Cesarean scar disorder (CSDi) is a pathological entity involving a myometrial defect at the site of a previous cesarean section, commonly associated with postmenstrual spotting, dysmenorrhea, and secondary infertility. While laparoscopic repair is an established treatment, intraoperative localization of the niche remains challenging.
Materials and Surgical Technique
We report a novel application of the Pharus method, which utilizes the full-color IR white-light overlay mode of a commercial imaging platform (ELITE III, Olympus, Tokyo, Japan) to enable real-time visualization of hysteroscopic transillumination as green lights under bright-field conditions. A 32-year-old woman diagnosed with CSDi underwent combined hysteroscopic and laparoscopic niche repair. The margins of the niche were precisely delineated, sharply excised, and the uterine wall was reconstructed in two layers using barbed sutures.
Discussion
This is the first reported use of the Pharus method in the laparoscopic repair of CSDi. The technique enhances intraoperative anatomical guidance without the need for reduced lighting. This method may offer a valuable advancement in laparoscopic repair of CSDi.
剖宫产疤痕症（CSDi）是一种病理实体，涉及先前剖宫产部位的子宫肌体缺损，通常与经后斑点、痛经和继发性不孕症有关。虽然腹腔镜修复是一种成熟的治疗方法，但术中定位小生境仍然具有挑战性。材料和手术技术：我们报告了Pharus方法的一项新应用，该方法利用商业成像平台（ELITE III, Olympus, Tokyo, Japan）的全彩色红外白光覆盖模式，在明亮场条件下实现宫腔镜透照的绿光实时可视化。诊断为CSDi的32岁女性接受了宫腔镜和腹腔镜联合生态位修复。精确地勾勒出子宫壁龛的边缘，迅速切除，并用倒钩缝合线将子宫壁重建为两层。讨论：这是首次报道使用Pharus方法在腹腔镜下修复CSDi。该技术增强了术中解剖指导，而不需要减少照明。该方法可为腹腔镜下CSDi修复提供有价值的进展。
{"title":"A Pharus Method for Laparoscopically Locating a Uterine Niche in Cesarean Scar Disorder","authors":"Akiko Yoshida-Ueno, Takayuki Sato, Kazutoshi Hayashi, Shinya Wakatsuki, Takaomi Namba, Yuji Tanaka, Shunichiro Tsuji","doi":"10.1111/ases.70197","DOIUrl":"10.1111/ases.70197","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cesarean scar disorder (CSDi) is a pathological entity involving a myometrial defect at the site of a previous cesarean section, commonly associated with postmenstrual spotting, dysmenorrhea, and secondary infertility. While laparoscopic repair is an established treatment, intraoperative localization of the niche remains challenging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>We report a novel application of the Pharus method, which utilizes the full-color IR white-light overlay mode of a commercial imaging platform (ELITE III, Olympus, Tokyo, Japan) to enable real-time visualization of hysteroscopic transillumination as green lights under bright-field conditions. A 32-year-old woman diagnosed with CSDi underwent combined hysteroscopic and laparoscopic niche repair. The margins of the niche were precisely delineated, sharply excised, and the uterine wall was reconstructed in two layers using barbed sutures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This is the first reported use of the Pharus method in the laparoscopic repair of CSDi. The technique enhances intraoperative anatomical guidance without the need for reduced lighting. This method may offer a valuable advancement in laparoscopic repair of CSDi.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662345","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}
Minimally invasive cardiac surgery enhanced by the daVinci robotic system offers benefits such as reduced morbidity and superior visualization. However, complications like unexpected bleeding may require conversion to median sternotomy, necessitating careful intraoperative manipulation. We report a rare case of left atrial roof injury during robotic mitral valvuloplasty in a 61-year-old woman with severe mitral regurgitation. Cardiopulmonary bypass was established via femoral and jugular vein cannulation. Upon initiation, bleeding was identified from a wire perforation at the left atrial roof. Hemostasis was successfully achieved using a 3-0 Prolene mattress suture. Mitral valve repair and patent foramen ovale closure were completed uneventfully, and the patient was discharged on postoperative day 8. This case highlights the critical importance of meticulous wire handling and comprehensive imaging guidance in minimally invasive cardiac surgery. While the robotic system's visualization aided in repair, the primary lesson underscores the need for robust preventive strategies to avoid such complications.
