Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Portal vein embolization (PVE) is the standard strategy to increase future liver remnant (FLR) before major hepatectomy, but its limitations-variable hypertrophy, slower kinetics, and clinically relevant dropout from insufficient FLR growth or tumor progression-have accelerated interest in alternative approaches. Liver venous deprivation (LVD), combining portal inflow deprivation with ipsilateral hepatic venous outflow occlusion, has a strong physiological rationale: It may intensify regenerative signaling and reduce compensatory collateralization within the embolized liver, thereby promoting faster FLR increase. Emerging observational evidence and multicenter experiences suggest that dual-vein strategies can shorten time to adequate FLR and may improve the probability of timely resection in selected high-risk candidates, without a clear safety penalty when performed in experienced centers. However, current data are heterogeneous in patient selection, technique, and endpoints; volumetric hypertrophy does not always translate into functional gain, particularly in injured or cholestatic livers. Therefore, LVD is not yet ready to universally replace PVE, but it is increasingly reasonable as a first-line alternative in carefully selected patients, ideally supported by multidisciplinary selection, standardized reporting, and functional FLR assessment. Ongoing randomized trials and harmonized outcome definitions will be decisive to establish whether LVD should become the new reference or remain a complementary option.

Background: The Endoscopic Surgical Skill Qualification System (ESSQS), established by the Japanese Society for Endoscopic Surgery, provides a centralized video-based framework for certifying advanced laparoscopic surgeons. Its impact on surgical practice and education in inguinal hernia repair has not been fully clarified.

Methods: Between 2016 and 2023, a nationwide questionnaire combining multiple-choice and open-ended items was distributed to all surgeons certified in endoscopic hernia repair under ESSQS. Of 120 eligible surgeons, 103 (85.8%) responded. Data included surgical techniques, dissection methods, mesh selection, fixation practices, and video submissions required for certification. Trends were analyzed across early (2016-2019) and late (2020-2023) cohorts.

Results: The surgical techniques used in the certification examination were transabdominal preperitoneal inguinal hernia repair (TAPP) (n = 99) and totally extraperitoneal inguinal hernia repair (n = 4). Gauze-assisted dissection became standard (>80% adoption). Use of L-sized mesh increased significantly in the late cohort compared with the early cohort (56.0% vs 85.7%; P = .00175), reflecting progressive standardization. Median video duration was 63 minutes, and the median number of cases before certification was approximately 100. Mesh fixation methods remained stable, with a median of 5-6 tacks per case.

Conclusions: The ESSQS has contributed to the standardization of surgical education and practice in Japan, particularly in TAPP hernia repair, and this framework-rarely seen in Western qualification systems-underscores the importance of structured evaluation in advancing both technical proficiency and educational quality. This study was approved by our Institutional Review Board (Approval No. 4763) and the Medical Ethics Committee of Kurashiki Central Hospital.

Situs inversus totalis (SIT) is a rare genetic condition that presents a significant challenge for laparoscopic surgery because of its mirror-image anatomy. While reported globally, this is the first documented case of laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis in a patient with SIT in Ethiopia. A 43-year-old female with known SIT presented to the hospital with a 5-year history of dyspepsia and left upper quadrant abdominal pain. Ultrasound confirmed cholelithiasis. After a thorough preoperative workup to rule out associated syndromes, she underwent elective LC. A modified trocar placement and the "French" patient position were utilized to accommodate the anatomical reversal and facilitate the procedure for a right-handed surgical team. LC is a feasible and safe procedure for patients with SIT, even in settings where laparoscopy is emerging. The French position can simplify the procedure by minimizing the cognitive and technical load for the surgeon, avoiding the need for a complete mirror-image setup. This case underscores the potential for expanding advanced minimally invasive techniques in Ethiopia through collaborative education and training.

