUS), and Robot Usability Score were all evaluated.
Results
The communication latency was stable at less than 12 msec, and there were no problems in performing the surgery. No significant differences were noted in Image Quality Score, System Usability Scale (mSUS), or Robot Usability Score. Pancreaticojejunostomy was performed using the Blumgart anastomosis technique, and all procedures were completed without any issues.
Conclusion
We demonstrated that pancreaticojejunostomy can be performed in a telesurgical environment. This system can be applied to remote surgical guidance and support in the future and it is expected to correct regional disparities in medical care, improve surgical education, and enhance the implementation of remote surgery in society.
{"title":"The Feasibility of Telerobotic Pancreaticojejunostomy Using a Surgical Robot: A Pilot Study With Commercial Optical Networks","authors":"Yusuke Wakasa, Kenichi Hakamada, Hajime Morohashi, Kazuki Yokoyama, Yuma Ebihara, Satoshi Hirano, Eiji Oki, Norihiko Ikeda, Akinobu Taketomi, Masaki Mori","doi":"10.1111/ases.70181","DOIUrl":"10.1111/ases.70181","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In recent years, the practical application of remote robotic surgery has become a reality, and is expected to be applied to difficult surgeries. The purpose of this study is to demonstrate whether the pancreaticojejunostomy in a pancreaticoduodenectomy, a difficult surgery, can be performed through a remote surgery-assisted robotic operation, as well as to verify the feasibility of remote surgery-assisted pancreaticojejunostomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Hirosaki city and Goshogawara city (about 30 km) were connected via a commercial communication line using the hinotori surgical robot, and five surgeons performed remote surgery on an artificial organ model for pancreaticojejunostomy. Four local surgeons were instructed remotely. Each procedure was repeated 3–5 times in sets of 8 min, and communication latency, Image Quality Score, System Usability Scale (mSUS), and Robot Usability Score were all evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The communication latency was stable at less than 12 msec, and there were no problems in performing the surgery. No significant differences were noted in Image Quality Score, System Usability Scale (mSUS), or Robot Usability Score. Pancreaticojejunostomy was performed using the Blumgart anastomosis technique, and all procedures were completed without any issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We demonstrated that pancreaticojejunostomy can be performed in a telesurgical environment. This system can be applied to remote surgical guidance and support in the future and it is expected to correct regional disparities in medical care, improve surgical education, and enhance the implementation of remote surgery in society.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12640768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588784","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}
Although mediastinal lymph node dissection is performed in both lung and esophageal cancer surgeries, the underlying concepts and indications may differ between these fields. This study aimed to clarify these differences through a nationwide questionnaire survey initiated by the 37th Annual Meeting of the Japan Society for Endoscopic Surgery.
Methods
A joint task force from the lung and esophageal surgery divisions developed a questionnaire focusing on four key areas: (i) lymph node dissection around the left recurrent nerve, (ii) subcarinal lymph node dissection, (iii) pulmonary ligament lymph node dissection, and (iv) en bloc lymph node dissection. The survey was distributed to certified core institutions across Japan.
Results
The response rates were 50.4% for lung cancer institutions and 57.0% for esophageal cancer institutions. In the esophageal division, dissection of the aforementioned lymph nodes was routinely performed in most core institutions. In contrast, practices in the lung division varied widely, particularly depending on tumor location. The concept of “sampling” was rarely recognized in esophageal surgery but was partially accepted in lung surgery. Furthermore, there was no uniform definition of “en bloc dissection” across either field.
Conclusion
This cross-sectional survey revealed notable conceptual differences between lung and esophageal cancer divisions regarding mediastinal lymph node dissection, despite targeting the same anatomical regions. Additionally, significant variability was observed even within the lung division. These findings indicate a lack of standardized consensus in Japan and highlight the need for ongoing cross-disciplinary dialog and consensus building.
