Annals of Surgical Treatment and Research最新文献

The da Vinci single-port (SP) platform (Intuitive Surgical, Inc.) has catalyzed a new phase of remote-access breast surgery by delivering multi-jointed, wristed instrumentation and stable 3-dimensional optics through a single trocar. This narrative review synthesizes contemporary evidence and practice patterns for SP-assisted procedures, drawing on a recent series of robotic nipple-sparing mastectomies (NSMs). Indications parallel conventional NSM with patient selection favoring small-to-moderate breasts and tumors distant from the nipple-areolar complex; formal contraindications largely mirror those of open techniques. SP kinematic features, such as cobra wrist configurations, diminish the blind spots typical of multiport approaches, and the SP system's combined multi-image display supports real-time imaging overlays that help maintain uniform flap thickness. Across comparative cohorts, overall postoperative complication rates with robotic approaches do not differ significantly from conventional NSM. Oncologic follow-up remains limited, underscoring the need for longer surveillance to establish non-inferiority. Cosmesis and patient satisfaction are consistently superior due to hidden incisions and improved contour. Unique risks demand caution, notably skin-flap ischemia/necrosis, as well as the opposite risk of residual tissue when flaps are made too thick. Safe adoption depends on structured training that includes device familiarization, team-based drills, high-fidelity simulation, and staged proctoring. Recognition of a learning curve characterized by substantial reductions in operative time was found across initial cases. Critical priorities are prospective, controlled trials of oncologic outcomes, standardized frameworks for credentialing and competency, and comprehensive cost-effectiveness evaluations. With disciplined case selection, standardized flap assessment, and team-based training, SP robotic breast surgery achieves concealed-scar cosmesis while maintaining core oncologic principles.

Robotic thyroidectomy has progressed from multiport to single-port (SP) platforms to minimize invasiveness and improve cosmesis. The da Vinci SP system (Intuitive Surgical) combines a flexible 3-dimensional endoscope with 3 wristed instruments in a single 2.5-cm cannula-enabled concealed remote access route and mitigates external arm collisions. This review synthesized PubMed-indexed reports (2020-2025) on SP robotic thyroidectomy using the following approaches: transaxillary variants, SP areolar, retroauricular/facelift (SP-hairline variants), and transoral approach. We focused on technical refinement, learning curves, and clinical outcomes. We highlight technical refinements and clinical outcomes across access routes. Contemporary series indicate that SP thyroidectomy is feasible and safe in well-selected patients, with high cosmetic satisfaction and operative metrics comparable to those of multiport cohorts. Among the SP routes, transaxillary variants have the most mature peer-reviewed reporting and are therefore discussed in greater detail. Early applications of SP-assisted lateral neck dissection have also been described. The limitations of current SP platforms include constrained counter-traction, reduced internal workspace, and incomplete integration of advanced energy devices. Nonetheless, ongoing device innovations and the growing global experience suggest that SP systems will increasingly shape endocrine neck surgeries.

Minimally invasive surgery for gastric cancer has progressed from conventional laparoscopy to reduced-port and single-incision techniques, and further to robotic systems that address ergonomic and technical constraints. Reduced-port laparoscopic gastrectomy and single-incision laparoscopic gastrectomy demonstrated feasibility and cosmetic advantages but faced inherent limitations-restricted triangulation, instrument collisions, and unstable visualization-resulting in steep learning curves and selective adoption. Reduced-port robotic platforms, notably Single-Site (Intuitive Surgical)-based reduced-port totally robotic distal gastrectomy, mitigated some limitations and enabled complex tasks, including D2 lymphadenectomy and intracorporeal anastomosis, with acceptable short-term outcomes. The da Vinci Single-Port (SP) system (Intuitive Surgical) represents the latest step in this trajectory, introducing three fully-wristed instruments and a flexible 3-dimensional endoscope through a single multichannel cannula, restoring internal triangulation and reducing collisions. Early clinical experiences from high-volume centers report no or low conversion rates, minimal blood loss, adequate lymph node retrieval, and acceptable morbidity across distal and selected total gastrectomies. Practical considerations for safe adoption include optimized port placement, deliberate scope orientation, and close collaboration with an experienced bedside assistant. Nonetheless, the platform's current lack of integrated robotic staplers and advanced energy or suction devices limits console autonomy; most cases still require an assistant port. Evidence remains confined largely to small series without head-to-head trials against reduced-port multi-arm robotic approaches. Future priorities include SP-dedicated energy and stapling tools, careful expansion to complex procedures, and robust multicenter studies assessing long-term oncologic outcomes. Taken together, the SP platform can be regarded as the present pinnacle of reduced-port gastrectomy and a promising path toward a reproducible, cosmetically favorable, and ergonomically enhanced approach for gastric cancer surgery.

