Background: Routine preoperative upper gastrointestinal endoscopy before sleeve gastrectomy remains debated. This study evaluated whether selected endoscopic and histopathologic findings were associated with 30-day outcomes after sleeve gastrectomy, with specific attention to reflux-related events and severity-stratified staple-line leak. Methods: We retrospectively analyzed 315 adults who underwent laparoscopic sleeve gastrectomy at a tertiary referral center between June 2016 and December 2019. All patients underwent preoperative esophagogastroduodenoscopy with Sydney-protocol biopsies. Postoperative outcomes were assessed within 30 days. The leak was classified as limited/minimal when managed with antibiotics alone and as major when invasive intervention or death occurred. Results: Postoperative reflux symptoms occurred in 47 patients (14.9%). Staple-line leak was diagnosed in 13 patients (4.1%) after oral intake using clinical findings, inflammatory markers, and contrast-enhanced computed tomography; routine postoperative day 1 upper gastrointestinal contrast passage studies were normal in all leak patients. Ten leaks were limited/minimal and resolved with antibiotics alone, whereas 3 patients (0.95%) had major leaks requiring percutaneous/endoscopic or surgical intervention. Hiatal hernia was associated with postoperative reflux symptoms, and previous upper abdominal surgery was associated with leak. Associations involving endoscopic bile reflux/possible pyloric dysfunction were exploratory because objective motility testing was unavailable. Conclusions: Preoperative endoscopy may identify selected foregut abnormalities relevant to early outcomes after sleeve gastrectomy, particularly reflux-related anatomy. Leak-related findings should be interpreted cautiously because event numbers were small; severity-stratified reporting provides a more clinically meaningful interpretation than an undifferentiated leak rate.
BACKGROUND:Ileal pouch-anal anastomosis (IPAA) is the standard restorative procedure for patients with ulcerative colitis requiring colectomy. Although robotic-assisted surgery has gained increasing acceptance in colorectal surgery, its role in IPAA remains uncertain. METHODS:A systematic search was conducted across PubMed, Scopus, and the Cochrane Central Register of Controlled Trials up to May 2026. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic. Sensitivity analyses were conducted to analyze outcomes with moderate or substantial heterogeneity. RESULTS:Six comparative observational studies involving 946 patients were included; 460 underwent robotic-assisted IPAA, and 486 underwent laparoscopic IPAA. No significant differences were observed between approaches regarding anastomotic leak (OR: 0.69; 95% CI: 0.37 to 1.28; P = .234), bleeding (OR: 0.59; 95% CI: 0.21 to 1.64; P = .309), Clavien-Dindo grade III or higher complications (OR: 1.17; 95% CI: 0.57 to 2.41; P = .670), conversion to open surgery (OR: 0.46; 95% CI: 0.16 to 1.34; P = .156), postoperative ileus (OR: 1.11; 95% CI: 0.65 to 1.91; P = .705), overall morbidity (OR: 1.17; 95% CI: 0.84 to 1.63; P = .361), reoperation (OR: 1.06; 95% CI: 0.27 to 4.19; P = .933), or 30-day readmission (OR: 0.83; 95% CI: 0.59 to 1.17; P = .278). Likewise, no significant differences were identified in operative time (MD 26.3 minutes; 95% CI: -1.9 to 54.4; P = .07) or hospital stay (MD -0.5 days; 95% CI: -1.5 to 0.5; P = .34). Sensitivity analyses did not materially alter the direction or statistical significance of the pooled estimates despite moderate to high heterogeneity in selected outcomes. CONCLUSION:Available observational evidence suggests that robotic-assisted IPAA yields short-term outcomes comparable to those of laparoscopic IPAA; however, the certainty of evidence is very low, and definitive conclusions are constrained by the observational nature of the available data.
BACKGROUND:Laparoscopic intracorporeal suturing and knot tying is a core minimally invasive surgical skill, but generic global rating instruments may not identify the task-specific technical errors needed for targeted feedback. We developed an 8-item performance rating scale for a standardized simulator task and evaluated its measurement properties. METHODS:In a cross-sectional cohort, 82 participants across 5 training levels completed 1 interrupted laparoscopic suture consisting of 1 needle pass, 3 intracorporeal knots, and final cutting. Deidentified videos were independently scored by 3 raters. Interrater reliability was estimated using 2-way random effects, absolute-agreement intraclass correlation coefficients (ICCs). Between-level performance was assessed using Kruskal-Wallis tests, Holm-adjusted pairwise comparisons, and Spearman correlation. Twelve learners completed the task before and after standardized training. RESULTS:Quality scores differed across training levels (P < .001) and correlated strongly with level (Spearman rho = 0.872, P < .001). Completion time decreased with level (rho = -0.897, P < .001). Total-score reliability was excellent (ICC[2,1] = 0.960; ICC[2,3] = 0.986). After training, mean quality score increased by 5.83 points, and completion time decreased by 29.17 seconds (both P < .001). CONCLUSIONS:The scale provides a reliable, reproducible method for video-based assessment of laparoscopic intracorporeal suturing and knot-tying performance. Its principal current use is to differentiate novice and early-stage operators and to track progress during simulator-based practice. More demanding tasks and multicenter evaluation are needed before use for advanced proficiency decisions.
