This document presents a comprehensive overview of the management of postinflammatory pancreatic and peripancreatic fluid collections, with a particular emphasis on endoscopic treatment, developed by a team of experts based on the latest clinical and scientific evidence. The guidelines present a detailed scheme of treatment of patients with local complications of acute pancreatitis in the form of postinflammatory pancreatic and peripancreatic fluid collections.
Introduction: Vaginal myomectomy (VM) is a minimally-invasive surgery to remove uterine fibroids; however, limited exposure, difficulties in suturing, and challenges in achieving hemostasis restrict its wider adoption. To address these limitations, the Sahin transvaginal extracorporeal (STVEC) technique was developed, allowing for complete uterine exteriorization for extracorporeal reconstruction.
Aim: We aimed to evaluate the safety, feasibility, and perioperative outcomes of the STVEC technique in women undergoing surgery for symptomatic uterine myomas.
Materials and methods: This retrospective cohort included 200 consecutive patients who underwent VM using the STVEC technique between February 2021 and October 2024. Demographic characteristics, myoma features according to the International Federation of Gynecology and Obstetrics (FIGO) classification, operative variables, postoperative outcomes, and complications were analyzed. The complications were graded using the Clavien-Dindo system. Conversion to laparotomy was performed when safe continuation of the STVEC approach was not feasible.
Results: Mean (SD) age of the study cohort was 39.1 (6.5) years and mean (SD) body mass index was 27.5 (5.8) kg/m². Mean (SD) myoma count was 1.8 (1.4; range: 1-5) and mean (SD) diameter was 6.7 (2.4; range, 5-10) cm. Intramural myomas (FIGO type 2-5) were the most common (55%). Conversion to laparotomy occurred in 8 patients (4%) due to adenomyotic uteri, adhesions, prior vaginal surgery, or altered cervical anatomy. Median (interquartile range [IQR]) hemoglobin decrease was 1.7 g/dl, median (IQR) estimated blood loss was 180 ml, and mean (SD) operative time was 71.9 (19.5) minutes. Blood transfusion was required in 18 patients (9%). Early complications occurred in 7 participants (3.5%), and all were minor.
Conclusions: The STVEC technique appears safe and feasible, offering good bleeding control, low complication rates, and rapid recovery. Further multicenter studies are needed to confirm our findings.
Introduction: Esophagectomy is a highly invasive procedure, and early enteral nutrition supports recovery. Feeding jejunostomy is common but may cause fixation-related mechanical complications. To address these issues, a duodenostomy using the hepatic round ligament was adapted to a fully laparoscopic approach.
Aim: We aimed to evaluate the feasibility and short-term outcomes of laparoscopic duodenostomy using the round ligament as enteral access during esophagectomy.
Materials and methods: We retrospectively reviewed 26 consecutive patients who underwent esophagectomy with duodenostomy at a single institution: 15 by a standardized laparoscopic technique and 11 by historical minilaparotomy. The laparoscopic method routes a catheter through a round-ligament sleeve, with double purse-string fixation at the duodenal bulb and 3-point anchoring at the intestinal and abdominal wall sites. The primary outcomes were feasibility and timing of enteral feeding initiation. A tube-related infection was defined as local redness, swelling, purulent discharge, or abscess along the catheter tract or exit site, consistent with the Centers for Disease Control and Prevention criteria. Noninfectious tube-related complications included dislodgement, inversion, or obstruction due to kinking. Differences between the groups are presented descriptively.
Results: All laparoscopic procedures achieved successful catheter placement. Enteral feeding began earlier after laparoscopy (median [interquartile range] postoperative day, 1 [1-2]) than minilaparotomy (2 [2-6]). Tube-related infection occurred in 0 of 15 laparoscopy procedures and 2 of 11 (18.2%) minilaparotomies, and noninfectious tube-related complications occurred in 1 of 15 patients (6.7%) from the former group and 1 of 11 (9.1%) from the latter.
Conclusions: In this small, single-center, retrospective, exploratory series, laparoscopic round-ligament duodenostomy was feasible and coherent with minimally-invasive esophagectomy, and may facilitate earlier enteral access while reducing fixation-related problems; these findings require confirmation in larger prospective studies.