{"title":"Cross-Sectional Survey on Mediastinal Lymph Node Dissection in Lung and Esophageal Cancer: A Project of the Anatomy of the Border Consensus Meeting at the 37th Annual Meeting of the Japan Society for Endoscopic Surgery","authors":"Kentaro Miura, Koji Shindo, Yukihiro Terada, Toshiya Abe, Kenoki Ohuchida, Koichi Suda, Mingyon Mun, Kazutaka Obama, Masato Watanabe, Hisashi Iwata, Hisashi Shinohara, Ichiro Uyama, Hirokazu Noshiro, Norihiko Ikeda, Masafumi Nakamura, Yuko Kitagawa, Kimihiro Shimizu","doi":"10.1111/ases.70187","DOIUrl":"10.1111/ases.70187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although mediastinal lymph node dissection is performed in both lung and esophageal cancer surgeries, the underlying concepts and indications may differ between these fields. This study aimed to clarify these differences through a nationwide questionnaire survey initiated by the 37th Annual Meeting of the Japan Society for Endoscopic Surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A joint task force from the lung and esophageal surgery divisions developed a questionnaire focusing on four key areas: (i) lymph node dissection around the left recurrent nerve, (ii) subcarinal lymph node dissection, (iii) pulmonary ligament lymph node dissection, and (iv) en bloc lymph node dissection. The survey was distributed to certified core institutions across Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The response rates were 50.4% for lung cancer institutions and 57.0% for esophageal cancer institutions. In the esophageal division, dissection of the aforementioned lymph nodes was routinely performed in most core institutions. In contrast, practices in the lung division varied widely, particularly depending on tumor location. The concept of “sampling” was rarely recognized in esophageal surgery but was partially accepted in lung surgery. Furthermore, there was no uniform definition of “en bloc dissection” across either field.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This cross-sectional survey revealed notable conceptual differences between lung and esophageal cancer divisions regarding mediastinal lymph node dissection, despite targeting the same anatomical regions. Additionally, significant variability was observed even within the lung division. These findings indicate a lack of standardized consensus in Japan and highlight the need for ongoing cross-disciplinary dialog and consensus building.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12640797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588705","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}
Gastric gastrointestinal stromal tumors are generally treated via local resection. Single-incision laparoscopic surgery has recently been reported as minimally invasive surgery. This study aimed to evaluate the safety and short-term and long-term outcomes of single incision laparoscopic local resection compared with those of multiport laparoscopic local resection for gastric gastrointestinal stromal tumors with extraluminal growth.
Methods
Laparoscopic local resection of the stomach was used for 71 patients with gastric gastrointestinal stromal tumors between January 2010 and March 2025 at Wakayama Medical University Hospital. Short-term and long-term outcomes were compared between those who underwent single incision laparoscopic local resection and those who underwent multiport laparoscopic local resection.
Results
Single incision laparoscopic local resection and multiport laparoscopic local resection were performed for 24 and 47 patients, respectively. Patient characteristics including tumor location and tumor size were not significantly different between the two groups. Further, there was no significant difference in operation time, blood loss, time to oral intake, postoperative hospital stays, or risk classification of recurrence. The postoperative max CRP of the single incision laparoscopic local resection group was significantly lower than that of the multiport laparoscopic local resection group. No postoperative complications were found in those who underwent single incision laparoscopic local resection. There was no recurrence in those who underwent single incision laparoscopic local resection, but two patients who underwent multiport laparoscopic local resection had recurrences: one with liver metastasis, the other with peritoneal metastasis.
Conclusion
Single incision laparoscopic local resection is considered to be a safe and feasible surgical technique for gastric gastrointestinal stromal tumors with extraluminal growth. Furthermore, long-term outcomes were also acceptable.
{"title":"Single Incision Laparoscopic Local Resection for Gastric Gastrointestinal Stromal Tumors Compared to Multiport Laparoscopic Local Resection: A Single-Center Retrospective Study","authors":"Shotaro Nagano, Junya Kitadani, Keiji Hayata, Taro Goda, Shinta Tominaga, Naoki Fukuda, Tomoki Nakai, Manabu Kawai","doi":"10.1111/ases.70191","DOIUrl":"10.1111/ases.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gastric gastrointestinal stromal tumors are generally treated via local resection. Single-incision laparoscopic surgery has recently been reported as minimally invasive surgery. This study aimed to evaluate the safety and short-term and long-term outcomes of single incision laparoscopic local resection compared with those of multiport laparoscopic local resection for gastric gastrointestinal stromal tumors with extraluminal growth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Laparoscopic local resection of the stomach was used for 71 patients with gastric gastrointestinal stromal tumors between January 2010 and March 2025 at Wakayama Medical University Hospital. Short-term and long-term outcomes were compared between those who underwent single incision laparoscopic local resection and those who underwent multiport laparoscopic local resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Single incision laparoscopic local resection and multiport laparoscopic local resection were performed for 24 and 47 patients, respectively. Patient characteristics including tumor location and tumor size were not significantly different between the two groups. Further, there was no significant difference in operation time, blood loss, time to oral intake, postoperative hospital stays, or risk classification of recurrence. The postoperative max CRP of the single incision laparoscopic local resection group was significantly lower than that of the multiport laparoscopic local resection group. No postoperative complications were found in those who underwent single incision laparoscopic local resection. There was no recurrence in those who underwent single incision laparoscopic local resection, but two patients who underwent multiport laparoscopic local resection had recurrences: one with liver metastasis, the other with peritoneal metastasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Single incision laparoscopic local resection is considered to be a safe and feasible surgical technique for gastric gastrointestinal stromal tumors with extraluminal growth. Furthermore, long-term outcomes were also acceptable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565832","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}
Inguinal hernia (IH) occurs relatively frequently after radical prostatectomy (RP) and can impair patients' quality of life. In recent years, most RPs in Japan have been performed robotically; however, strategies for preventing postoperative IH remain diverse and are not clearly defined.