BACKGROUND:Benign biliary strictures, most commonly anastomotic after hepaticojejunostomy or related to bile duct injury, are conventionally managed with balloon dilation, multiple plastic stents, or covered metal stents, all of which typically require repeated procedures. Magnesium-based balloon-expandable biodegradable stents (UNITY-B) have been proposed as a single-step alternative, but dedicated cohort data are limited. METHODS:We retrospectively reviewed 22 consecutive UNITY-B stent-placement procedures performed in 21 patients with benign biliary strictures at a single center (April 2024-February 2026). The primary endpoint, clinical success (freedom from stricture recurrence during follow-up), was estimated using the Kaplan-Meier method at the patient level (n = 21), with a procedure-level sensitivity analysis (n = 22) and a competing-risks sensitivity analysis (Aalen-Johansen estimator) accounting for two unrelated deaths. Technical success and stent-related complications, assessed within 30 days after stent placement, were evaluated at the procedure level. RESULTS:Median age was 58.0 years (interquartile range 51.0-70.0); 76.2% of strictures were anastomotic at a hepaticojejunostomy. Technical success was achieved in 22/22 procedures (100%), with no stent-related complications within 30 days. Stricture recurrence occurred in 6/21 patients (28.6%) at a median of 7.0 months; all underwent reintervention. Kaplan-Meier freedom from recurrence was 90.5% (95% CI 67.0-97.5%) at 6 months and 66.0% (95% CI 38.7-83.3%) at 12 months. Two deaths, unrelated to the procedure, occurred during follow-up. CONCLUSIONS:In this small, retrospective, single-arm cohort, magnesium-based balloon-expandable biodegradable biliary stenting was technically feasible, with no stent-related complications observed within 30 days after stent placement, and freedom from recurrence in approximately two-thirds of patients at 1 year. These findings are hypothesis-generating; prospective comparative studies with longer follow-up are needed before this approach can be positioned relative to established alternatives.
INTRODUCTION:Preoperative glycemic control is a key concern in bariatric surgery. However, the extent to which suboptimal HbA1c levels impact short-term postoperative morbidity remains uncertain. This study evaluated the association between preoperative HbA1c categories and 30-day postoperative morbidity in a large Middle Eastern bariatric surgery cohort, using propensity score weighting and unsupervised clustering to refine risk stratification. METHODS:This retrospective cohort analysis included 1778 bariatric surgery patients operated between 2019 and 2024 at a tertiary referral center in the United Arab Emirates. Patients were stratified into two groups: controlled HbA1c (≤6.5%, n = 1557) and elevated HbA1c (>6.5%, n = 221). Baseline demographics, perioperative parameters, and 30-day outcomes were extracted from a prospectively maintained registry. Statistical analysis included inverse probability weighting using propensity scores to adjust for age, BMI, and sex. Principal component analysis (PCA) followed by K-means clustering was performed on age and HbA1c to identify multivariate patient subgroups. Both unweighted and weighted analyses were performed. RESULTS:Elevated HbA1c patients were older than those with controlled HbA1c (43.2 ± 12.1 versus 34.6 ± 10.8 years, P < .001 unweighted; 43.2 ± 12.1 versus 42.1 ± 12.0 years, P = .364 weighted). BMI was modestly higher in the elevated group but not significant after weighting. Thirty-day complication rates were low across all groups. The highest risk was observed in patients >60 years with diabetes (8.1%), while patients ≤20 years had negligible complications. In adults 21-60 years, complication rates increased modestly with HbA1c (normal 3.9%-5.3%, prediabetes 3.9%-6.3%, diabetes 6.5%-8.6%). No deaths occurred. Other complications, including deep/organ-space SSI, pneumonia, pulmonary embolism, renal failure, myocardial infarction, transfusion, gastrointestinal bleeding, readmission, and reoperation, were rare and showed no significant differences across HbA1c strata (all P > .05). CONCLUSION:Elevated HbA1c was not an independent predictor of short-term morbidity after bariatric surgery. PCA-cluster analysis identified a distinct high-risk subgroup: older diabetic patients, who demonstrated the greatest vulnerability to short-term complications. These findings suggest that perioperative risk assessment should move beyond HbA1c cutoffs alone and incorporate multivariate patient profiling to guide individualized care.