Introduction: Renal artery embolization (RAE) is a minimally-invasive therapeutic option for iatrogenic renal vascular injuries (IRVIs).
Aim: We aimed to assess the efficacy and safety of RAE in treating IRVIs resulting from percutaneous interventions.
Materials and methods: The study included 34 patients (25 men, 9 women; mean [SD] age, 49.1 [18.9] years) who were treated with RAE for IRVIs at our center between February 2019 and May 2025. The etiology and type of IRVIs, hemoglobin levels, accompanying radiological findings, and parameters related to the RAE procedure were retrospectively analyzed.
Results: Among the 34 patients, the etiology of IRVI was percutaneous biopsy in 17 individuals and percutaneous nephrolithotomy in the remaining 17 cases. A total of 35 RAE procedures were performed (1 reintervention). The IRVIs were classified as active extravasation (n = 24), pseudoaneurysm (n = 9), and arteriovenous fistula (n = 2). Parenchymal laceration was observed in 10 patients, and a collecting system injury was noted in 1 individual. The embolic agents used were coils (49%), N-butyl cyanoacrylate mixed with lipiodol (28%), polyvinyl alcohol (PVA) particles (14%), a combination of coils, glue, and lipiodol (6%), and a combination of PVA particles and coils (3%). The technical success rate was 100%, while the clinical success rate was 97%. Only 1 patient required reintervention due to persistent hemorrhage. Minor complications occurred in 3 patients, and no major complications were observed.
Conclusions: RAE is a safe, highly effective, and minimally-invasive treatment for IRVIs. The procedure offers additional advantages, including nephron preservation and the potential for repeat intervention, if necessary.
Introduction: Minimally-invasive cholecystectomy is one of the most commonly performed surgical procedures. However, iatrogenic injuries related to the hepatocystic triangle anatomy can occur even if the performing surgeon has extensive experience. Therefore, an objective method that could help prevent such damages during surgery is needed.
Aim: This study aimed to develop an artificial intelligence (AI)-based image recognition model using indocyanine green (ICG)-based near-infrared cholangiography (NIRC) to identify the hepatocystic triangle during minimally-invasive cholecystectomy.
Materials and methods: Anatomical landmark prediction of the hepatocystic triangle was evaluated using the YOLOv5s model, a real-time object detection algorithm in computer vision. From 200 cholecystectomy videos, 3796 images were extracted, of which 2979 were used for training and 817 for validation. Original and ICG-enhanced images were overlaid and annotated to identify the hepatocystic triangle, and the model generated bounding boxes for each predicted landmark.
Results: Using the nonmaximum suppression (NMS) algorithm, model performance changed according to the intersection over union (IoU) threshold. This high level of IoU threshold (0.7-0.9) resulted in duplicate predictions. The optimal IoU of NMS was 0.6 in multiple experiments, and the average precision score was 0.859.
Conclusions: We successfully developed an AI-based image recognition model using intraoperative ICG-NIRC to predict the location of the hepatocystic triangle and help prevent bile duct injury during cholecystectomy. This model, based on real anatomical localization data, shows potential clinical utility by predicting the bile duct location before tissue dissection.
Introduction: Anxiety and depression are persistent problems among patients with gastrointestinal (GI) cancers.
Aim: This study aimed to evaluate the efficacy of time-dynamic screening for anxiety and depression in patients undergoing primary surgery for GI cancers.
Materials and methods: A total of 876 individuals were reviewed. The patients who underwent dynamic screening for anxiety and depression were selected as the screening cohort. A 1:1 propensity-score matching was performed for the controls. The primary end point was 1-year disease-free survival (DFS). Secondary outcomes included inflammatory cytokine levels, leukocyte counts, and scores from the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 item (GAD-7), and the 5-level European Quality of Life Five-dimension (EQ-5D-5L) assessment.