{"title":"A Rare Case of Iatrogenic Left Atrial Roof Injury by a Guidewire During Robotic Mitral Valvuloplasty","authors":"Daiki Yoshiyama, Norihiko Ishikawa, Kazuto Miyata, Tomoko Kanai, Motomu Miyagi, Michie Sato, Toru Koakutsu, Jaewon Park, Takafumi Horikawa, Sayaka Shigematsu, Shigeyuki Tomita, Toshiya Ohtsuka, Go Watanabe","doi":"10.1111/ases.70205","DOIUrl":"10.1111/ases.70205","url":null,"abstract":"<div>\u0000 \u0000 <p>Minimally invasive cardiac surgery enhanced by the daVinci robotic system offers benefits such as reduced morbidity and superior visualization. However, complications like unexpected bleeding may require conversion to median sternotomy, necessitating careful intraoperative manipulation. We report a rare case of left atrial roof injury during robotic mitral valvuloplasty in a 61-year-old woman with severe mitral regurgitation. Cardiopulmonary bypass was established via femoral and jugular vein cannulation. Upon initiation, bleeding was identified from a wire perforation at the left atrial roof. Hemostasis was successfully achieved using a 3-0 Prolene mattress suture. Mitral valve repair and patent foramen ovale closure were completed uneventfully, and the patient was discharged on postoperative day 8. This case highlights the critical importance of meticulous wire handling and comprehensive imaging guidance in minimally invasive cardiac surgery. While the robotic system's visualization aided in repair, the primary lesson underscores the need for robust preventive strategies to avoid such complications.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662364","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 cholecystectomy for difficult gallbladders is risky because severe inflammation obscures local anatomy. We investigated the usefulness of “the body-first approach” with laparoscopic cholecystectomy for acute cholecystitis at our institution.
Patients and Methods
Two hundred and five patients were diagnosed with acute cholecystitis and underwent cholecystectomy at our hospital between January 2017 and December 2024. Eight cases were excluded due to severe adhesions from previous surgery. From July 2022, we have performed the body-first approach for difficult surgical cases until bailout surgery was required. To evaluate the usefulness of the body-first approach, the period was divided into before and after the start of the body-first approach. The patient characteristics, conversion rate to laparotomy, and total cholecystectomy rates were examined.
Results
There were no significant differences in terms of age, gender, BMI, or the operative difficulty grading between the two periods. The operative time was significantly longer in the later period than in the early period (p = 0.0346). There were no cases requiring blood transfusion. The conversion rate to open surgery was significantly lower in the later period than in the early period (p = 0.000629). The total cholecystectomy rate was significantly higher in the later period than in the early period (p = 0.00012). No cases of vasculobiliary injury were observed in either period.
Conclusion
It was suggested that even in difficult gallbladder cases, the body-first approach may reduce the rate of conversion to laparotomy and increase the rate of total cholecystectomy without vascular-biliary injury.
{"title":"Body First Approach of Laparoscopic Cholecystectomy for Difficult Gallbladder","authors":"Hiroshi Ohtani, Shinya Nomura, Satoru Noda, Ryuma Tada, Hiroji Nakagawa, Kiyoshi Maeda","doi":"10.1111/ases.70195","DOIUrl":"10.1111/ases.70195","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Laparoscopic cholecystectomy for difficult gallbladders is risky because severe inflammation obscures local anatomy. We investigated the usefulness of “the body-first approach” with laparoscopic cholecystectomy for acute cholecystitis at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Two hundred and five patients were diagnosed with acute cholecystitis and underwent cholecystectomy at our hospital between January 2017 and December 2024. Eight cases were excluded due to severe adhesions from previous surgery. From July 2022, we have performed the body-first approach for difficult surgical cases until bailout surgery was required. To evaluate the usefulness of the body-first approach, the period was divided into before and after the start of the body-first approach. The patient characteristics, conversion rate to laparotomy, and total cholecystectomy rates were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no significant differences in terms of age, gender, BMI, or the operative difficulty grading between the two periods. The operative time was significantly longer in the later period than in the early period (<i>p</i> = 0.0346). There were no cases requiring blood transfusion. The conversion rate to open surgery was significantly lower in the later period than in the early period (<i>p</i> = 0.000629). The total cholecystectomy rate was significantly higher in the later period than in the early period (<i>p</i> = 0.00012). No cases of vasculobiliary injury were observed in either period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It was suggested that even in difficult gallbladder cases, the body-first approach may reduce the rate of conversion to laparotomy and increase the rate of total cholecystectomy without vascular-biliary injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649522","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 laparoscopic local resection of the stomach for gastric gastrointestinal stromal tumors (GISTs), wedge resection and laparoscopic and endoscopic cooperative surgery (LECS) are commonly employed. However, wedge resection can result in excessive removal of gastric tissue, leading to postoperative deformity, while LECS carries risks such as surgical site infection, intra-abdominal abscess, and potential tumor cell seeding due to gastric lumen opening. To overcome these limitations, we developed the “lift-and-cut method,” a minimally invasive surgery (MIS) designed to minimize gastric resection without opening the gastric lumen. This study reports the short- and long-term outcomes of patients treated with this approach.