OBJECTIVE:This study aimed to assess short- and long-term outcomes in patients undergoing surgery for pathological stage IV esophageal cancer. BACKGROUND DATA:Esophageal cancer has a very poor prognosis in advanced stages, with 5-year survival rates below 6% in stage IV disease. Although current guidelines generally discourage surgery in metastatic patients, selected cases with oligometastatic disease may benefit from esophagectomy within a multimodal treatment framework. METHODS:We retrospectively reviewed a prospectively maintained database of 437 esophagectomies performed between January 2013 and June 2024. Sixty patients with pathological stage IV esophageal carcinoma (AJCC 8th edition) were included, including adenocarcinoma, squamous cell carcinoma, and undifferentiated tumors. Patients were divided into stage IV-A (n = 39) and stage IV-B (n = 21), all of whom were oligometastatic according to the OMEC classification. The primary endpoints were overall survival (OS) and disease-free survival (DFS). RESULTS:Median age was 63.5 years, and 61.7% of patients were male. Neoadjuvant chemoradiotherapy was administered in 48.3% of cases. Postoperative morbidity was 43.3%, and in-hospital mortality rate of 5%, showing no significant differences between groups. Median OS was significantly longer in stage IV-A compared with stage IV-B (18.0 versus 8.0 months, P = .003), as was median DFS (10.0 versus 3.0 months, P = .010). Among stage IV-B patients, survival differed according to metastatic site, with better outcomes in nodal-only disease. CONCLUSION:Esophagectomy may be feasible in highly selected stage IV patients, offering meaningful survival in stage IV-A cases, while outcomes in stage IV-B remain limited and influenced by metastatic pattern.
OBJECTIVE:The primary aim of this study was to compare perioperative and functional outcomes between conventional laparoscopic pyeloplasty (CLP) and mini-laparoscopic pyeloplasty (MLP) in pediatric patients. As a secondary objective, we evaluated a composite trifecta outcome, defined as a structured summary measure rather than a validated endpoint. METHODS:This retrospective study included 129 pediatric patients (<18 years) who underwent CLP (n = 67) or MLP (n = 62) between August 2009 and February 2025. Trifecta success was defined as a composite outcome comprising: (1) a ≥14 mm reduction in AP pelvic diameter, (2) absence of obstruction on postoperative scintigraphy, and (3) absence of postoperative complications. Univariate logistic regression analysis was performed to identify predictors of trifecta success. RESULTS:The mean age was 7.2 ± 5.8 years, and 33.3% of patients were female. Operative time was significantly longer in the CLP group (113 ± 35.5 versus 90.6 ± 26.2 minutes; P = .001), whereas anastomosis time was comparable between groups (P = .152). Minor complications occurred in 16.5% of patients. Receiver operating characteristic analysis demonstrated that a reduction in AP diameter ≥14 mm predicted trifecta success, with an AUC of 0.659, sensitivity of 52.8%, and specificity of 80%. Overall, trifecta success was achieved in 76.7% of patients, with no significant difference between CLP and MLP (74.6% versus 79%, P = .677). Logistic regression analysis did not identify any significant predictors of trifecta success, including surgical technique (odds ratio [OR] 1.528, P = .361). CONCLUSION:CLP and MLP are safe and effective approaches with comparable perioperative and functional outcomes. The proposed trifecta criteria may provide a structured framework for outcome assessment; however, external validation is warranted. Future prospective multicenter studies incorporating patient-reported outcomes are needed to better define the clinical impact of instrument miniaturization in pediatric urology.
INTRODUCTION:The expansion of indications for laparoscopic surgery is associated by an increase in morbidity that must be evaluated. The objective of the current study was to evaluate the postoperative complications of laparoscopic surgery in Ouagadougou. METHODS:A retrospective descriptive cross-sectional study conducted over a 5-year period. All patients aged 15 years and older who underwent laparoscopic surgery in the general surgery departments of four health care facilities in Ouagadougou and who experienced postoperative complications were included. RESULTS:Complications were recorded in 38 cases, representing 2.8% of the 1,377 laparoscopic surgical procedures performed. The study included 23 women and 15 men with a mean age of 42.6 years, and a male-to-female ratio of 0.68. The procedure was performed as an emergency in 65.8% of cases, and the most frequent indication for surgery was acute appendicitis (12 cases). The mean time to onset of complication was 2.5 days. The complication was surgical site infection in 71.9% of cases. There was no mortality. The mean length of hospital stay was 9.5 days. CONCLUSION:Despite the current reported complications, especially infectious ones, laparoscopic surgery remains a preferred and recommended method in general surgery in Burkina Faso. Infection prevention measures must be strengthened to reduce this avoidable morbidity.