Results: One-year DFS was higher among the screening cohort than the controls (91.4% vs 81.2%; P <0.001). The levels of anxiety and depression decreased over time in the screening cohort, with lower mean (SD) PHQ-9 scores of 8.19 (1.32) 1 month postoperatively and 6.9 (1.33) at 3-month follow-up (P <0.001), and lower mean (SD) GAD-7 scores of 7.73 (3.94) 1 month after surgery and 5.01 (3.31) 3 months postoperatively (P <0.001), as compared with the controls. At 3 months postsurgery, the screening cohort showed better outcomes than the controls in terms of the levels of interleukin-6 (P = 0.003) and tumor necrosis factor α (P <0.001), as well as the CD3+ cell count (P = 0.02), CD4+/CD8+ ratio (P = 0.02), and natural killer cell count (P = 0.006). The patients undergoing screening exhibited greater improvements in the EQ-5D-5L scores over time than the controls (P <0.001). Minor adverse events were observed in 8.2% of the screening cohort.
Conclusions: Time-dynamic screening for GI cancers effectively reduces anxiety and depression after surgery, improves immune function, and enhances quality of life, thus contributing to a better prognosis at 1 year follow-up.
Introduction: Giant cervical disc herniation (GCDH), defined as CDH occupying more than 50% of the spinal canal, presents a significant challenge in spinal surgery. This study specifically investigated a distinct subgroup of patients with soft GCDH, characterized by an absence of ossification of the posterior longitudinal ligament (OPLL) or significant calcification.
Aim: We aimed to assess the feasibility and efficacy of microscopy-assisted anterior cervical discectomy and fusion (MS-ACDF) for treating soft GCDH-induced cervical spondylotic myelopathy (GCDH-CSM).
Materials and methods: This retrospective study analyzed 22 consecutive patients with soft GCDH-CSM who underwent MS-ACDF. The inclusion criteria explicitly required confirmation of soft DH without OPLL or signs of significant calcification on preoperative imaging. The analysis included clinical and imaging data, encompassing demographic characteristics, pre- and postoperative visual analog scale (VAS), Neck Disability Index (NDI), and Japanese Orthopedic Association (JOA) scores, X-ray, magnetic resonance imaging (MRI), and computed tomography results to assess efficacy of the technique.
Results: All surgical procedures were successfully completed without complications, demonstrating the safety and reliability of the MS-ACDF technique. Postoperative assessment showed marked clinical improvement, with MRI confirming thorough removal of the herniated disc and adequate decompression of the spinal cord. During a median (interquartile range [IQR]) follow-up of 14 (13-17) months, mean (SD) VAS and NDI scores, respectively, decreased from preoperative 4.82 (1.11) and 15.95 (2.26) to 2.22 (1.08) and 10.22 (2.02) at day 3 postoperatively, and further to 0.77 (0.79) and 7.04 (1.06) at the final follow-up. Mean (SD) JOA score improved from 9.27 (1.81) preoperatively to 12.77 (1.51) on postoperative day 3, and further increased to 15.22 (0.95) at the final follow-up. No severe complications were noted.
Conclusions: MS-ACDF represents a viable option for soft, noncalcified GCDH, providing satisfactory clinical and functional improvement at mid-term follow-up.
Introduction: Robotic-assisted thoracic surgery (RATS) is increasingly used in lung cancer treatment. As surgical education progressively shifts to online platforms, such as YouTube, concerns have emerged regarding the reliability of available content. This study evaluated the educational quality of the most-viewed RATS lobectomy videos on YouTube, using the Laparoscopic Surgery Video Educational Guidelines (LAP-VEGaS) and the Critical View of Safety (CVS) criteria.
Aim: We aimed to evaluate the educational quality of widely viewed YouTube videos on RATS using the LAP-VEGaS assessment and CVS criteria tools.
Materials and methods: A YouTube search was performed using a key word "robotic lobectomy." A total of 25 videos with more than 5000 views that met the inclusion criteria were evaluated in terms of video characteristics and educational quality. The assessment was performed using the CVS and LAP-VEGaS criteria, and statistical analyses were conducted to explore correlations between video features and the scores.