Background: Laparoscopic appendectomy represents the standard of care for pediatric acute appendicitis. However, conventional techniques utilizing CO₂ pneumoperitoneum introduce physiological disturbances that may increase postoperative care requirements. The gasless single-port transumbilical extracorporeal approach (gasless-TULAA) eliminates pneumoperitoneum-related complications, yet its impact on nursing workload and recovery dynamics remains systematically unexamined in pediatric populations.

Objective: To compare the effects of gasless-TULAA versus conventional laparoscopic appendectomy (CLA) on postoperative nursing burden and recovery outcomes in pediatric patients.

Methods: A retrospective cohort study was conducted involving 266 pediatric patients with uncomplicated acute appendicitis at a single tertiary center between January 2022 and March 2025. Patients were allocated to either gasless-TULAA (n = 101) or CLA (n = 165). The primary endpoints were the frequency of postoperative nursing interventions and time to first ambulation and bowel function recovery. Secondary outcomes included postoperative pain scores, complication rates, length of hospital stay, direct hospitalization costs, and cosmetic satisfaction.

Results: The gasless-TULAA group demonstrated significantly reduced nursing interventions (mean 2.17 ± 2.10 versus 2.74 ± 1.93, P = .029), shorter time to first ambulation (7.72 ± 1.20 hours versus 11.69 ± 2.06 hours, P < .001), and faster bowel recovery (10.30 ± 4.03 hours versus 11.64 ± 5.08 hours, P = .025). Postoperative pain scores were lower (median Numeric Rating Scale score 2 versus 3, P = .002), costs were reduced (944.41 ± 254.11 USD versus 1032.77 ± 223.34 USD, P = .004), and cosmesis satisfaction was higher (9.05 ± 0.73 versus 8.00 ± 0.92, P < .001). Complication rates did not differ (9.8% versus 10.2%, P = .902).

Conclusion: Gasless-TULAA significantly reduces nursing burden and accelerates recovery compared with CLA, without compromising safety, supporting its integration to optimize perioperative care efficiency in pediatric surgery.

Purpose: Aquablation and Rezūm are established minimally invasive surgical therapies for benign prostatic hyperplasia (BPH) in men with moderate-sized prostates. However, direct real-world data comparing outcomes of these techniques in prostates <80 g remain limited. This study aimed to evaluate and contextualize perioperative and functional outcomes of Aquablation and Rezūm in a prospective, nonrandomized cohort.

Methods: We conducted a prospective, nonrandomized comparative cohort study between 2023 and 2025 at a single tertiary center. Treatment allocation was based on the patient's informed preference following standardized counseling. Men with moderate-to-severe lower urinary tract symptoms and prostate volume <80 g were included. Outcomes included the International Prostate Symptom Score, quality of life (QoL), irritative symptoms, urinary continence, sexual function, perioperative parameters, complications, and retreatment. Between-group comparisons were exploratory and interpreted descriptively due to baseline differences.

Results: A total of 428 patients were analyzed, including 324 who underwent Aquablation and 104 who underwent Rezūm. Baseline characteristics differed between groups, with Aquablation patients being older and having larger prostates and higher comorbidity burden. Both procedures resulted in significant and durable improvements in lower urinary tract symptoms and QoL. Aquablation demonstrated numerically greater symptom improvement and faster reduction in irritative symptoms, while Rezūm was associated with shorter operative time and same-day discharge. Erectile and ejaculatory function were largely preserved in both cohorts. Perioperative complication and retreatment rates were low and comparable.

Conclusion: In this real-world, nonrandomized cohort, both Aquablation and Rezūm provided meaningful and durable symptom relief with preservation of sexual function in men with prostates <80 g. Given baseline imbalances and patient-preference-based allocation, outcomes should be interpreted as descriptive of real-world performance rather than as definitive comparative superiority. These findings support both modalities as effective minimally invasive options, with treatment selection guided by patient characteristics, expectations, and resource considerations.

