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}
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}
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