Annals of Surgical Treatment and Research最新文献

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.

Purpose: Neoadjuvant therapy (NAT) followed by surgical resection is the standard treatment for borderline resectable pancreatic cancer. The optimal timing for surgery after NAT, however, is unclear.

Methods: This study retrospectively analyzed 83 patients who underwent NAT followed by resection between January 2018 and December 2021.

Results: Before NAT, 22.9% of patients had resectable disease, 57.8% had borderline resectable disease, and 19.3% had locally advanced disease. After NAT, 26.5% of patients showed a downstaging of their clinical stage. After NAT, median CA 19-9 levels decreased from 148.0 to 31.7, mean tumor size from 3.1 to 2.3 cm, and the mean PET-CT maximum standardized uptake value from 6.3 to 3.6. Three-year overall survival (OS) and recurrence-free survival (RFS) were 46.7% and 22.6%, respectively. RFS and OS were significantly associated with CA 19-9 levels, lymph node metastasis, and postsurgical pathological stage, while OS was also significantly associated with tumor size and NAT. Patients with elevated CA 19-9 (> 37) which normalized after NAT showed a 3-year RFS of 32.5% compared to 0.0% in those who did not. In patients with elevated CA 19-9, OSs were 58.3% and 25.0% for those with a post-NAT decrease of ≥70% vs. those with no decrease, respectively, while RFSs were 22.6% and 0%.

Conclusion: Timing of surgery after NAT should be decided considering post-NAT tumor size and CA 19-9 levels.

Purpose: The hospitalist system, formally adopted in South Korea in 2021 after a pilot program in 2016, has been associated with improvements in inpatient care outcomes and patient satisfaction. However, a persistent shortage of hospitalists- recently worsened by increasing demands on inpatient care-has raised concerns regarding workforce stability. This study aimed to compare job satisfaction and its determinants between medical and surgical hospitalists in South Korea.

Methods: A nationwide cross-sectional online survey was conducted in February 2024 among 389 board-certified hospitalists registered with the Korean Society of Hospital Medicine and the Korean Society of Surgical Hospital Medicine. The survey included questions on demographics, work environment, job satisfaction (monetary and nonmonetary), and career intentions. Statistical analyses included chi-square tests, Mann-Whitney U-tests, and multiple linear regression.

Results: A total of 94 hospitalists responded (67 medical and 27 surgical). Surgical hospitalists reported significantly longer weekly working hours (47.9 hours vs. 40.9 hours, P = 0.013) and higher patient loads (19.5 patients vs. 15.4 patients, P = 0.003). Despite these differences, overall satisfaction levels were similar between the groups. Eligibility for faculty appointment and availability of research and education funding were significantly associated with nonmonetary satisfaction. Annual salary was the most significant predictor of monetary satisfaction, explaining 17.2% of the variance.

Conclusion: Surgical hospitalists experienced higher workloads but maintained comparable satisfaction levels to their medical counterparts. Enhancing academic opportunities and tailoring financial incentives may be effective strategies to improve job satisfaction and support workforce retention across specialties.

Purpose: Laparoscopic excision of choledochal cysts (CC) has become increasingly popular in pediatric surgical practice in Korea. This study aimed to evaluate the efficacy and safety of laparoscopic CC excision in pediatric patients by comparing its outcomes with those of open surgery at a national children's hospital.

Methods: We retrospectively reviewed patients aged <19 years who underwent CC excision with Roux-en-Y hepaticojejunostomy between 2010 and 2024 at our center. The patients were divided into laparoscopic and open surgery groups, and their clinical and perioperative outcomes were compared. Variables included demographics, clinical characteristics, operative details, and preoperative and postoperative laboratory findings.

Results: Seventy-nine patients (17 boys and 62 girls) were included, of whom 33 (41.8%) underwent laparoscopic excision, and 46 underwent open surgery. There were no clinically meaningful differences between the groups in terms of laboratory parameters or the incidence of cholangitis and pancreatitis. The mean operative time was significantly longer in the laparoscopic group (322.3 ± 63.3 minutes vs. 278.2 ± 53.9 minutes, P = 0.002) but decreased with increasing experience. There were no significant differences in the incidence of short- or long-term complications between the groups.

Conclusion: Laparoscopic CC excision is a safe and effective alternative to open surgery in pediatric patients. Although the operation was initially longer, it decreased with accumulated surgical experience. This study shows that laparoscopic CC excision can be safely and effectively implemented in a national children's hospital located outside the capital region, supporting its broader application across diverse clinical settings.