Methods
We retrospectively reviewed consecutive cases of gastric GIST treated with the “lift-and-cut method” between June 2011 and May 2024.
Results
A total of 80 patients underwent the “lift-and-cut method”. The median operative time was 107 min (interquartile range [IQR], 77–141 min), with no intraoperative blood loss (IQR, 0–0 g). The median postoperative hospital stay was 7 days (IQR, 6–8 days). One patient experienced a postoperative urinary tract infection. According to the modified Fletcher classification, tumor risk levels were very low (n = 9), low (n = 49), intermediate (n = 14), and high (n = 8). After a median follow-up of 60.0 months (IQR, 24.0–89.3 months), one patient died of recurrence, and another from an unrelated cause.
Conclusion
The “lift-and-cut method” appears to be a safe and effective minimally invasive option for gastric GIST, offering favorable short- and long-term outcomes while minimizing tissue resection and avoiding gastric lumen entry.
{"title":"Short-Term and Long-Term Outcomes of Laparoscopic Local Resection of the Stomach Using the “Lift-And-Cut Method” for Gastric Gastrointestinal Stromal Tumors","authors":"Shun Akiyama, Norihiro Shimoike, Seiichiro Kanaya, Shinya Yoshida, Tomoaki Okada, Akira Mori, Hisahiro Hosogi","doi":"10.1111/ases.70198","DOIUrl":"https://doi.org/10.1111/ases.70198","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In laparoscopic local resection of the stomach for gastric gastrointestinal stromal tumors (GISTs), wedge resection and laparoscopic and endoscopic cooperative surgery (LECS) are commonly employed. However, wedge resection can result in excessive removal of gastric tissue, leading to postoperative deformity, while LECS carries risks such as surgical site infection, intra-abdominal abscess, and potential tumor cell seeding due to gastric lumen opening. To overcome these limitations, we developed the “lift-and-cut method,” a minimally invasive surgery (MIS) designed to minimize gastric resection without opening the gastric lumen. This study reports the short- and long-term outcomes of patients treated with this approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed consecutive cases of gastric GIST treated with the “lift-and-cut method” between June 2011 and May 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 80 patients underwent the “lift-and-cut method”. The median operative time was 107 min (interquartile range [IQR], 77–141 min), with no intraoperative blood loss (IQR, 0–0 g). The median postoperative hospital stay was 7 days (IQR, 6–8 days). One patient experienced a postoperative urinary tract infection. According to the modified Fletcher classification, tumor risk levels were very low (<i>n</i> = 9), low (<i>n</i> = 49), intermediate (<i>n</i> = 14), and high (<i>n</i> = 8). After a median follow-up of 60.0 months (IQR, 24.0–89.3 months), one patient died of recurrence, and another from an unrelated cause.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The “lift-and-cut method” appears to be a safe and effective minimally invasive option for gastric GIST, offering favorable short- and long-term outcomes while minimizing tissue resection and avoiding gastric lumen entry.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626860","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}
The Japan Society for Endoscopic Surgery organized the Anatomy on the Border Expert Consensus Meeting in 2024 to foster cross-disciplinary discussions. One of the themes, on parenchymal organs, brought together liver, lung, and kidney specialists to jointly discuss the current status and future perspectives of three-dimensional image reconstruction and augmented/virtual/mixed reality technologies in surgery. This report summarizes the results of these discussions in relation to liver surgery.
