Anastomotic leakage is a major complication after low anterior resection for rectal cancer, particularly in transanal total mesorectal excision (taTME) cases, where the low anastomotic level makes conventional leak testing difficult. We developed a novel leak test using the AirSeal system to improve intraoperative detection of leakage in such cases.
Materials and Surgical Technique
This technique was applied in patients undergoing low anterior resection combined with taTME for lower rectal cancer within 10 cm of the anal verge, reconstructed using the single-stapling technique. After anastomosis, the AirSeal system was set to a flow rate of 20 L/min and a pressure of 8 mmHg, while laparoscopic intra-abdominal pressure was maintained at 10–12 mmHg. The pelvic cavity was filled with saline, and the anastomosis was inspected for air or water column leakage.
Discussion
The AirSeal-assisted leak test may be helpful for reliable intraoperative identification of anastomotic leakage by utilizing a controlled pressure differential. It may facilitate the prevention of leakage and stenosis, warranting further prospective validation.
{"title":"Usefulness of AirSeal Leak Test for taTME-Assisted Surgery for Lower Rectal Cancer","authors":"Yume Minagawa, Yasumitsu Hirano, Sohei Akuta, Akihito Nakanishi, Yusuke Nishi, Hisashi Hayashi, Takatsugu Fujii, Yasuhiro Ishiyama, Chikashi Hiranuma","doi":"10.1111/ases.70176","DOIUrl":"10.1111/ases.70176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Anastomotic leakage is a major complication after low anterior resection for rectal cancer, particularly in transanal total mesorectal excision (taTME) cases, where the low anastomotic level makes conventional leak testing difficult. We developed a novel leak test using the AirSeal system to improve intraoperative detection of leakage in such cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>This technique was applied in patients undergoing low anterior resection combined with taTME for lower rectal cancer within 10 cm of the anal verge, reconstructed using the single-stapling technique. After anastomosis, the AirSeal system was set to a flow rate of 20 L/min and a pressure of 8 mmHg, while laparoscopic intra-abdominal pressure was maintained at 10–12 mmHg. The pelvic cavity was filled with saline, and the anastomosis was inspected for air or water column leakage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The AirSeal-assisted leak test may be helpful for reliable intraoperative identification of anastomotic leakage by utilizing a controlled pressure differential. It may facilitate the prevention of leakage and stenosis, warranting further prospective validation.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534803","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}
Masaya Yamoto, Ken Suzuki, Shuto Ikeda, Shohei Kishida, Marie Todo, Yuichi Takama, Masafumi Kamiyama
Introduction
Sacrococcygeal teratoma (SCT) is the most common neonatal tumor, and complete resection including the coccyx is the standard treatment. Although a combined abdominosacral approach has been traditionally used for Altman type II–III lesions, the use of laparoscopy as an adjunct to facilitate dissection and improve cosmetic outcomes has been reported in a limited number of cases.
Materials and Surgical Technique
We report a full-term male neonate with an Altman type II SCT measuring approximately 7 cm in maximal diameter, composed of both cystic and solid components. On day 6 of life, a laparoscopic-assisted abdominosacral resection was performed. Laparoscopy allowed safe mobilization of the tumor from the cranial side within the abdominal cavity, while the sacral approach enabled complete en bloc excision with the coccyx. The specimen was diagnosed as immature teratoma, Grade I. The postoperative course was uneventful, and the cosmetic result was excellent.
Discussion
Laparoscopic-assisted abdominosacral resection offers a minimally invasive and cosmetically favorable alternative for selected SCT cases, enabling safe circumferential dissection while minimizing large abdominal or sacral incisions.
