Pub Date : 2025-12-13DOI: 10.1016/j.cireng.2025.800267
Jordi Navinés-López, Alba Zárate Pinedo, Francisco Espin Alvarez, Esteban Cugat Andorrà
This article provides a detailed description of the robotic approach used to perform an extended left hepatectomy with venous resection in a 65-year-old female patient with a Bismuth-Corlette tumour type 3b infiltrating the portal confluence. A Glissonean pedicle approach was used to achieve total prehepatic vascular control and resection of the left portal confluence, followed by transverse reconstruction according to the Heineke-Mikulicz technique. The parenchymal transection, including the entire caudate lobe, was performed robotically, with left hanging manoeuvre after complete piggybacking of the vena cava. The final pathological result was G3 pT2bN1M0 (2/11) signet ring cell adenocarcinoma. The robotic approach enabled adjuvant treatment to be initiated immediately. No major complications were recorded within 90 days, and the patient was discharged on the 5th day.
{"title":"Real robotic approach for left hepatectomy with en bloc caudatectomy and portal vein resection for Bismuth IIIb hilar cholangiocarcinoma.","authors":"Jordi Navinés-López, Alba Zárate Pinedo, Francisco Espin Alvarez, Esteban Cugat Andorrà","doi":"10.1016/j.cireng.2025.800267","DOIUrl":"10.1016/j.cireng.2025.800267","url":null,"abstract":"<p><p>This article provides a detailed description of the robotic approach used to perform an extended left hepatectomy with venous resection in a 65-year-old female patient with a Bismuth-Corlette tumour type 3b infiltrating the portal confluence. A Glissonean pedicle approach was used to achieve total prehepatic vascular control and resection of the left portal confluence, followed by transverse reconstruction according to the Heineke-Mikulicz technique. The parenchymal transection, including the entire caudate lobe, was performed robotically, with left hanging manoeuvre after complete piggybacking of the vena cava. The final pathological result was G3 pT2bN1M0 (2/11) signet ring cell adenocarcinoma. The robotic approach enabled adjuvant treatment to be initiated immediately. No major complications were recorded within 90 days, and the patient was discharged on the 5<sup>th</sup> day.</p>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800267"},"PeriodicalIF":0.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.cireng.2025.800273
Giuseppe Serena, Naib Chowdhury, Gary Bernard Deutsch, Sandeep Anantha Sathyanarayana
While pancreaticoduodenectomy is the standard for duodenal malignancy, pancreas-sparing duodenectomy (PSD) is a surgical option for benign duodenal disease. Robotic surgery for PSD offers advantages, such as enhanced visualization, improved instrument dexterity, and optimized dissection, while maintaining resection quality. After preoperative imaging review, we performed a totally robotic PSD with intracorporeal duodenojejunostomy in a 70-year-old patient with a 2.2-cm sessile polyp and dysplasia in the D3 portion of the duodenum. Although PSD is not indicated for malignancy, a negative intraoperative frozen section is critical before proceeding in select cases. A key learning point is combining robotic visualization with upper endoscopy to accurately define the distance between the ampulla and the lesion, ensuring oncologic margins. This manuscript outlines a stepwise surgical approach in a technically challenging scenario, aiming to preserve patient safety and provide an oncologically sound resection using totally robotic techniques.