Purpose: Non-midline incisional hernias are technically challenging abdominal wall defects, and evidence of laparoscopic intraperitoneal onlay mesh (IPOM) in this setting is limited. This study evaluated the safety and efficacy of laparoscopic IPOM for non-midline incisional hernias and assessed the impact of different defect closure techniques on perioperative outcomes.

Methods: This single-center retrospective study included patients who underwent laparoscopic IPOM repair for non-midline incisional hernias between September 2019 and June 2025. Demographics, body mass index, comorbidities, hernia classification, defect size and area, closure technique, operative time, blood loss, postoperative length of stay, 24-hour pain scores, complications, and recurrence were recorded. Comparisons among the closure groups were performed using the Kruskal-Wallis test.

Results: A total of 43 patients were included. The mean defect area was 57.15 ± 53.12 cm², operative time was 133.51 ± 40.68 minutes, intraoperative blood loss was 20.65 ± 11.42 mL, and postoperative hospital stay was 5.79 ± 2.45 days. Overall complication rate was 7.0%, including 1 case each of chronic pain, seroma, and ileus, and recurrence occurred in 1 patient. Barbed suture, hernia needle, and combined closure techniques were used in 10, 16, and 17 patients, respectively. The combined group had larger defects and longer operative times, whereas blood loss, hospital stay, and 24-hour pain scores were comparable among the groups.

Conclusions: Laparoscopic IPOM is a safe and effective option for non-midline incisional hernias, achieving low complication and recurrence rates. A combined closure technique is suitable for larger defects, increasing operative time without worsening early perioperative outcomes.

Preserving anal function in ultra-low rectal cancer surgery remains challenging in terms of technique and perioperative management. With advancements in minimally invasive techniques, Da Vinci robot-assisted intersphincteric resection (ISR) has been increasingly utilized, yet its clinical benefits remain unclear. This retrospective cohort study included 142 patients who underwent ISR at the Second Xiangya Hospital of Central South University from January 2019 to December 2024, divided into the robot-assisted ISR (RoISR) group (n = 71) and the laparoscopic ISR (LaISR) group (n = 71). Perioperative outcomes, postoperative complications, pain scores (numerical rating scale [NRS]), Wexner scores, quality of life (Functional Assessment of Cancer Therapy-Colorectal [FACT-C] scale), and long-term survival outcomes were compared. Results showed that RoISR had a longer operative time (220.27 ± 32.21 versus 179.63 ± 23.88 minutes, P < .001) but earlier time to first flatus (1.77 ± 1.50 versus 2.32 ± 1.67 days, P = .041) and shorter hospital stay (8.25 ± 3.38 versus 9.77 ± 4.63 days, P = .027), with comparable blood loss and costs. The 30-day complication rate was lower in the RoISR group (7.04% versus 19.72%, P = .027), including reduced anastomotic complications (1.41% versus 5.63%) and bleeding (0% versus 4.23%). NRS pain scores were lower in the RoISR group at 12 hours (3.56 ± 0.84 versus 4.79 ± 1.11, P < .001), 24 hours (1.90 ± 0.85 versus 2.35 ± 1.02, P = .05), and 48 hours (1.07 ± 0.87 versus 1.61 ± 0.80, P < .001). Wexner scores showed greater improvement in the RoISR group at 3 months (9.49 ± 2.26 versus 10.45 ± 2.10, P = .01) and 6 months (7.18 ± 1.88 versus 7.94 ± 1.96, P = .02). Emotional functioning on the FACT-C scale was significantly better in the RoISR group (P = .028). Kaplan-Meier analysis indicated no significant differences in overall survival or recurrence-free survival (RFS) between groups. In conclusion, RoISR offers advantages in perioperative recovery, reduced complications, and improved aspects of quality of life, with long-term survival outcomes comparable to LaISR.