{"title":"Laparoscopic-Assisted Abdominosacral Resection for Altman Type II Sacrococcygeal Teratoma in a Neonate","authors":"Masaya Yamoto, Ken Suzuki, Shuto Ikeda, Shohei Kishida, Marie Todo, Yuichi Takama, Masafumi Kamiyama","doi":"10.1111/ases.70179","DOIUrl":"10.1111/ases.70179","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Sacrococcygeal teratoma (SCT) is the most common neonatal tumor, and complete resection including the coccyx is the standard treatment. Although a combined abdominosacral approach has been traditionally used for Altman type II–III lesions, the use of laparoscopy as an adjunct to facilitate dissection and improve cosmetic outcomes has been reported in a limited number of cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>We report a full-term male neonate with an Altman type II SCT measuring approximately 7 cm in maximal diameter, composed of both cystic and solid components. On day 6 of life, a laparoscopic-assisted abdominosacral resection was performed. Laparoscopy allowed safe mobilization of the tumor from the cranial side within the abdominal cavity, while the sacral approach enabled complete en bloc excision with the coccyx. The specimen was diagnosed as immature teratoma, Grade I. The postoperative course was uneventful, and the cosmetic result was excellent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Laparoscopic-assisted abdominosacral resection offers a minimally invasive and cosmetically favorable alternative for selected SCT cases, enabling safe circumferential dissection while minimizing large abdominal or sacral incisions.</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":"145534796","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}
Trung Hieu Le, Van Quang Vu, Van Thanh Le, Manh Thang Tran, Thanh Nghi Le, Van Duong Bui, Van Quynh Nguyen
Introduction
Situs inversus totalis (SIT) is a rare congenital anomaly in which thoracic and abdominal organs are mirrored from normal positions. Hepatolithiasis, common in East and Southeast Asia, often requires hepatectomy for localized disease with parenchymal atrophy. Laparoscopic approaches in SIT patients are challenging due to reversed anatomy and ergonomics. This report presents the first case of laparoscopic anatomical left hepatectomy for hepatolithiasis in a SIT patient, guided by the dilated bile duct and middle hepatic vein.
Materials and Surgical Technique
A 57-year-old woman with SIT presented with recurrent cholangitis. Imaging showed multiple intrahepatic stones, strictures, and severe left liver atrophy, indicating localized disease. Laparoscopic left hepatectomy was performed with adaptations: mirrored trocar placement, French positioning, and dissection using the dilated bile duct and middle hepatic vein as anatomical landmarks. The procedure ensured safe navigation of mirror-image anatomy.
Discussion
The surgery was completed with minimal blood loss and no complications; the patient was discharged on postoperative day six and remained asymptomatic at follow-up. This case highlights that meticulous preoperative planning, ergonomic adjustments, and bile duct–oriented resection enable safe laparoscopic hepatectomy in SIT, achieving complete stone clearance and reducing recurrence risk in complex hepatolithiasis scenarios.
{"title":"Laparoscopic Anatomical Left Hepatectomy Guided by the Dilated Bile Duct and Middle Hepatic Vein for Hepaticolithiasis in a Patient With Situs Inversus Totalis: How I Do It","authors":"Trung Hieu Le, Van Quang Vu, Van Thanh Le, Manh Thang Tran, Thanh Nghi Le, Van Duong Bui, Van Quynh Nguyen","doi":"10.1111/ases.70180","DOIUrl":"10.1111/ases.70180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Situs inversus totalis (SIT) is a rare congenital anomaly in which thoracic and abdominal organs are mirrored from normal positions. Hepatolithiasis, common in East and Southeast Asia, often requires hepatectomy for localized disease with parenchymal atrophy. Laparoscopic approaches in SIT patients are challenging due to reversed anatomy and ergonomics. This report presents the first case of laparoscopic anatomical left hepatectomy for hepatolithiasis in a SIT patient, guided by the dilated bile duct and middle hepatic vein.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>A 57-year-old woman with SIT presented with recurrent cholangitis. Imaging showed multiple intrahepatic stones, strictures, and severe left liver atrophy, indicating localized disease. Laparoscopic left hepatectomy was performed with adaptations: mirrored trocar placement, French positioning, and dissection using the dilated bile duct and middle hepatic vein as anatomical landmarks. The procedure ensured safe navigation of mirror-image anatomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The surgery was completed with minimal blood loss and no complications; the patient was discharged on postoperative day six and remained asymptomatic at follow-up. This case highlights that meticulous preoperative planning, ergonomic adjustments, and bile duct–oriented resection enable safe laparoscopic hepatectomy in SIT, achieving complete stone clearance and reducing recurrence risk in complex hepatolithiasis scenarios.</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":"145534824","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}
This study aimed to update the literature and present findings from a national survey on the current use and perceived utility of indocyanine green (ICG) fluorescence imaging in laparoscopic and robotic kidney surgeries, as discussed at the Consensus Meeting on Anatomy on the Border.
