Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Introduction: Celiac artery stenosis (CAS) may exacerbate postoperative complications by impairing arterial perfusion in upper abdominal organs. This study evaluated the prevalence of CAS in patients undergoing pancreaticoduodenectomy and its association with clinically significant postoperative pancreatic fistula (POPF). Methods: A retrospective analysis of 151 patients who underwent pancreaticoduodenectomy between 2017 and 2022 was conducted. CAS was assessed via preoperative computed tomography with a stenosis threshold of ≥50%. Multivariate logistic regression identified risk factors for POPF. Results: CAS ≥50% was observed in 17.2% of patients, and Grade B/C POPF occurred in 17.9%. In patients with a CAS ≥50%, the risk of POPF was significantly increased (Odds Ratio: 16.458, 95% Confidence Interval: 4.575-59.203, P < .001). A pancreatic duct diameter of less than 3 mm and a soft pancreatic texture were found to be associated with POPF in the univariate analysis (P = .029, P = .032, respectively). Additionally, the prevalence of smoking and the median age were higher in patients with a CAS ≥50 (respectively, P = .011 and P = .052). Conclusions: CAS is an independent risk factor for clinically significant POPF. Preoperative CAS identification and management are vital to minimizing postoperative complications. Further studies are needed to confirm these findings.

This piece reflects on the significant evolution in liver surgery over the past five years, building upon a previous series we published in your journal in 2020. We discuss the current state of robotic liver surgery, presenting data on its adoption in Italy and the United States, outcomes compared to open and laparoscopic techniques, and its groundbreaking potential in liver transplantation. The editorial is based on robust, recent literature and aims to provide a balanced and insightful perspective for your readership.

Aim: The aim of the study was to show whether the complications of hepatomegaly increase in patients undergoing LSG. Material Method: This study was designed as a retrospective study. LSG surgeries performed between 2014 and 2024 were examined. Complications were determined by examining blood test results, radiological images, and epicrisis information. Complications were classified according to the Clavian-Dindo classification. The patients were divided into two groups according to the presence of hepatomegaly. Groups were compared according to complications. Results: The study was conducted with a total of 972 patients. Of the patients, 303 (31.1%) were male and 669 (68.8%) were female. The mean age was 37.7 years (range: 18-65). Of all patients, 623 (64%) had hepatomegaly, and 349 (36%) had normal liver size. In the hepatomegaly group, 26 patients had major complications, while 3 patients in the non-hepatomegaly group had them. It was found that major complications were significantly higher in the hepatomegaly group compared to the non-hepatomegaly group (P < .05). Minor complications were observed in 129 patients in the hepatomegaly group and 66 patients in the non-hepatomegaly group. The difference between the two groups for the minor complications was not significant (P > .05).In addition, the average surgery duration and hospital stay were statistically significantly higher in the hepatomegaly group (P < .05). Conclusions: Hepatomegaly significantly increases the major complications after LSG.

Purpose: The aim of this study is to evaluate whether the number of linear stapler firings used during rectal division influences the rate of anastomotic leakage (AL) in patients undergoing left hemicolectomy, sigmoidectomy, or anterior resection for cancer. Methods: This is a retrospective analysis of prospectively collected data. All consecutive patients with left or sigmoid colon or rectal cancer who underwent elective resection with primary anastomosis from 2013 to 2025 were included. Patients were categorized into three groups according to the number of linear stapler firings used to divide the rectum: rectal division with one stapler firing (group A), rectal division with two stapler firings (group B), and rectal division with three or more stapler firings (group C). Results: One hundred and sixty patients were included in group A, 68 patients in group B, and 17 patients in group C. The overall AL rate was 8.2% and rose significantly when multiple stapler firings were used (4.4% versus 13.2% versus 23.5% in groups A, B, and C, respectively; A versus B: P = .04; A versus C: P ≤ .01; B versus C: P = .55). Multivariate analysis confirmed multiple firings as an independent predictor of AL (two stapler firings: odds ratio [OR] = 3.06, P = .04; three or more stapler firings: OR = 5.04, P = .02). Conclusions: Multiple stapler firings during rectal transection are linked to increased rates of AL compared with the use of a single stapler firing. Prospective, multicenter trials are needed to validate these findings and to improve anastomotic safety in left colon, sigmoid, and rectal cancer surgery.