Results: A total of 25 videos met the inclusion criteria. Right upper lobectomy was the most frequently demonstrated procedure. Median view count was 7157 (6001-14 152), with significant correlations between views and likes, as well as duration online. Overall educational quality was limited, with median CVS compliance of 50% (50%-62.5%) and a median LAP-VEGaS score of (4-10.5).
Conclusions: The educational quality of robotic-assisted lobectomy videos on YouTube is heterogeneous and generally suboptimal. Peer-reviewed and standardized video archives curated by academic institutions or professional societies are needed to ensure reliable resources for robotic surgery training.
Introduction: Urological disorders requiring laparoscopic intervention are increasingly common in modern medical practice.
Aim: This study aimed to evaluate the effect of seamless intervention in the operating room combined with pain management on urological laparoscopic surgery efficiency.
Materials and methods: A total of 100 patients undergoing urological laparoscopic surgery at our hospital from May 2022 to May 2024 were divided into 2 equal groups. The control group received conventional nursing, while the observation group received seamless intervention combined with pain management. Various comparisons were made, including pre- and postnursing anxiety (as assed via the Self-Rating Anxiety Scale [SAS]), depression (as evaluated using the Self-Rating Depression Scale [SDS]), and sleep quality (as measured with the Pittsburgh Sleep Quality Index [PSQI]) scores, pain levels (as assessed via the numeric rating scale [NRS]), surgical efficiency (turnover time, preparation time, and operative time), stress response indicators before and 24 hours after surgery, patient satisfaction, and complication rates.
Results: Postnursing, the SAS, SDS, and PSQI scores were lower in the observation group (P <0.01). The NRS scores on days 2 and 3 after surgery were also reduced in the observation group (P <0.01), as compared with the controls. Surgical efficiency (turnover time, preparation time, and operative time) was greater in the observation group (P <0.01). Stress response indicators 24 hours postsurgery were notably reduced in the observation group (P <0.01). The observation group had a higher satisfaction rate (P <0.001) and a lower incidence of complications (P = 0.09), as compared with the control group.
Conclusions: Seamless intervention in the operating room combined with pain management significantly improves psychological state, sleep quality, pain relief, surgical efficiency, stress response, and patient satisfaction, as well as reduces complications in urological laparoscopic surgery patients.
Introduction: Primary liver cancer ranks among the most prevalent malignancies globally. AIM We aimed to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with targeted immunotherapy in initially unresectable hepatocellular carcinoma (uHCC), and identify patients most likely to benefit from this approach.
Materials and methods: We retrospectively analyzed 68 uHCC patients treated with TACE with targeted immunotherapy at the Nanjing Drum Tower Hospital (April 2020-July 2024). Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors. Progression‑free survival (PFS) and overall survival rates were estimated with the Kaplan-Meier analysis. Logistic and Cox regression models were used to identify the predictors of response and survival.
Results: The objective response rate was 57.4%, and the disease control rate amounted to 89.7%. Median PFS was 13.8 months (95% CI, 8.7-19), with 6- and 12‑month PFS rates of 73.1% and 52.5%, respectively. Surgical conversion occurred in 52.9% of the patients, with 94.6% achieving R0 resection; 47.2% had ma‑ jor pathologic response. Multivariable analysis showed that fewer than 3 tumors (hazard ratio [HR], 6.35; P = 0.01) and absence of major vascular invasion (HR, 3.89; P = 0.03) independently predicted favorable response, while the male sex (HR, 0.27; P <0.001), China Liver Cancer (CNLC) stage Ib-IIa (HR, 6.05; P <0.001), and proton density fat fraction (PDFF) below 6.5% (P = 0.03) predicted longer PFS. Grade 3 adverse events occurred in 52.9% of the patients, with no grade 4-5 events. All were manageable.
Conclusions: TACE with targeted immunotherapy yields high response and surgical conversion rates with acceptable toxicity in uHCC. Patients with CNLC stage Ib-IIa, fewer than 3 tumors, no major vascular inva‑ sion, and low PDFF derive the greatest benefit, supporting this approach as an effective conversion strategy.
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