Methods
This study consisted of two parts. First, a narrative review of previous studies on ICG application in kidney surgeries was conducted. Second, a questionnaire for urologists certified in laparoscopic surgery was created to evaluate current practices regarding ICG usage.
Results
Nine studies on ICG use in partial nephrectomy were reviewed. The sole randomized controlled trial (RCT) found no significant benefit of ICG-guided robotic-assisted partial nephrectomy (RAPN), although the majority of observational studies suggested potential advantages. The lack of methodological standardization remains a major barrier to its wider implementation. Of the 114 urologists contacted, 32 (28%) responded, most of whom had over 20 years of surgical experience. Among the respondents, 31% reported using ICG in renal surgeries: 20% used it exclusively in RAPN, 60% in RAPN in combination with other procedures, and 20% in other surgeries. The dosing varied, but over half of the respondents used 12.5 mg per injection.
Conclusion
Although observational data indicate the potential utility of ICG in renal surgery, the RCT finding is inconclusive, and its current use among urologists remains limited. Nevertheless, ICG holds promise for a broader application in urological procedures.
{"title":"Details and Updates From the Consensus Meeting on Anatomical Borders for ICG Usage in Urological Laparoscopic and Robotic Kidney Surgery","authors":"Shintaro Narita, Junji Ichinose, Shinji Itoh, Satoshi Kobayashi, Shuichi Morizane, Daisuke Asano, Yujin Kudo, Toshiya Abe, Kenoki Ohuchida, Keiichi Akahoshi, Go Wakabayashi, Kimihiro Shimizu, Hisashi Iwata, Atsushi Takeneka, Minoru Tanabe, Masatoshi Eto, Norihiko Ikeda, Masafumi Nakamura, Yuko Kitagawa, Tomoharu Yoshizumi, Mingyon Mun, Tomonori Habuchi","doi":"10.1111/ases.70184","DOIUrl":"10.1111/ases.70184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study aimed to update the literature and present findings from a national survey on the current use and perceived utility of indocyanine green (ICG) fluorescence imaging in laparoscopic and robotic kidney surgeries, as discussed at the Consensus Meeting on Anatomy on the Border.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study consisted of two parts. First, a narrative review of previous studies on ICG application in kidney surgeries was conducted. Second, a questionnaire for urologists certified in laparoscopic surgery was created to evaluate current practices regarding ICG usage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine studies on ICG use in partial nephrectomy were reviewed. The sole randomized controlled trial (RCT) found no significant benefit of ICG-guided robotic-assisted partial nephrectomy (RAPN), although the majority of observational studies suggested potential advantages. The lack of methodological standardization remains a major barrier to its wider implementation. Of the 114 urologists contacted, 32 (28%) responded, most of whom had over 20 years of surgical experience. Among the respondents, 31% reported using ICG in renal surgeries: 20% used it exclusively in RAPN, 60% in RAPN in combination with other procedures, and 20% in other surgeries. The dosing varied, but over half of the respondents used 12.5 mg per injection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although observational data indicate the potential utility of ICG in renal surgery, the RCT finding is inconclusive, and its current use among urologists remains limited. Nevertheless, ICG holds promise for a broader application in urological procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507767","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}
Rectal gastrointestinal stromal tumors (GISTs) are rare and pose significant surgical challenges due to anatomical constraints and the need to preserve anorectal and urinary functions. Local excision is generally avoided for tumors ≥ 5 cm due to concerns over margin positivity and recurrence. We report a case of a 76-year-old woman with a 5-cm rectal GIST on the right posterior wall, successfully resected using transanal minimally invasive surgery (TAMIS) alone. R0 resection was achieved without complications. The patient did not receive neoadjuvant imatinib due to the feasibility of primary surgical resection. Histology confirmed a c-kit and CD34-positive GIST. This case highlights that TAMIS allows safe and complete local excision of large rectal GISTs with excellent visualization and function preservation. Additionally, it demonstrates the potential of TAMIS in cases where imatinib is ineffective or contraindicated. Although the tumor involved approximately 40% of the rectal circumference, primary closure was successfully performed by adjusting insufflation pressure. These findings suggest that TAMIS may be applicable beyond conventional size and circumferential criteria, especially when combined with readiness to convert to TaTME if needed.