{"title":"A stepwise approach to totally robotic pancreas-sparing duodenectomy with intracorporeal duodenojejunostomy.","authors":"Giuseppe Serena, Naib Chowdhury, Gary Bernard Deutsch, Sandeep Anantha Sathyanarayana","doi":"10.1016/j.cireng.2025.800273","DOIUrl":"10.1016/j.cireng.2025.800273","url":null,"abstract":"<p><p>While pancreaticoduodenectomy is the standard for duodenal malignancy, pancreas-sparing duodenectomy (PSD) is a surgical option for benign duodenal disease. Robotic surgery for PSD offers advantages, such as enhanced visualization, improved instrument dexterity, and optimized dissection, while maintaining resection quality. After preoperative imaging review, we performed a totally robotic PSD with intracorporeal duodenojejunostomy in a 70-year-old patient with a 2.2-cm sessile polyp and dysplasia in the D3 portion of the duodenum. Although PSD is not indicated for malignancy, a negative intraoperative frozen section is critical before proceeding in select cases. A key learning point is combining robotic visualization with upper endoscopy to accurately define the distance between the ampulla and the lesion, ensuring oncologic margins. This manuscript outlines a stepwise surgical approach in a technically challenging scenario, aiming to preserve patient safety and provide an oncologically sound resection using totally robotic techniques.</p>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800273"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.cireng.2025.800264
Iago Justo, María Calatayud, Javier Salamanca, María Camara, Alvaro García-Sesma, Carmelo Loinaz
{"title":"Can we decrease the risk of complex liver surgery with the new GLP1 and GIP analogues?","authors":"Iago Justo, María Calatayud, Javier Salamanca, María Camara, Alvaro García-Sesma, Carmelo Loinaz","doi":"10.1016/j.cireng.2025.800264","DOIUrl":"10.1016/j.cireng.2025.800264","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":" ","pages":"800264"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cireng.2025.800231
Laura Comín Novella , Mónica Oset García , Marta González Pérez , El Mostafa el Yaqine er Raoudi , Pedro Pablo Stredel Russian , Francisco Luis Carrillo Trabalón , Sandra Lario Pérez , José Francisco Noguera Aguilar
Introduction
In breast cancer, recommendations for axillary surgery are currently shifting toward omitting SLNB. Studies have shown that not performing axillary staging has no impact on regional control or survival and translates into improved quality of life. We sought to determine whether certain clinical factors such as tumor size or type, immunohistochemical characteristics, tumor grade or Ki 67 value are predictive of metastatic disease in the lymph nodes.
Methods
A retrospective observational study was conducted of patients who underwent breast cancer surgery during the years 2019–2024. Inclusion criteria were: tumor size equal to or less than 2 cm as measured by ultrasound, and axilla that was clinically and ultrasound-negative.
Results
One hundred and fifty-six breasts were operated on, with a mean age of 64.5 years. Regarding immunohistochemistry, tumor grade, and age, no differences were observed. However, patients with tumors >2 cm and lobular tumors did have greater lymph node involvement (P < .05).
Conclusions
There are no variables that predict lymph node involvement before surgery. Today, we are not prepared to lose the information provided by SLNB, and part of the postoperative treatment is determined by its results.
{"title":"Predictive values of axillary involvement in breast cancer","authors":"Laura Comín Novella , Mónica Oset García , Marta González Pérez , El Mostafa el Yaqine er Raoudi , Pedro Pablo Stredel Russian , Francisco Luis Carrillo Trabalón , Sandra Lario Pérez , José Francisco Noguera Aguilar","doi":"10.1016/j.cireng.2025.800231","DOIUrl":"10.1016/j.cireng.2025.800231","url":null,"abstract":"<div><h3>Introduction</h3><div>In breast cancer, recommendations for axillary surgery are currently shifting toward omitting SLNB. Studies have shown that not performing axillary staging has no impact on regional control or survival and translates into improved quality of life. We sought to determine whether certain clinical factors such as tumor size or type, immunohistochemical characteristics, tumor grade or Ki 67 value are predictive of metastatic disease in the lymph nodes.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted of patients who underwent breast cancer surgery during the years 2019–2024. Inclusion criteria were: tumor size equal to or less than 2 cm as measured by ultrasound, and axilla that was clinically and ultrasound-negative.</div></div><div><h3>Results</h3><div>One hundred and fifty-six breasts were operated on, with a mean age of 64.5 years. Regarding immunohistochemistry, tumor grade, and age, no differences were observed. However, patients with tumors >2 cm and lobular tumors did have greater lymph node involvement (<em>P</em> < .05).</div></div><div><h3>Conclusions</h3><div>There are no variables that predict lymph node involvement before surgery. Today, we are not prepared to lose the information provided by SLNB, and part of the postoperative treatment is determined by its results.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800231"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cireng.2025.800243