Purpose: We investigated the antiadhesive effects of lidocaine, methylene blue, and atorvastatin, with a focus on preventing remote adhesions in a rat model of postoperative adhesions.

Methods: Models were assigned to either the control group (saline infusion only) or treatment groups (group L, lidocaine; group M, methylene blue; or group S, atorvastatin). Adhesions were induced by intestinal or abdominal wall injuries. The rats were sacrificed 2 weeks after surgery.

Results: The number of remote adhesions was markedly lower in groups L, M, and S than in the control group. The macroscopic adhesion score was substantially lower in groups L, M, and S than in the control group. Acute and chronic inflammation, as well as fibrosis scores, were also markedly lower in groups L, M, and S than in the control group. IL-1β levels were considerably reduced in groups L, M, and S at 2 hours after surgery and remained substantially lower in group S at 48 hours. IL-6 levels were markedly reduced in groups M and S at 2 hours and in all treatment groups at 48 hours than in the control group.

Conclusion: Intraperitoneal administration of lidocaine, methylene blue, and atorvastatin effectively reduced remote adhesion formation, macroscopic and microscopic adhesion scores, and inflammatory cytokine levels in a rat adhesion model.

The da Vinci Single-Port (SP) robotic system (Intuitive Surgical) was developed to enable true single-incision surgery while preserving the dexterity and precision of advanced robotic platforms. Since its clinical introduction, the SP system has generated growing interest in colorectal surgery, particularly for procedures performed in anatomically confined spaces. However, clinical evidence remains limited and heterogeneous. This narrative review summarizes the current clinical applications, technical considerations, and perioperative outcomes of the da Vinci SP system in the treatment of colorectal cancer. Available literature-predominantly from South Korea and selected centers in the United States-suggests that SP surgery is technically feasible for both colon and rectal cancer. In colon cancer, outcomes appear comparable to conventional laparoscopic and multiport robotic approaches, albeit with longer operative times during early experience. In rectal cancer, SP surgery demonstrates distinct technical advantages, including single docking, reduced incision burden, and favorable short-term outcomes, particularly for low anterior resection and intersphincteric resection. Pathologic outcomes, including lymph node yield and resection margins, are oncologically acceptable across reported series. While early results support the safety and feasibility of SP colorectal surgery, long-term oncologic outcomes and high-level comparative evidence remain lacking. Further prospective studies are warranted to define optimal indications and establish the long-term value of this emerging platform.

Purpose: Weight regain following metabolic/bariatric surgery (MBS) is a common challenge that may compromise the long-term benefits of surgery. This study evaluated the effects of an 8-week circuit training and dietary counseling program on body composition and obesity-related hormones in patients with early post-bariatric weight regain and assessed the influence of FTO rs9939609 genotype.

Methods: This prospective, single-arm intervention enrolled 16 adults with ≥5% weight regain after MBS. Participants completed a structured hybrid program consisting of weekly supervised and home-based circuit training, alongside standardized dietary guidance. Anthropometric, hormonal, and metabolic parameters were measured before and after the intervention. Participants were genotyped for FTO rs9939609 and categorized into TT (non-risk) and AA/AT (risk allele) groups.