{"title":"Local Excision of a 5-cm Rectal Gastrointestinal Stromal Tumor Using Transanal Minimally Invasive Surgery (TAMIS): A Case Report","authors":"Yoshihisa Watanuki, Takashi Mori, Yuki Nakamura, Atsuhiko Ochi, Kodai Taguchi, Shun Sato, Takanori Nishimura, Yusuke Suka, Masaki Ogawa, Motoki Nagai","doi":"10.1111/ases.70177","DOIUrl":"10.1111/ases.70177","url":null,"abstract":"<div>\u0000 \u0000 <p>Rectal gastrointestinal stromal tumors (GISTs) are rare and pose significant surgical challenges due to anatomical constraints and the need to preserve anorectal and urinary functions. Local excision is generally avoided for tumors ≥ 5 cm due to concerns over margin positivity and recurrence. We report a case of a 76-year-old woman with a 5-cm rectal GIST on the right posterior wall, successfully resected using transanal minimally invasive surgery (TAMIS) alone. R0 resection was achieved without complications. The patient did not receive neoadjuvant imatinib due to the feasibility of primary surgical resection. Histology confirmed a c-kit and CD34-positive GIST. This case highlights that TAMIS allows safe and complete local excision of large rectal GISTs with excellent visualization and function preservation. Additionally, it demonstrates the potential of TAMIS in cases where imatinib is ineffective or contraindicated. Although the tumor involved approximately 40% of the rectal circumference, primary closure was successfully performed by adjusting insufflation pressure. These findings suggest that TAMIS may be applicable beyond conventional size and circumferential criteria, especially when combined with readiness to convert to TaTME if needed.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507696","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 robot-assisted pyeloplasty, intraoperative placement of a double-J ureteral stent (DJ stent) is an essential step to ensure ureteral patency and anastomotic healing. However, the procedure can be technically demanding because of limited tactile feedback and the need for precise coordination between the console surgeon (CS) and the patient-side surgeon (PSS).
Materials and Surgical Technique
To address these challenges, we applied the Assistent guide (UMIHIRA Co. Ltd., Kyoto, Japan), originally developed for robot-assisted intracorporeal ileal conduit diversion. The device is a stainless-steel instrument with a blunt tip and side hole, accommodating all stent sizes and insertable through a 5-mm trocar. During RAPP, the PSS advances the guide through the trocar to the ureteral anastomosis, the CS inserts the guidewire under direct vision, and the PSS advances the DJ stent antegrade along the guidewire. The CS provides countertraction to stabilize the ureter.
Discussion
Since August 2022, six patients underwent RAPP using this technique. Stent placement was successful in all cases without complications such as stent damage, malpositioning, or ureteral injury. The PSS reported smooth handling and reliable torque transmission compared with conventional methods. The Assistent guide costs approximately ¥80 000 per device and is reusable. Although limited by sample size and single-institution experience, this technique provides a practical solution to a technically challenging step in RAPP. Further multi-institutional evaluation is warranted to confirm safety, efficacy, and broader applicability.