Methods
In July 2024, the Japan Society for Endoscopic Surgery conducted an anonymous, web-based survey of 114 members of the Japanese Urological Association to assess intraoperative IH prevention practices during RP. Twenty-seven urologists responded (response rate: 24%), providing information on their clinical experience, estimated IH incidence, recognized risk factors, and prevention techniques.
Results
Most respondents were highly experienced: 85% had more than 20 years of practice, 78% had performed over 100 RPs, and 96% routinely used robotic surgery. Seventy-four percent identified both patient- and surgeon-related factors as contributors to IH, and 52% estimated the incidence of IH to be 5%–10%. Preventive measures were used routinely by 22% of respondents, selectively by 33%, and not at all by 45%. Common preventive techniques included ligation and transection of the patent processus vaginalis with peritoneal closure (89%), mobilization of the vas deferens and spermatic cord (70%), and circumferential incision of the internal inguinal ring (70%). Mesh reinforcement was rarely employed (4%), although 74% reported documenting IH risk in the informed consent process.
Conclusions
Despite limited high-level evidence, Japanese urologists implement diverse intraoperative IH prevention strategies during RP. Prospective multicenter studies and standardized protocols are needed to validate these techniques and reduce postoperative IH rates.
{"title":"Current Practices for Preventing Inguinal Hernia During Radical Prostatectomy: Findings From the “Anatomy on the Border” Consensus Survey by the Japan Society for Endoscopic Surgery","authors":"Shuichi Morizane, Satoshi Kobayashi, Shintaro Narita, Kei Fujii, Toshiya Abe, Kenoki Ohuchida, Masatoshi Eto, Tomonori Habuchi, Toru Eguchi, Masafumi Nakamura, Yuko Kitagawa, Atsushi Takenaka","doi":"10.1111/ases.70185","DOIUrl":"10.1111/ases.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Inguinal hernia (IH) occurs relatively frequently after radical prostatectomy (RP) and can impair patients' quality of life. In recent years, most RPs in Japan have been performed robotically; however, strategies for preventing postoperative IH remain diverse and are not clearly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In July 2024, the Japan Society for Endoscopic Surgery conducted an anonymous, web-based survey of 114 members of the Japanese Urological Association to assess intraoperative IH prevention practices during RP. Twenty-seven urologists responded (response rate: 24%), providing information on their clinical experience, estimated IH incidence, recognized risk factors, and prevention techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most respondents were highly experienced: 85% had more than 20 years of practice, 78% had performed over 100 RPs, and 96% routinely used robotic surgery. Seventy-four percent identified both patient- and surgeon-related factors as contributors to IH, and 52% estimated the incidence of IH to be 5%–10%. Preventive measures were used routinely by 22% of respondents, selectively by 33%, and not at all by 45%. Common preventive techniques included ligation and transection of the patent processus vaginalis with peritoneal closure (89%), mobilization of the vas deferens and spermatic cord (70%), and circumferential incision of the internal inguinal ring (70%). Mesh reinforcement was rarely employed (4%), although 74% reported documenting IH risk in the informed consent process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite limited high-level evidence, Japanese urologists implement diverse intraoperative IH prevention strategies during RP. Prospective multicenter studies and standardized protocols are needed to validate these techniques and reduce postoperative IH rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565797","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}
Postoperative incisional hernia impairs patients' quality of life and may require surgical intervention. This study investigated the risk of incisional hernia following laparoscopic colorectal cancer surgery.
Methods
In total, 199 patients who underwent laparoscopic colorectal cancer surgery were enrolled in this retrospective single-center study. The patients were divided into the no incisional hernia group (n = 185) and the incisional hernia group (n = 9). Subcutaneous fat area (SFA) and visceral fat area (VFA) at the level of the umbilicus were measured using specialized computed tomography imaging software. Data from an additional 78 patients who underwent laparoscopic colorectal cancer surgery in another hospital were used as a validation cohort.