Results: After 8 weeks, participants showed significant reductions in body mass index (-4.4%, P < 0.001), waist circumference (-5.8%, P = 0.001), and fat mass (-7.1%, P = 0.004), whereas muscle mass decreased modestly (-2.7%, P = 0.056). Leptin (-29.8%, P = 0.002), ghrelin (-10.2%, P = 0.002), and insulin (-14.5%, P = 0.039) levels also declined significantly. Although the AA/AT group exhibited higher absolute adiposity than the TT group both pre- and postintervention, percentage changes in anthropometric parameters did not significantly differ between the 2 groups.

Conclusion: A structured hybrid exercise and dietary program was effective in reversing early weight regain and improving hormonal profiles after MBS. The FTO risk allele was associated with greater baseline obesity but did not attenuate response to the intervention.

Single-port robotic surgery is emerging in hepatobiliary and pancreatic procedures. Current studies demonstrate safety and feasibility in cholecystectomy, distal pancreatectomy, pancreaticoduodenectomy, and selected liver resections. Although evidence remains limited and indications conservative, ergonomic advantages, stable visualization, and learning-curve improvement suggest expanding applicability as technology and instrumentation mature.

Purpose: In living donor liver transplantation (LDLT), biliary complications (BC) represent the most frequent and challenging postoperative issues. Some centers have adopted external biliary drainage (EBD) to mitigate these complications. While the conventional practice typically involves maintaining the drainage tube for 3 to 12 months, our institution pioneered a short-term placement protocol lasting 6 weeks. This study presents a single-center experience showcasing the efficacy and outcomes of this short-term EBD in LDLT.

Methods: Between January 2013 and November 2022, a total of 123 patients underwent liver transplantation at The Catholic University of Korea, Incheon St. Mary's Hospital. Of these, a retrospective cohort study was conducted on 59 patients who underwent duct-to-duct anastomosis with EBD, excluding 53 patients who underwent deceased donor liver transplantation and 11 patients with insufficient data (due to follow-up loss or absence of EBD). EBD (feeding tube, 500 mm, 5 French) was placed across the biliary anastomosis during the operation. EBD was naturally drained for the first 1 to 3 weeks and was removed after 6 weeks.

Results: Overall, BC was observed in 22 patients (37.3%), comprising 4 cases (6.8%) of bile leakage and 18 cases (30.5%) of biliary stricture. Notably, without reoperation, all BC cases were successfully managed through minimally invasive interventions, including endoscopic retrograde biliary drainage and percutaneous transhepatic biliary drainage. Importantly, no mortalities were attributed to BC, nor were there any severe complications linked to the early removal of EBD.

Conclusion: A single institutional experience showed the effectiveness and safety of short-term EBD.

Purpose: Single-incision laparoscopic totally extraperitoneal hernia repair (SILTEP) is a minimally invasive technique for inguinal hernia that promotes faster recovery. Advanced bipolar (AB) energy devices have recently emerged, offering several benefits in surgical outcomes. This study aimed to compare AB and conventional monopolar (CM) energy devices to assess their impact on surgical outcomes in SILTEP and to evaluate the necessity of using AB devices.

Methods: A retrospective comparative analysis was conducted involving 304 patients who underwent SILTEP, divided into the CM and AB groups based on the energy device used. Patient characteristics, operative details, and postoperative outcomes were compared between the groups.

Results: The AB group exhibited longer operation times but similar morbidity rates compared to the CM group (53.5 ± 21.0 minutes vs. 42.9 ± 14.5 minutes, P < 0.001; 8.1% vs. 11.2%, P = 0.618). There was a significant difference in intraoperative blood loss (CM group: 7.2 ± 4.1 mL vs. AB group: 3.3 ± 5.0 mL, P < 0.001). Although statistically non-significant, a lower trend of seroma formation was observed in the AB group than in the CM group (7.4% vs. 10.7%). Similar early postoperative pain scores were observed in both groups of patients using patient-controlled analgesia; no significant differences in chronic pain were observed between the groups.

Conclusion: AB energy devices may offer advantages for SILTEP, including reduced intraoperative blood loss. AB energy devices may be useful and viable options for SILTEP. Further prospective studies are warranted to validate these findings.