{"title":"Use of the Assistent Guide Facilitates Ureteral Stent Placement in Robot-Assisted Pyeloplasty","authors":"Yutaro Sasaki, Saki Kobayashi, Kei Daizumoto, Fumiya Kadoriku, Marika Atagi, Tetsuhiro Yano, Mitsuki Nishiyama, Ryoei Minato, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Kunihisa Yamaguchi, Tomoya Fukawa, Yasuyo Yamamoto, Junya Furukawa","doi":"10.1111/ases.70178","DOIUrl":"10.1111/ases.70178","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In robot-assisted pyeloplasty, intraoperative placement of a double-J ureteral stent (DJ stent) is an essential step to ensure ureteral patency and anastomotic healing. However, the procedure can be technically demanding because of limited tactile feedback and the need for precise coordination between the console surgeon (CS) and the patient-side surgeon (PSS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>To address these challenges, we applied the Assistent guide (UMIHIRA Co. Ltd., Kyoto, Japan), originally developed for robot-assisted intracorporeal ileal conduit diversion. The device is a stainless-steel instrument with a blunt tip and side hole, accommodating all stent sizes and insertable through a 5-mm trocar. During RAPP, the PSS advances the guide through the trocar to the ureteral anastomosis, the CS inserts the guidewire under direct vision, and the PSS advances the DJ stent antegrade along the guidewire. The CS provides countertraction to stabilize the ureter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Since August 2022, six patients underwent RAPP using this technique. Stent placement was successful in all cases without complications such as stent damage, malpositioning, or ureteral injury. The PSS reported smooth handling and reliable torque transmission compared with conventional methods. The Assistent guide costs approximately ¥80 000 per device and is reusable. Although limited by sample size and single-institution experience, this technique provides a practical solution to a technically challenging step in RAPP. Further multi-institutional evaluation is warranted to confirm safety, efficacy, and broader applicability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490157","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}
Yu Suyama, Takeo Nakada, Yuto Watanabe, Maki Nakashima, Ai Otani, Yo Tsukamoto, Takamasa Shibazaki, Tomonari Kinoshita, Takashi Ohtsuka
A 70-year-old man underwent a video-assisted thoracoscopic S1 + 2 segmentectomy for suspected left upper lobe lung cancer. Despite an uneventful intraoperative procedure with no air leakage on intraoperative testing, a postoperative pneumothorax developed after the patient returned to the ward. Conservative management, including autologous blood pleurodesis was attempted; however, persistent air leakage necessitated reoperation on postoperative day five. Intraoperatively, the dislodged staple fragment was found embedded in the remaining left upper lobe, causing an air leak. This fragment likely originated from a malformed staple during the initial resection. The staple was removed, and the leak point was successfully repaired. This case demonstrates the rare but significant risk of postoperative pneumothorax caused by dislodged staple fragments. We emphasize the critical importance of meticulous staple-line assessment and careful intraoperative management when using staple-line reinforcement (SLR) materials. Surgeons must increase their awareness of these potential complications and implement preventive measures to ensure patient safety.
{"title":"A Case of Postoperative Pneumothorax due to a Dislodged Reinforced Staple Fragment After Thoracoscopic Segmentectomy: Recommendations for the Safe Use of Reinforced Staplers","authors":"Yu Suyama, Takeo Nakada, Yuto Watanabe, Maki Nakashima, Ai Otani, Yo Tsukamoto, Takamasa Shibazaki, Tomonari Kinoshita, Takashi Ohtsuka","doi":"10.1111/ases.70173","DOIUrl":"10.1111/ases.70173","url":null,"abstract":"<div>\u0000 \u0000 <p>A 70-year-old man underwent a video-assisted thoracoscopic S1 + 2 segmentectomy for suspected left upper lobe lung cancer. Despite an uneventful intraoperative procedure with no air leakage on intraoperative testing, a postoperative pneumothorax developed after the patient returned to the ward. Conservative management, including autologous blood pleurodesis was attempted; however, persistent air leakage necessitated reoperation on postoperative day five. Intraoperatively, the dislodged staple fragment was found embedded in the remaining left upper lobe, causing an air leak. This fragment likely originated from a malformed staple during the initial resection. The staple was removed, and the leak point was successfully repaired. This case demonstrates the rare but significant risk of postoperative pneumothorax caused by dislodged staple fragments. We emphasize the critical importance of meticulous staple-line assessment and careful intraoperative management when using staple-line reinforcement (SLR) materials. Surgeons must increase their awareness of these potential complications and implement preventive measures to ensure patient safety.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432804","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}