Results
Nine patients (4.6%) were diagnosed with incisional hernia. Body mass index, SFA, and VFA were significantly higher in the hernia group than in the non-hernia group (p = 0.04, 0.004, and 0.03, respectively). In the multivariate analysis, only SFA of ≥ 167.8 cm2 remained an independent risk factor (odds ratio: 7.73, 95% confidence interval: 1.31–45.8, p = 0.02). Subcutaneous fat thickness (SFT), which can be easily measured on routine computed tomography scans, showed a strong correlation with SFA (coefficient = 0.779, p < 0.001) and was also significantly associated with incisional hernia. This association was validated in an independent cohort.
Conclusion
High SFA was an independent risk factor for incisional hernia following laparoscopic colorectal cancer surgery. SFT may serve as a practical surrogate for SFA.
{"title":"Subcutaneous Fat, Not Visceral Fat, as a Risk Factor for Incisional Hernia After Laparoscopic Colorectal Cancer Surgery","authors":"Kumiko Sekiguchi, Akihisa Matsuda, Takeshi Yamada, Satoshi Matsumoto, Keisuke Minamimura, Youichi Kawano, Takeshi Matsutani, Hiroshi Maruyama, Nobuhiko Taniai, Yoshiharu Nakamura, Hiroshi Yoshida","doi":"10.1111/ases.70190","DOIUrl":"10.1111/ases.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Postoperative incisional hernia impairs patients' quality of life and may require surgical intervention. This study investigated the risk of incisional hernia following laparoscopic colorectal cancer surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In total, 199 patients who underwent laparoscopic colorectal cancer surgery were enrolled in this retrospective single-center study. The patients were divided into the no incisional hernia group (<i>n</i> = 185) and the incisional hernia group (<i>n</i> = 9). Subcutaneous fat area (SFA) and visceral fat area (VFA) at the level of the umbilicus were measured using specialized computed tomography imaging software. Data from an additional 78 patients who underwent laparoscopic colorectal cancer surgery in another hospital were used as a validation cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine patients (4.6%) were diagnosed with incisional hernia. Body mass index, SFA, and VFA were significantly higher in the hernia group than in the non-hernia group (<i>p</i> = 0.04, 0.004, and 0.03, respectively). In the multivariate analysis, only SFA of ≥ 167.8 cm<sup>2</sup> remained an independent risk factor (odds ratio: 7.73, 95% confidence interval: 1.31–45.8, <i>p</i> = 0.02). Subcutaneous fat thickness (SFT), which can be easily measured on routine computed tomography scans, showed a strong correlation with SFA (coefficient = 0.779, <i>p</i> < 0.001) and was also significantly associated with incisional hernia. This association was validated in an independent cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>High SFA was an independent risk factor for incisional hernia following laparoscopic colorectal cancer surgery. SFT may serve as a practical surrogate for SFA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565859","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}
Inguinal hernia is a common complication following radical prostatectomy, yet preventive and therapeutic strategies remain inconsistent across specialties.
Methods
Clinical questions addressing etiology, prevention, and treatment were developed through a literature review and a nationwide survey of general surgeons and urologists. Consensus recommendations were subsequently refined using the Delphi method by an expert panel.
Results
Among respondents, 66% managed more than 101 hernia cases annually, and 85% had over 20 years of surgical experience. Surgeons primarily emphasized the transversalis fascia (91%) and preperitoneal fascia (65%), whereas urologists focused on the flank pad (70%) and lateroconal fascia (67%). Most surgeons (84%) identified an association between radical prostatectomy and subsequent hernia formation, with urologists attributing causation to both patient-related and surgical factors. Repair after prostatectomy was mainly performed by open anterior approaches (80%), whereas laparoscopic transabdominal preperitoneal repair (TAPP) (20%) was less common and frequently perceived as challenging. Nearly half of respondents preferred leaving a dilated internal ring untreated, while 43% reported that preoperative hernia required no consultation. Simultaneous repair at the time of prostatectomy was rare (15%), and 72% considered prophylactic intervention unnecessary. Based on these findings, a clinical question and recommendation were formulated and, in the final Delphi round, unanimously endorsed with 100% agreement among experts.
Conclusion
Marked specialty-based differences in perception and practice were observed. Evidence for prophylactic or simultaneous repair remains insufficient. Anterior mesh repair, or laparoscopic repair by experienced surgeons, is recommended. This consensus underscores the importance of interdisciplinary collaboration and evidence-based management of post-prostatectomy inguinal hernia.