Methods
A questionnaire was distributed to board-certified expert training facilities of the Japanese Society of Hepato-Biliary-Pancreatic Surgery and liver surgeons certified by the Japan Society for Endoscopic Surgery. A systematic review of English language articles published between 2015 and 2024 was also conducted.
Results
Responses were obtained from 86 institutions. The majority (88%) reported routine use of three-dimensional image reconstruction, mainly for preoperative planning (92%) and anatomical understanding (88%). It was rated as very or moderately useful by 99% of respondents. A literature review confirmed the perioperative benefits of this technique. In contrast, augmented/virtual/mixed reality technologies were used in only 16% of the institutions; the majority of these (79%) acknowledged their usefulness, primarily for anatomical understanding and education. The barriers to implementation included cost and data preparation complexity. The educational benefits were supported by data from randomized controlled trials; however, clinical evidence remains limited and inconsistent.
Conclusion
Three-dimensional image reconstruction has become essential in liver surgery. Augmented/virtual/mixed reality technologies, although in the early stages, show promise for surgical education and may eventually contribute to surgical practice as accessibility improves.
{"title":"Anatomy on the Border Expert Consensus Meeting: Current Status and Future Perspectives of Three-Dimensional Image Reconstruction and Immersive Technologies in Liver Surgery","authors":"Daisuke Asano, Yujin Kudo, Satoshi Kobayashi, Toshiya Abe, Kenoki Ohuchida, Keiichi Akahoshi, Go Wakabayashi, Kimihiro Shimizu, Mingyon Mun, Hisashi Iwata, Atsushi Takenaka, Tomonori Habuchi, Minoru Tanabe, Tomoharu Yoshizumi, Daisuke Ban, Norihiko Ikeda, Masatoshi Eto, Yuko Kitagawa, Masafumi Nakamura","doi":"10.1111/ases.70182","DOIUrl":"https://doi.org/10.1111/ases.70182","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Japan Society for Endoscopic Surgery organized the Anatomy on the Border Expert Consensus Meeting in 2024 to foster cross-disciplinary discussions. One of the themes, on parenchymal organs, brought together liver, lung, and kidney specialists to jointly discuss the current status and future perspectives of three-dimensional image reconstruction and augmented/virtual/mixed reality technologies in surgery. This report summarizes the results of these discussions in relation to liver surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A questionnaire was distributed to board-certified expert training facilities of the Japanese Society of Hepato-Biliary-Pancreatic Surgery and liver surgeons certified by the Japan Society for Endoscopic Surgery. A systematic review of English language articles published between 2015 and 2024 was also conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Responses were obtained from 86 institutions. The majority (88%) reported routine use of three-dimensional image reconstruction, mainly for preoperative planning (92%) and anatomical understanding (88%). It was rated as very or moderately useful by 99% of respondents. A literature review confirmed the perioperative benefits of this technique. In contrast, augmented/virtual/mixed reality technologies were used in only 16% of the institutions; the majority of these (79%) acknowledged their usefulness, primarily for anatomical understanding and education. The barriers to implementation included cost and data preparation complexity. The educational benefits were supported by data from randomized controlled trials; however, clinical evidence remains limited and inconsistent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Three-dimensional image reconstruction has become essential in liver surgery. Augmented/virtual/mixed reality technologies, although in the early stages, show promise for surgical education and may eventually contribute to surgical practice as accessibility improves.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70182","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626223","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}
Hironari Kawai, Shunjin Ryu, Daiki Suzuki, Hyuga Kawakubo, Shunsuke Nakashima, Takehiro Kobayashi, Yuta Imaizumi, Ryusuke Ito
Introduction
Laparoscopic cholecystectomy (Lap-C) is generally considered an entry-level surgical procedure. However, achieving a properly tensioned and well-exposed surgical field tailored to each specific case is not always straightforward. In this study, we demonstrate our surgical field exposure strategy based on three key concepts in Lap-C: planarization, squarization (“square-shaped exposure”), and verticalization.