Laparoscopic liver resection (LLR) has been widely adopted; however, limited instrument mobility remains a challenge. Such technical limitations can be overcome with the novel articulating laparoscopic device ARTISENTIAL, but its use in LLR has not previously been described. Here we report the first anatomical liver resection performed using the ARTISENTIAL device. A 73-year-old man with a segment-3 hepatic mass underwent laparoscopic left hepatectomy, with lymph node sampling. This procedure was performed using ARTISENTIAL. Parenchymal transection was performed using the clamp-crushing technique with ARTISENTIAL. The Glissonian stump was closed with sutures. Compared to robotic systems, ARTISENTIAL provides similar motion benefits, without the associated cost or set-up requirements. ARTISENTIAL is a versatile and cost-effective technique. This case is the first reported anatomical LLR performed using ARTISENTIAL. Our experience suggests that this device can effectively overcome the major limitations of conventional instruments in LLR.
{"title":"The First Report of Anatomical Laparoscopic Liver Resection Performed Using ARTISENTIAL","authors":"Go Shinke, Yutaka Takeda, Yoshifumi Iwagami, Mitsuru Kinoshita, Yoshiro Yukawa, Asami Arita, Kiminori Yanagisawa, Shinsuke Katsuyama, Masayuki Hiraki, Keijiro Sugimura, Masayoshi Yasui, Kohei Murata","doi":"10.1111/ases.70172","DOIUrl":"10.1111/ases.70172","url":null,"abstract":"<p>Laparoscopic liver resection (LLR) has been widely adopted; however, limited instrument mobility remains a challenge. Such technical limitations can be overcome with the novel articulating laparoscopic device ARTISENTIAL, but its use in LLR has not previously been described. Here we report the first anatomical liver resection performed using the ARTISENTIAL device. A 73-year-old man with a segment-3 hepatic mass underwent laparoscopic left hepatectomy, with lymph node sampling. This procedure was performed using ARTISENTIAL. Parenchymal transection was performed using the clamp-crushing technique with ARTISENTIAL. The Glissonian stump was closed with sutures. Compared to robotic systems, ARTISENTIAL provides similar motion benefits, without the associated cost or set-up requirements. ARTISENTIAL is a versatile and cost-effective technique. This case is the first reported anatomical LLR performed using ARTISENTIAL. Our experience suggests that this device can effectively overcome the major limitations of conventional instruments in LLR.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12580167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432797","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}
Esophageal squamous cell carcinoma (ESCC) and squamous cell carcinoma of the head and neck (HN) often occur simultaneously. Total esophagectomy with pharyngolaryngectomy (TE-TPL) is a highly invasive surgery associated with significant mortality. In thoracic esophagectomy, minimally invasive esophagectomy (MIE) has gained widespread acceptance. This study evaluates the efficacy of MIE in TE-TPL.
Methods
We retrospectively analyzed patients who underwent TE-TPL between January 2007 and December 2022 at the National Cancer Center Hospital in Tokyo, Japan. A total of 33 patients were enrolled, with 19 undergoing minimally invasive esophagectomy (MIE group) and 14 undergoing conventional esophagectomy (Open group).
Results
MIE was associated with a significantly shorter operative time (532 min vs. 687 min, p = 0.028), less intraoperative bleeding (371 mL vs. 840 mL, p < 0.01), shorter hospital stays (21 days vs. 34 days, p < 0.01), and a lower reoperation rate (11% vs. 29%, p = 0.036) compared to the Open group. The 3-year overall survival (OS) and progression-free survival (PFS) rates were not significantly different between the two groups (OS: 47.4% vs. 50.0%, p = 0.72; PFS: 34.0% vs. 47.1%, p = 0.41).