Gema Cabanillas Vera , Alejandro Rodriguez Caballero , Alberto Hernández Matías , Sara Gortázar de las Casas
{"title":"Inguinoscrotal hernia with bladder herniation and ureterohydronephrosis","authors":"Gema Cabanillas Vera , Alejandro Rodriguez Caballero , Alberto Hernández Matías , Sara Gortázar de las Casas","doi":"10.1016/j.cireng.2025.800243","DOIUrl":"10.1016/j.cireng.2025.800243","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800243"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cireng.2025.800241
María del Mar Gómez Cisneros , Cristina Méndez García , Jesús Cañete Gómez , Pablo Parra-Membrives
{"title":"Hepatic gas gangrene","authors":"María del Mar Gómez Cisneros , Cristina Méndez García , Jesús Cañete Gómez , Pablo Parra-Membrives","doi":"10.1016/j.cireng.2025.800241","DOIUrl":"10.1016/j.cireng.2025.800241","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800241"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cireng.2025.800255
Esther Brea Gómez , Pablo Dabán López , Ana Belén Vico Arias , Antonio Palomeque Jiménez , Natalia Zambudio Carroll , María Trinidad Villegas Herrera , Jesús María Villar del Moral , Mario Serradilla Martín
Introduction
The textbook outcome (TO) is a qualitative measurement tool for surgical procedures that has been tested in a multitude of cases. Liver transplantation (LT) is one of the most complex interventions in our specialty. In this study, we evaluate the achievement of TO in patients undergoing LT. We also propose a definition of specific TO for LT surgery.
Materials and methods
A single-centre retrospective study was conducted between May 2012 and December 2022. Patients whose data were incomplete in the database, patients with retransplantation, transplants for acute liver failure, intraoperative findings of portal vein thrombosis, and patients who received a donor graft after circulatory death were excluded. TO was defined as the absence of mortality and major complications in the first 90 days after surgery, absence of readmission in the first 30 days, and a hospital stay not prolonged > p75.
Results
A total of 132 patients were included. More than half achieved TO (56.8%). Prolonged hospital stay was the variable that most limited the achievement of TO (25% of patients). Pre-transplant hypertension in the recipient and prolonged cold ischaemia time were associated with a lower rate of TO. Survival was higher in the group that achieved TO, although statistical significance could not be demonstrated.
Conclusions
TO is a valuable measure for assessing LT. A universal definition of TO for LT will be necessary given the lack of consensus on the criteria used among the different series published to date.
{"title":"Evaluation of textbook outcome in liver transplantation","authors":"Esther Brea Gómez , Pablo Dabán López , Ana Belén Vico Arias , Antonio Palomeque Jiménez , Natalia Zambudio Carroll , María Trinidad Villegas Herrera , Jesús María Villar del Moral , Mario Serradilla Martín","doi":"10.1016/j.cireng.2025.800255","DOIUrl":"10.1016/j.cireng.2025.800255","url":null,"abstract":"<div><h3>Introduction</h3><div>The textbook outcome (TO) is a qualitative measurement tool for surgical procedures that has been tested in a multitude of cases. Liver transplantation (LT) is one of the most complex interventions in our specialty. In this study, we evaluate the achievement of TO in patients undergoing LT. We also propose a definition of specific TO for LT surgery.</div></div><div><h3>Materials and methods</h3><div>A single-centre retrospective study was conducted between May 2012 and December 2022. Patients whose data were incomplete in the database, patients with retransplantation, transplants for acute liver failure, intraoperative findings of portal vein thrombosis, and patients who received a donor graft after circulatory death were excluded. TO was defined as the absence of mortality and major complications in the first 90 days after surgery, absence of readmission in the first 30 days, and a hospital stay not prolonged > p75.</div></div><div><h3>Results</h3><div>A total of 132 patients were included. More than half achieved TO (56.8%). Prolonged hospital stay was the variable that most limited the achievement of TO (25% of patients). Pre-transplant hypertension in the recipient and prolonged cold ischaemia time were associated with a lower rate of TO. Survival was higher in the group that achieved TO, although statistical significance could not be demonstrated.</div></div><div><h3>Conclusions</h3><div>TO is a valuable measure for assessing LT. A universal definition of TO for LT will be necessary given the lack of consensus on the criteria used among the different series published to date.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800255"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cireng.2025.800226
María Asunción Acosta-Mérida , Raquel Bañolas-Suárez , Julia Díaz-Dávila , Pedro Saavedra-Santana , Joaquín Marchena-Gómez
Introduction
Although laparoscopic sleeve gastrectomy (LSG) has positioned itself as the leading bariatric technique worldwide, surpassing laparoscopic Roux-en-Y gastric bypass (LRYGB), its possible inferiority in terms of weight and metabolic results remains controversial. The of this study was to compare the response of both techniques in terms of weight loss and obesity-related metabolic complications.