Materials and Surgical Technique
To verbalize the surgical technique, we first defined the three key concepts—planarization, squarization, and verticalization—in the context of Lap-C. The operative procedure was then divided into four major steps: serosal incision, creation of the critical view of safety, transection of cystic structures, and dissection of the gallbladder bed. Each step was performed with conscious application of these principles to optimize the surgical field.
Discussion
The use of verbalized surgical techniques may facilitate more optimal surgical field exposure and tissue dissection, ultimately contributing to safer laparoscopic cholecystectomy.
{"title":"Planarization, Squarization, and Verticalization for Optimal Surgical View Exposure in Laparoscopic Cholecystectomy (With Video)","authors":"Hironari Kawai, Shunjin Ryu, Daiki Suzuki, Hyuga Kawakubo, Shunsuke Nakashima, Takehiro Kobayashi, Yuta Imaizumi, Ryusuke Ito","doi":"10.1111/ases.70192","DOIUrl":"https://doi.org/10.1111/ases.70192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Laparoscopic cholecystectomy (Lap-C) is generally considered an entry-level surgical procedure. However, achieving a properly tensioned and well-exposed surgical field tailored to each specific case is not always straightforward. In this study, we demonstrate our surgical field exposure strategy based on three key concepts in Lap-C: planarization, squarization (“square-shaped exposure”), and verticalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>To verbalize the surgical technique, we first defined the three key concepts—planarization, squarization, and verticalization—in the context of Lap-C. The operative procedure was then divided into four major steps: serosal incision, creation of the critical view of safety, transection of cystic structures, and dissection of the gallbladder bed. Each step was performed with conscious application of these principles to optimize the surgical field.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The use of verbalized surgical techniques may facilitate more optimal surgical field exposure and tissue dissection, ultimately contributing to safer laparoscopic cholecystectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626226","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}
Resection of the extrahepatic bile duct including the gallbladder and the dilated segment, is a widely accepted surgical concept in congenital biliary dilatation (CBD) in both adult and pediatric surgeons. However, owing to the existence of various types of CBD and differences in the extent of dilatation, no consensus has been reached regarding the appropriate resection margins.
Methods
Consensus statements regarding the appropriate surgical margins for both the duodenal and hepatic hilum sides were developed as two clinical questions (CQs) during a multidisciplinary consensus meeting. A comprehensive literature review and expert survey were conducted. Consensus was achieved through a Delphi voting process, with statements approved when ≥ 75% agreement was reached.
Results
In a nationwide expert survey, pediatric institutions resected the bile duct closer to the junction of the pancreatic duct on the duodenal side relative to adult institutions. In contrast, adult institutions aggressively transected higher levels of the hepatic duct on the hilum side. Taking literature reviews into account, the following consensus statement was developed: “The narrow segment is a good landmark to remove closely to the pancreatic junction on the duodenal side and the decision on the resection line on the hepatic hilum side should be dependent on the type of Todani's classification.” This statement achieved a unanimous agreement in the Delphi vote.
Conclusion
It should be noted that there are differences in surgical concepts between adult and pediatric institutions. Further research is needed to determine the long-term outcomes related to the resection line.