Conclusion
MIE may be a more feasible and efficient option than the conventional approach for TE-TPL.
背景：食管鳞状细胞癌（ESCC）和头颈部鳞状细胞癌（HN）常同时发生。全食管切除术合并咽喉癌切除术（TE-TPL）是一种高侵入性手术，死亡率高。在胸段食管切除术中，微创食管切除术（MIE）已被广泛接受。本研究评价MIE治疗TE-TPL的疗效。方法：我们回顾性分析了2007年1月至2022年12月在日本东京国立癌症中心医院接受TE-TPL的患者。共纳入33例患者，其中微创食管切除术19例（MIE组），常规食管切除术14例（Open组）。结果：MIE与手术时间显著缩短（532 min vs. 687 min, p = 0.028），术中出血较少（371 mL vs. 840 mL, p）相关。结论：MIE可能是TE-TPL的一种更可行和有效的选择。
{"title":"Short-Term Outcomes of Minimally-Invasive Esophagectomy Compared to Thoracotomy and Transhiatal Approaches in Total Esophagectomy With Pharyngolaryngectomy","authors":"Ryoko Nozaki, Daisuke Kurita, Koshiro Ishiyama, Junya Oguma, Ryota Kakuta, Shota Igaue, Eigo Akimoto, Daichi Utsunomiya, Yasuyuki Seto, Hiroyuki Daiko","doi":"10.1111/ases.70169","DOIUrl":"10.1111/ases.70169","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Esophageal squamous cell carcinoma (ESCC) and squamous cell carcinoma of the head and neck (HN) often occur simultaneously. Total esophagectomy with pharyngolaryngectomy (TE-TPL) is a highly invasive surgery associated with significant mortality. In thoracic esophagectomy, minimally invasive esophagectomy (MIE) has gained widespread acceptance. This study evaluates the efficacy of MIE in TE-TPL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed patients who underwent TE-TPL between January 2007 and December 2022 at the National Cancer Center Hospital in Tokyo, Japan. A total of 33 patients were enrolled, with 19 undergoing minimally invasive esophagectomy (MIE group) and 14 undergoing conventional esophagectomy (Open group).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MIE was associated with a significantly shorter operative time (532 min vs. 687 min, <i>p</i> = 0.028), less intraoperative bleeding (371 mL vs. 840 mL, <i>p</i> < 0.01), shorter hospital stays (21 days vs. 34 days, <i>p</i> < 0.01), and a lower reoperation rate (11% vs. 29%, <i>p</i> = 0.036) compared to the Open group. The 3-year overall survival (OS) and progression-free survival (PFS) rates were not significantly different between the two groups (OS: 47.4% vs. 50.0%, <i>p</i> = 0.72; PFS: 34.0% vs. 47.1%, <i>p</i> = 0.41).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MIE may be a more feasible and efficient option than the conventional approach for TE-TPL.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145393989","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}
Gallbladder bed detachment (GBB-D) in laparoscopic cholecystectomy (LC) lacks a standardized technique. We developed butterfly traction (BT) to perform optimal GBB-D. This study evaluates its effectiveness and potential for standardization.
Methods
BT aligns the dissection axis with the surgeon's dominant hand by positioning the gallbladder upright and using a left-sided lateral approach. This improves right-side mobility, enabling horizontal traction and avoiding axis interference. BT has been adopted in all LCs at our institution since July 2023. Among 118 LCs performed from 2019 to 2024, three open conversion cases and 13 bailout cases were excluded. Operative outcomes in the remaining patients were compared between the BT group (n = 50) and the nonstandardized (NS) group (n = 52).
Results
No significant differences were observed in age, gender, comorbidities, or preoperative gallbladder drainage between groups. However, the BT group had more surgeons with ≤ 5 years of experience (52% vs. 29%, p = 0.017). Operative times were comparable (p = 0.363), but bile contamination due to gallbladder perforation during GBB-D was significantly lower in the BT group (4% vs. 17%, p = 0.030), as was blood loss (0 vs. 1 g, p = 0.003). BT was particularly effective in higher difficulty cases (Grade B/C from Tokyo Guidelines 2018), with shorter operative times (95 vs. 116 min, p = 0.095), less blood loss (0 vs. 2 g, p < 0.001), and fewer perforations (6% vs. 24%, p = 0.046).