Methods
We conducted a retrospective study of all patients who had undergone LSG and LRYGB in our center from 2013 to 2022. Patient characteristics, postoperative complications, postoperative weight loss and evolution of comorbidities were recorded. Propensity score matching (1:1) was performed to homogenize the 2 intervention groups for body mass index (BMI) and preoperative metabolic syndrome.
Results
Out of the 354 patients who met the selection criteria, 309 patients were ultimately included in the study (172 LSG and 137 LRYGB); mean age was 45.8 ± 9.5 years; 205 were women (66.3%). Median BMI was 47 (interquartile range = 42.8–52.9). After propensity score matching, 118 patients remained in each group. BMI trajectories during the first 3 years of follow-up after the 2 types of surgery showed no significant differences (P = .693). One month after treatment, there were also no differences in postoperative metabolic syndrome parameters or complication rates (P = .866).
Conclusions
Our data suggest that sleeve gastrectomy provides a similar weight and metabolic response to Roux-en-Y gastric bypass in patients with similar BMI and metabolic syndrome characteristics.
{"title":"Comparison of weight loss and metabolic syndrome parameters between sleeve gastrectomy and Roux-en-Y gastric bypass: A propensity score analysis","authors":"María Asunción Acosta-Mérida , Raquel Bañolas-Suárez , Julia Díaz-Dávila , Pedro Saavedra-Santana , Joaquín Marchena-Gómez","doi":"10.1016/j.cireng.2025.800226","DOIUrl":"10.1016/j.cireng.2025.800226","url":null,"abstract":"<div><h3>Introduction</h3><div>Although laparoscopic sleeve gastrectomy (LSG) has positioned itself as the leading bariatric technique worldwide, surpassing laparoscopic Roux-en-Y gastric bypass (LRYGB), its possible inferiority in terms of weight and metabolic results remains controversial. The of this study was to compare the response of both techniques in terms of weight loss and obesity-related metabolic complications.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of all patients who had undergone LSG and LRYGB in our center from 2013 to 2022. Patient characteristics, postoperative complications, postoperative weight loss and evolution of comorbidities were recorded. Propensity score matching (1:1) was performed to homogenize the 2 intervention groups for body mass index (BMI) and preoperative metabolic syndrome.</div></div><div><h3>Results</h3><div>Out of the 354 patients who met the selection criteria, 309 patients were ultimately included in the study (172 LSG and 137 LRYGB); mean age was 45.8 ± 9.5 years; 205 were women (66.3%). Median BMI was 47 (interquartile range = 42.8–52.9). After propensity score matching, 118 patients remained in each group. BMI trajectories during the first 3 years of follow-up after the 2 types of surgery showed no significant differences (<em>P</em> = .693). One month after treatment, there were also no differences in postoperative metabolic syndrome parameters or complication rates (<em>P</em> = .866).</div></div><div><h3>Conclusions</h3><div>Our data suggest that sleeve gastrectomy provides a similar weight and metabolic response to Roux-en-Y gastric bypass in patients with similar BMI and metabolic syndrome characteristics.</div></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":"103 12","pages":"Article 800226"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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