Background: Obstructive jaundice is a common condition in daily clinical practice. Given the severity of its potential complications, prompt management and resolution are essential. Percutaneous biliary drainage is a viable therapeutic option. The aim is to evaluate the effectiveness of percutaneous biliary drainage in reducing bilirubin levels and providing symptomatic relief in patients with obstructive jaundice treated at Hospital Nacional Posadas between 2019 and 2024. Methods: A retrospective review was conducted using the database of Hospital Nacional Prof. A. Posadas. All patients diagnosed with obstructive jaundice (total bilirubin ≥2 mg/dL) who underwent percutaneous biliary drainage between June 2019 and May 2024 were included (n = 118). Data collected included age, sex, comorbidities, procedures, underlying cause, complications, laboratory results, and symptomatic improvement. Results: A total of 118 patients underwent percutaneous biliary drainage. Of these, 58 (49.1%) were female and 60 (50.8%) were male. The mean age was 60.43 years. The average baseline total bilirubin level was 15.44 mg/dL. Clinical presentation included jaundice (86.44%), fever (20.33%), and pain (55.08%). At 72 hours postprocedure, 59.32% of patients experienced a 50% reduction in bilirubin levels, and 70.33% reported symptomatic relief. The average total bilirubin at discharge was 8.6 mg/dL. Procedure-related complications occurred in 5.08% of patients, the most common being hemorrhage (2.54%). A second drainage procedure or catheter replacement was necessary in 31.34% of cases, and 15.25% required an additional intervention (endoscopic retrograde cholangiopancreatography or surgery) to achieve adequate bilirubin reduction. Conclusion: In our series, percutaneous biliary drainage proved to be an effective and safe method for reducing bilirubin levels and providing symptomatic relief, with an acceptably low complication rate.

Introduction: Following a previous study focused on the status of robotic surgery in Italy in 2020, we aimed to present the updated study reflecting data up to 2025. Patients and Methods: An online questionnaire has been sent to robotic pediatric centers in Italy. The duration of robotic activity, the number of surgeons performing robot-assisted surgery (RAS), the modality of training, volume, type, and outcome of RAS in each participating center have been collected and analyzed. Results: The number of centers practicing robotic surgery in Italy increased by 55.5% rate. All 14 centers adopted the Da Vinci Intuitive console. Three out of 14 centers have a dedicated console, while 11 out of 14 centers share the robotic platform with adult surgeons. Nine out of 14 centers routinely adopted a fourth 5-mm laparoscopic trocar for the bedside surgeon. About 1105 robotic procedures have been performed, the majority were still urological (46.7%). The others were gastrointestinal 18%, oncological 17.1%, gynecological 10.9%, and thoracic 3.6%. The rest (3.7%) were considered varia. All centers prefer to operate patients weighing more than 10-15 kg. Conclusions: Robotic pediatric activity in Italy has had an important development in the last 5 years. Although there has been a significant increase, the majority of centers (78.6%) have a minimal robotic activity. Future directions are going to be the presence of robotic platforms in every pediatric centers; in this way, the robots can be adopted routinely in the pediatric surgical practice as laparoscopy. For pediatric surgery, we also need smaller instruments because 8 mm cannot be adopted in neonates and smaller infants.

Background: Direct peroral cholangioscopy (DPOC) offers enhanced visualization and therapeutic capabilities in biliary tract procedures. However, comparative data on intubation methods and procedural efficiency remain limited. This study aimed to evaluate the success rate, complication rate, and intubation time across five different biliary intubation techniques used in DPOC. Methods: This retrospective study analyzed 36 consecutive patients who underwent DPOC between December 2021 and March 2024. Indications included cholelithiasis, cholangiocarcinoma, proximal migration of biliary prostheses, and self-expandable metallic stent (SEMS) occlusion. Five intubation methods were assessed: freehand, freehand with overtube, intraductal balloon, intraductal balloon with overtube, and intraductal balloon with overtube plus SEMS. Primary outcomes were technical success, intubation time, and complications. Results: All 36 procedures achieved successful biliary intubation (100% technical success) with no reported complications (0%). Mean intubation time differed significantly between methods (P < .001), with the shortest time observed in the intraductal balloon group (mean 73.3 seconds) and the longest in the freehand group (mean 202.25 seconds). No significant differences in intubation time were observed across clinical indications (P = .31). Conclusions: DPOC is a safe and effective procedure for various biliary pathologies, with accessory-assisted methods-particularly balloon-based techniques-demonstrating greater procedural efficiency. These findings support broader adoption of DPOC and tailored selection of intubation strategies based on anatomical and clinical context.