Conclusions
BT improved surgical outcomes and minimized bile contamination, even when performed by less experienced surgeons. It shows strong potential as a standard technique for GBB-D in LC.
腹腔镜胆囊切除术（LC）中胆囊床脱离（GBB-D）缺乏标准化的技术。我们开发了蝶式牵引（BT）来实现最佳的GBB-D。本研究评估其有效性和标准化潜力。方法：BT通过使胆囊直立并采用左侧外侧入路，使夹层轴与外科医生的惯用手对齐。这提高了右侧的机动性，使水平牵引和避免轴干扰。自2023年7月起，我们机构的所有lc都采用了BT。在2019年至2024年执行的118个LCs中，排除了3个公开转换案例和13个救助案例。将其余患者的手术结果与BT组（n = 50）和非标准化（NS）组（n = 52）进行比较。结果：两组患者在年龄、性别、合并症、术前胆囊引流等方面无显著差异。而BT组≤5年经验的外科医生较多（52% vs. 29%, p = 0.017）。手术时间比较（p = 0.363），但BT组在GBB-D期间因胆囊穿孔引起的胆汁污染显著降低（4%比17%，p = 0.030），出血量也显著降低（0比1 g， p = 0.003）。BT在高难度病例中特别有效（2018年东京指南B/C级），手术时间更短（95对116分钟，p = 0.095），出血量更少（0对2 g， p）。结论：BT改善了手术效果，最大限度地减少了胆汁污染，即使是由经验不足的外科医生实施。它显示出作为LC中gb - d标准技术的强大潜力。
{"title":"Butterfly Traction: A New Standardized Approach for Gallbladder Bed Detachment in Laparoscopic Cholecystectomy","authors":"Daisuke Noguchi, Takahiro Ito, Aoi Hayasaki, Yusuke Iizawa, Takehiro Fujii, Akihiro Tanemura, Yasuhiro Murata, Naohisa Kuriyama, Masashi Kishiwada, Shugo Mizuno","doi":"10.1111/ases.70171","DOIUrl":"10.1111/ases.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gallbladder bed detachment (GBB-D) in laparoscopic cholecystectomy (LC) lacks a standardized technique. We developed butterfly traction (BT) to perform optimal GBB-D. This study evaluates its effectiveness and potential for standardization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>BT aligns the dissection axis with the surgeon's dominant hand by positioning the gallbladder upright and using a left-sided lateral approach. This improves right-side mobility, enabling horizontal traction and avoiding axis interference. BT has been adopted in all LCs at our institution since July 2023. Among 118 LCs performed from 2019 to 2024, three open conversion cases and 13 bailout cases were excluded. Operative outcomes in the remaining patients were compared between the BT group (<i>n</i> = 50) and the nonstandardized (NS) group (<i>n</i> = 52).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences were observed in age, gender, comorbidities, or preoperative gallbladder drainage between groups. However, the BT group had more surgeons with ≤ 5 years of experience (52% vs. 29%, <i>p</i> = 0.017). Operative times were comparable (<i>p</i> = 0.363), but bile contamination due to gallbladder perforation during GBB-D was significantly lower in the BT group (4% vs. 17%, <i>p</i> = 0.030), as was blood loss (0 vs. 1 g, <i>p</i> = 0.003). BT was particularly effective in higher difficulty cases (Grade B/C from Tokyo Guidelines 2018), with shorter operative times (95 vs. 116 min, <i>p</i> = 0.095), less blood loss (0 vs. 2 g, <i>p</i> < 0.001), and fewer perforations (6% vs. 24%, <i>p</i> = 0.046).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BT improved surgical outcomes and minimized bile contamination, even when performed by less experienced surgeons. It shows strong potential as a standard technique for GBB-D in LC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12558715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379364","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号