{"title":"Nationwide Expert Survey on Appropriate Bile Duct Transection Line in Adult and Pediatric Congenital Biliary Dilatation Surgery in Japan: AOB Consensus Meeting","authors":"Toshiharu Matsuura, Yoshitaka Kiya, Masahiro Takeda, Hiroki Mori, Takahisa Tainaka, Tetsuya Idichi, So Nakamura, Toshiya Abe, Kohei Nakata, Kenoki Ohuchida, Takao Ohtsuka, Hiroki Ishibashi, Hiroyuki Koga, Hiroo Uchida, Yuichi Nagakawa, Tatsuro Tajiri, Masafumi Nakamura, Yuko Kitagawa","doi":"10.1111/ases.70194","DOIUrl":"https://doi.org/10.1111/ases.70194","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Resection of the extrahepatic bile duct including the gallbladder and the dilated segment, is a widely accepted surgical concept in congenital biliary dilatation (CBD) in both adult and pediatric surgeons. However, owing to the existence of various types of CBD and differences in the extent of dilatation, no consensus has been reached regarding the appropriate resection margins.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consensus statements regarding the appropriate surgical margins for both the duodenal and hepatic hilum sides were developed as two clinical questions (CQs) during a multidisciplinary consensus meeting. A comprehensive literature review and expert survey were conducted. Consensus was achieved through a Delphi voting process, with statements approved when ≥ 75% agreement was reached.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In a nationwide expert survey, pediatric institutions resected the bile duct closer to the junction of the pancreatic duct on the duodenal side relative to adult institutions. In contrast, adult institutions aggressively transected higher levels of the hepatic duct on the hilum side. Taking literature reviews into account, the following consensus statement was developed: “The narrow segment is a good landmark to remove closely to the pancreatic junction on the duodenal side and the decision on the resection line on the hepatic hilum side should be dependent on the type of Todani's classification.” This statement achieved a unanimous agreement in the Delphi vote.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It should be noted that there are differences in surgical concepts between adult and pediatric institutions. Further research is needed to determine the long-term outcomes related to the resection line.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626225","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}
Despite the development of surgical instruments combining ultrasonic scissors and an advanced bipolar device, thermal management has still been considered a persistent issue, similar to that in conventional ultrasonic scissors. To address this issue, the next-generation hybrid device (NGHD) with a new tip and handle design has been devised while maintaining the high cutting and sealing performance of combined surgical instruments (THUNDERBEAT Type S, TBS). We compared them in an ex vivo and nonclinical in vivo environment and investigated their perceived clinical usefulness.
Methods
Ex vivo testing included measurements of cutting speed, posterior thermal spread from the jaw, and lateral thermal spread. The nonclinical in vivo study involved evaluations such as cutting capability while maintaining the tissue layer, and handle ergonomics.
Results
The NGHD demonstrated a significantly faster cutting speed than did TBS (2.41 [2.31–2.50] vs. 3.04 [2.94–3.13] s, p < 0.01) with 5–7 mm arteries, as well as significant improvements in the posterior thermal spread on arteries during activation (5.67 [0–12.84] vs. 84.22 [35.34–133.10] μm, p < 0.01) and lateral thermal spread (2.22 [2.06–2.38] vs. 2.79 [2.55–3.03] mm, p < 0.05). Surgeon assessments indicated more improvements with the NGHD than with TBS, especially regarding cutting while maintaining the tissue layer and handle ergonomics.
Conclusion
The NGHD promoted improvements in thermal management generally associated with TBS and maintained the benefits of combining devices capable of ultrasonic and advanced bipolar output. The NGHD has the potential to support safe and efficient endoscopic procedures, pending further clinical evaluation.
尽管结合超声剪刀和先进的双极装置的手术器械得到了发展，热管理仍然被认为是一个持久的问题，类似于传统的超声剪刀。为了解决这个问题，新一代混合装置（NGHD）采用了新的尖端和手柄设计，同时保持了联合手术器械（THUNDERBEAT Type S， TBS）的高切割和密封性能。我们在离体和非临床的体内环境中比较了它们，并调查了它们的临床用途。方法体外实验包括测量切削速度、下颌后向热扩散和侧向热扩散。非临床的体内研究包括评估，如切割能力，同时保持组织层，并处理人体工程学。结果在5-7 mm动脉中，NGHD的切割速度明显快于TBS (2.41 [2.31-2.50] vs. 3.04 [2.94-3.13] s, p < 0.01)，激活时动脉后侧热扩散（5.67 [0-12.84]vs. 84.22 [35.34-133.10] μm, p < 0.01）和侧侧热扩散（2.22 [2.06-2.38]vs. 2.79 [2.55-3.03] mm, p < 0.05）。外科医生评估表明，NGHD比TBS有更多的改善，特别是在切割时保持组织层和处理人体工程学方面。结论NGHD促进了与TBS相关的热管理的改善，并保持了超声和先进双极输出设备相结合的优势。NGHD有可能支持安全有效的内窥镜手术，有待进一步的临床评估。