Background: Cholelithiasis is a very common pathology in the world, with Mexico being one of the countries with the highest prevalence, affecting approximately 27% of the female population. It is also known that the coexistence of cholelithiasis and choledocholithiasis occurs in approximately 15% of cases, in which case a simultaneous surgical approach is possible: cholecystectomy and biliary tract exploration. Furthermore, it is reported that approximately 10% of patients with choledocholithiasis present as "difficult stone," in which the endoscopic approach is ineffective, making a surgical approach necessary. Therefore, surgery is essential in cases when the biliary tract needs to be explored. Hence, the purpose of this study is to demonstrate our experience with the minimally invasive surgical approach for choledocholithiasis using transductal bile duct exploration.

Methods: Between January 2020 and May 2025, 29 consecutive patients underwent minimally invasive biliary tract exploration surgery at our hospital; from these, 26 cases were included. Information regarding the demographics of patients, comorbidities, number of previous endoscopic retrograde cholangio-pancreatographys (ERCPs) before surgery, preoperative diagnostic workup, therapeutic interventions, details of minimally invasive transductal bile duct exploration, and postoperative outcomes, including morbidity and mortality, was recorded retrospectively.

Results: We recorded 29 patients who underwent bile duct exploration; from these, 26 patients with choledocholithiasis were operated on with minimally invasive transductal bile duct exploration (TD-BDE) (22 laparoscopic, 4 robotic). Women represented 65.3% of the cases. The median age was 54 years (range 31-87). The median operative time was 181 minutes (range 75-310) and bleeding 125 mL (range 10-350); 21 cases (80.7%) include cholecystectomy in the same procedure. Oral intake was started in the first 48 hours. A bile leak occurred in 1 case (3.8%). There was 1 patient who needed a new ERCP 2 years after surgery because of bile duct stenosis. None of the patients required re-intervention. No mortality was recorded. The maximum follow-up was 36 months (range 1-36).

Conclusions: TD-BDE is a therapeutical option for choledocholithiasis, especially for "difficult stone" cases, with low morbidity and mortality. Furthermore, the benefits of minimally invasive approaches, either laparoscopic or robotic, seem to be feasible and safe; and also ERAS programs can be established considering the multidisciplinary approach of patients.

Introduction: Complete mesocolic excision (CME) may increase lymph node retrieval and provide a more complete oncologic excision compared with D2 dissection, although its perioperative safety remains uncertain. This systematic review and Bayesian meta-analysis compared clinical and operative outcomes between CME and D2 in right colectomy.

Methods: PubMed, EMBASE, and Cochrane Central were searched through November 2025. Randomized controlled trials comparing CME with D2 were included. Frequentist analyses used random-effects models with DerSimonian-Laird estimation. Bayesian random-effects models applied weakly informative priors (binary outcomes: log[RR] ∼ N(0, 1.5²), τ ∼ Half-Normal(0.5); blood loss: μ ∼ N(0, 100²), τ ∼ Half-Normal(100); lymph node yield: μ ∼ N(0, 6²), and τ ∼ Half-Normal(3)). Heterogeneity was assessed using I² and Cochran's Q. Analyses were conducted in R (v4.4.2) with bayesmeta.

Results: Three randomized trials (1378 patients; CME 678, D2 700) met inclusion criteria. CME resulted in higher lymph node harvest (MD + 3.9; 95% CI: 2.8 to 5.0; P < .001) and longer operative time (MD + 11.6 minutes; 95% CI: 6.6 to 16.7; P < .001). No significant differences were found in blood loss, overall complications, severe complications, intraoperative complications, conversion, or 30-day mortality. Bayesian modeling provided very strong evidence for increased nodal yield (P[CME > D2] = 99.1%) and hemostatic equivalence (P[equivalent ± 50 mL] = 95.9%), with a modest probability favoring fewer severe complications (P[RR < 1] = 82.9%).

Conclusion: CME offers superior oncologic radicality, reflected by higher lymph node retrieval, while maintaining perioperative outcomes equivalent to D2. Bayesian evidence reinforces CME as an effective and safe surgical strategy for right-sided colon cancer.