Purpose: This study aimed to assess the effectiveness, safety, and feasibility of a novel robotic surgical system-the KangDuo Surgical Robot-01 (KD-SR-01)-for treating clinical stage I-III distal gastric cancer (GC) by comparing it to conventional laparoscopic gastrectomy (LG). Methods: From September to December 2023, 15 patients with distal GC underwent gastrectomies using the KD-SR-01 (KD group). An additional 15 cases of LG performed by the same surgeon during the same period were selected as the control group (LG group). Preoperative, intraoperative, and postoperative data were analyzed and compared between the two groups. Results: Both groups achieved the same surgical success rate, with no conversions to open surgery. The KD group exhibited significantly less blood loss (30 [20-60] mL versus 50 [30-200] mL, P < .001) and reported a lighter workload (27.5 ± 3.0 versus 30.1 ± 2.6, P = .011) compared to the LG group. Although the operation time in the KD group was significantly longer (213.3 ± 30.1 minutes versus 166.0 ± 32.8 minutes, P < .001), it was not significantly different from the LG group when excluding the device docking time of KD-SR-01 (179.7 ± 24.5 minutes versus 166.0 ± 32.8 minutes, P = .207). There were no significant differences in postoperative hospital stay (7.7 ± 1.5 days versus 7.3 ± .8 days, P = .357) and complication rates (26.7% versus 40.0%, P = .700) between the two groups. Conclusion: The KD-SR-01 is safe and effective for treating distal GC and may be a viable alternative to conventional LG.

Introduction: Single-port robotic surgery (SPRS) provides a single-incision alternative to multiport robotic surgery (MPRS), preserving benefits such as enhanced visualization, dexterity, and ergonomics while reducing the number of incisions. Earlier single-site platforms were limited by instrument mobility and steep learning curves. The da Vinci SP® system addresses these limitations with independently articulated robotic arms that improve precision and maneuverability. Methods: We retrospectively reviewed 5 adolescent patients who underwent SPRS using the da Vinci SP® system at our institution between November 2024 and March 2025. Perioperative and postoperative outcomes were assessed, with follow-up conducted in the clinic within 3 weeks. Data were analyzed using Microsoft Excel. Results: Procedures included cholecystectomy (n = 3), femoral hernia repair (n = 1), and left ovarian cystectomy (n = 1). All procedures were completed via a single 20-25 mm umbilical incision without additional ports or conversion to open. The mean age was 16.4 years (range: 14-18), and the mean weight was 60.8 kg (range: 45.5-77.6). Console times ranged from 32 to 54 minutes (mean 41). All patients were discharged the same day, received no narcotics, and experienced no postoperative complications at 3 weeks. Conclusion: SPRS using the da Vinci SP® system appears technically feasible in carefully selected adolescent patients, with favorable short-term outcomes in this small case series. While encouraging, these results should be interpreted as preliminary. Further studies with larger cohorts and longer follow-up are needed to determine long-term safety, outcomes, and cost-effectiveness.

Background: Lymphocele is an important condition commonly seen in the follow-up of patients who underwent radical prostatectomy and extended pelvic lymph node dissection (ePLND) for prostate cancer. Since the formation and treatment of lymphocele may have negative consequences in terms of patient-care and health expenditure. Several techniques have been used to prevent lymphocele. In this study, we aimed to investigate the efficacy of the previously described preventing lymphocele ensuring absorption transperitoneally (P.L.E.A.T.) technique and compare the outcomes of patients who underwent this technique. Methodology: The data of patients who underwent robot-assisted laparoscopic radical prostatectomy with ePLND for prostate cancer between 2017 and 2023 in our institution were retrospectively analyzed. Patients were divided into two groups according to the application of the P.L.E.A.T. technique in their operations. All patients were followed up with the same protocol. Patient characteristics and postoperative follow-up data were statistically analyzed. Results: Data of 78 patients (26 patients in the P.L.E.A.T. group and 52 patients in control group) were evaluated retrospectively. There were no statistically significant differences between the groups in terms of demographic and clinical characteristics, including age, prostate-specific antigen levels, body mass index, American Society of Anaesthesiologists score, D'Amico risk classification, or the number of lymph nodes removed. Analysis of postoperative data revealed statistically significant differences between the two groups in total amount of drainage (P < .05), drain removal day (P < .05), and length of hospital stay (P < .05). Conclusions: Our experience with the P.L.E.A.T. technique showed potential advantages in line with the literature, with a considerable reduction in total drain amount, drain removal day, and length of stay.