{"title":"Consensus Statement on the Management of Inguinal Hernias Following Radical Prostatectomy: A Delphi-Based Expert Panel Report From Anatomy on the Border (AOB) at the 37th Annual Meeting of the Japan Society for Endoscopic Surgery","authors":"Kei Fujii, Taketo Matsubara, Takuya Saito, Shunsuke Hayakawa, Shuichi Morizane, Toshiya Abe, Kenoki Ohuchida, Yo Kawarada, Nozomi Ueno, Tetsushi Hayakawa, Masafumi Nakamura, Yuko Kitagawa, Atsushi Takenaka, Toru Eguchi","doi":"10.1111/ases.70183","DOIUrl":"10.1111/ases.70183","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Inguinal hernia is a common complication following radical prostatectomy, yet preventive and therapeutic strategies remain inconsistent across specialties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical questions addressing etiology, prevention, and treatment were developed through a literature review and a nationwide survey of general surgeons and urologists. Consensus recommendations were subsequently refined using the Delphi method by an expert panel.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among respondents, 66% managed more than 101 hernia cases annually, and 85% had over 20 years of surgical experience. Surgeons primarily emphasized the transversalis fascia (91%) and preperitoneal fascia (65%), whereas urologists focused on the flank pad (70%) and lateroconal fascia (67%). Most surgeons (84%) identified an association between radical prostatectomy and subsequent hernia formation, with urologists attributing causation to both patient-related and surgical factors. Repair after prostatectomy was mainly performed by open anterior approaches (80%), whereas laparoscopic transabdominal preperitoneal repair (TAPP) (20%) was less common and frequently perceived as challenging. Nearly half of respondents preferred leaving a dilated internal ring untreated, while 43% reported that preoperative hernia required no consultation. Simultaneous repair at the time of prostatectomy was rare (15%), and 72% considered prophylactic intervention unnecessary. Based on these findings, a clinical question and recommendation were formulated and, in the final Delphi round, unanimously endorsed with 100% agreement among experts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Marked specialty-based differences in perception and practice were observed. Evidence for prophylactic or simultaneous repair remains insufficient. Anterior mesh repair, or laparoscopic repair by experienced surgeons, is recommended. This consensus underscores the importance of interdisciplinary collaboration and evidence-based management of post-prostatectomy inguinal hernia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534699","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}
An 86-year-old woman presented with repeated vomiting and hematemesis. Imaging revealed extensive mediastinal food debris accumulation, diagnosing spontaneous esophageal perforation. CT showed debris predominantly in the anterior-right mediastinum around the esophagogastric junction, with minimal bilateral pleural effusion. Upper gastrointestinal contrast study demonstrated luminal contrast extravasation without thoracic or abdominal extension. Additional history from family members revealed that the patient had been previously diagnosed with a hiatal hernia by a physician. Given stable conditions, we hypothesized that the perforation was contained within the hernia sac and selected a transhiatal approach. Intraoperatively, an approximately 5-cm longitudinal tear across the esophagogastric junction was identified and successfully repaired with drainage utilizing the hiatal hernia space. Unlike typical esophageal perforation progressing to severe left-sided empyema, this case's hiatal hernia created lax esophageal adventitia, distributing pressure into the hernia sac and preventing thoracic or abdominal perforation.
{"title":"Successful Transhiatal Repair of Spontaneous Esophagogastric Junction Perforation Contained Within a Hiatal Hernia Sac: A Case Report","authors":"Eiichiro Nakao, Yasunori Kurahashi, Motoki Murakami, Shugo Kohno, Yudai Hojo, Tatsuro Nakamura, Yoshinori Ishida, Hisashi Shinohara","doi":"10.1111/ases.70188","DOIUrl":"10.1111/ases.70188","url":null,"abstract":"<p>An 86-year-old woman presented with repeated vomiting and hematemesis. Imaging revealed extensive mediastinal food debris accumulation, diagnosing spontaneous esophageal perforation. CT showed debris predominantly in the anterior-right mediastinum around the esophagogastric junction, with minimal bilateral pleural effusion. Upper gastrointestinal contrast study demonstrated luminal contrast extravasation without thoracic or abdominal extension. Additional history from family members revealed that the patient had been previously diagnosed with a hiatal hernia by a physician. Given stable conditions, we hypothesized that the perforation was contained within the hernia sac and selected a transhiatal approach. Intraoperatively, an approximately 5-cm longitudinal tear across the esophagogastric junction was identified and successfully repaired with drainage utilizing the hiatal hernia space. Unlike typical esophageal perforation progressing to severe left-sided empyema, this case's hiatal hernia created lax esophageal adventitia, distributing pressure into the hernia sac and preventing thoracic or abdominal perforation.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534843","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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