{"title":"Preclinical Evaluation of a New Surgical Hybrid Energy Device Compared to the Conventional Energy Device","authors":"Satoru Matsuda, Kazuhisa Ehara, Hiroyasu Kagawa, Shunsuke Tsukamoto, Kohei Nakata, Mamoru Morimoto, Sayaka Yasui, Jumpei Torikai, Ichiro Uyama","doi":"10.1111/ases.70201","DOIUrl":"https://doi.org/10.1111/ases.70201","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite the development of surgical instruments combining ultrasonic scissors and an advanced bipolar device, thermal management has still been considered a persistent issue, similar to that in conventional ultrasonic scissors. To address this issue, the next-generation hybrid device (NGHD) with a new tip and handle design has been devised while maintaining the high cutting and sealing performance of combined surgical instruments (THUNDERBEAT Type S, TBS). We compared them in an ex vivo and nonclinical in vivo environment and investigated their perceived clinical usefulness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ex vivo testing included measurements of cutting speed, posterior thermal spread from the jaw, and lateral thermal spread. The nonclinical in vivo study involved evaluations such as cutting capability while maintaining the tissue layer, and handle ergonomics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The NGHD demonstrated a significantly faster cutting speed than did TBS (2.41 [2.31–2.50] vs. 3.04 [2.94–3.13] s, <i>p</i> < 0.01) with 5–7 mm arteries, as well as significant improvements in the posterior thermal spread on arteries during activation (5.67 [0–12.84] vs. 84.22 [35.34–133.10] μm, <i>p</i> < 0.01) and lateral thermal spread (2.22 [2.06–2.38] vs. 2.79 [2.55–3.03] mm, <i>p</i> < 0.05). Surgeon assessments indicated more improvements with the NGHD than with TBS, especially regarding cutting while maintaining the tissue layer and handle ergonomics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The NGHD promoted improvements in thermal management generally associated with TBS and maintained the benefits of combining devices capable of ultrasonic and advanced bipolar output. The NGHD has the potential to support safe and efficient endoscopic procedures, pending further clinical evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626325","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}
Fusion robot-assisted thoracic surgery (fusion RATS) has gained much attention as an alternative to console-only approaches (pure RATS), as during fusion RATS, the bedside assistant performs stapling and actively supports the procedure. This study retrospectively analyzed data from 553 patients who underwent robotic anatomical pulmonary resection with either fusion or pure RATS to compare perioperative outcomes. After 1:2 propensity score matching, 294 patients were included in the analysis. Fusion RATS exhibited substantially shorter operative and console times without an increase in complication rates. Moreover, it allowed for flexible stapler insertion angles, enabling the use of reinforced staplers. Assistant participation in key steps may provide educational benefits and improve adaptability, specifically when integrated robotic staplers are unavailable. Fusion RATS proved to be a practical and safe alternative with additional technical and educational advantages, supporting its broader adoption in thoracic surgery.
{"title":"Clinical Outcomes of Fusion Robot-Assisted Thoracic Surgery: A Retrospective Analysis With Propensity Score Matching","authors":"Yasuaki Kubouchi, Toho Wada, Ryota Yasuda, Yuji Nozaka, Wakako Fujiwara, Shinji Matsui, Yugo Tanaka","doi":"10.1111/ases.70193","DOIUrl":"10.1111/ases.70193","url":null,"abstract":"<div>\u0000 \u0000 <p>Fusion robot-assisted thoracic surgery (fusion RATS) has gained much attention as an alternative to console-only approaches (pure RATS), as during fusion RATS, the bedside assistant performs stapling and actively supports the procedure. This study retrospectively analyzed data from 553 patients who underwent robotic anatomical pulmonary resection with either fusion or pure RATS to compare perioperative outcomes. After 1:2 propensity score matching, 294 patients were included in the analysis. Fusion RATS exhibited substantially shorter operative and console times without an increase in complication rates. Moreover, it allowed for flexible stapler insertion angles, enabling the use of reinforced staplers. Assistant participation in key steps may provide educational benefits and improve adaptability, specifically when integrated robotic staplers are unavailable. Fusion RATS proved to be a practical and safe alternative with additional technical and educational advantages, supporting its broader adoption in thoracic surgery.</p>\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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606778","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 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}
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