OBJECTIVE:To systematically evaluate the global research landscape, knowledge structure, collaboration networks, research hotspots, and emerging trends of robot-assisted spleen-related surgery (RAS) through bibliometric analysis. METHODS:English-language original articles and reviews related to RAS were retrieved from the Web of Science Core Collection, including the Science Citation Index Expanded (SCI- Expanded) and Social Sciences Citation Index (SSCI), for the period from January 1, 2005, to December 31, 2025. Bibliometric analyses and visualizations were performed using CiteSpace, VOSviewer, and BiblioVista to assess publication trends, citation patterns, collaboration networks, leading contributors, keyword co-occurrence, clustering, cocitation, and burst references. RESULTS:A total of 130 publications were included. Annual output showed a fluctuating upward trend, especially after 2014, and peaked in 2023. Surgical Endoscopy was the most productive and influential journal. The United States led in publication output, Italy showed the strongest overall citation performance, and Yonsei University and its affiliated health system were leading institutions. Major themes included robotic surgery, laparoscopic splenectomy, distal pancreatectomy, minimally invasive surgery, partial splenectomy, spleen preservation, learning curve, complications, and perioperative outcomes. Hotspots evolved from early feasibility and safety assessment toward complex pancreaticosplenic procedures, functional preservation, perioperative optimization, and precision minimally invasive surgery. CONCLUSION:RAS research has progressed from technical exploration toward complex, precision-oriented, and function-preserving applications. Future studies should strengthen multicenter collaboration and further evaluate long-term outcomes, cost-effectiveness, and standardized surgical strategies.
BACKGROUND:Pancreaticoduodenectomy (Whipple procedure) is rarely required in children, but remains the standard of care for resectable pancreatic head tumors. Robotic pancreaticoduodenectomy (RPD) has been increasingly performed in adults, demonstrating safety, feasibility, and in some series, superior perioperative outcomes compared with open surgery. In children, however, there are only three published case reports worldwide. METHODS:We describe two adolescent females with pancreatic head solid pseudopapillary neoplasms (SPNs) who underwent RPD at high-volume U.S. CENTERS:Both cases were managed by multidisciplinary teams including pediatric surgeons and adult surgical oncologists experienced in robotic pancreatic surgery. RESULTS:Case 1: A 13-year-old underwent robotic pylorus-preserving pancreaticoduodenectomy utilizing intraoperative Indocyanine Green Firefly and ultrasound to assess critical anatomy. Reconstruction was performed with Blumgart pancreaticojejunostomy and hepaticojejunostomy. She advanced to diet by postoperative day (POD) 3 and was discharged on POD 3. Case 2: A 17-year-old underwent RPD with pylorus preservation in a similar fashion at an adult hospital. Her recovery was uncomplicated, drains were removed on POD 4, and she was discharged on POD 5. Final pathology in both patients confirmed SPN with negative margins. CONCLUSIONS:These represent the first pediatric RPDs reported in the United States and the first using the da Vinci Xi platform. Our experience demonstrates that pediatric RPD is feasible and safe when performed in collaboration with high-volume adult robotic pancreatic programs. Given the rarity of pediatric pancreatic tumors, collaborative registries and continued reporting are essential to define outcomes and guide best practice.
OBJECTIVE:Surgical intervention techniques to correct unilateral vesicoureteral reflux (VUR) are advocated to prevent recurrent urinary tract infections and further renal damage. Although unilateral ureteral reimplantation is highly successful, new contralateral reflux (NCVUR) can develop postoperatively in some patients. The purpose of this study was to review and analyse the outcomes of Endoscopic injection of dextranomer/hyaluronic acid (ET) and transvesicoscopic Cohen ureteral reimplantation (TVUR) in unilateral VUR, along with incidence and clinical outcomes of NCVUR. METHODS:After IRB approval, the data of children that underwent ET (group 1) and TVUR (group 2) for unilateral VUR over a 6-year period was reviewed. Children with secondary and bilateral VUR, duplex kidneys, and no postoperative follow-up were excluded. Various parameters were compared between the two groups. RESULTS:Ninety-eight children (42 group 1 and 56 group 2) were included. The mean grade of VUR was significantly higher in group 2 than group 1 (P < .001). Group 1 had significantly shorter operating time and hospital stay than group 2 (P = .0001), while group 2 had higher success (P = .007), although the clinical efficacy for grades 2 to 3 VUR was comparable in both groups. The overall incidence of NCVUR was 6%, with no significant difference between the groups (P = .715). During a mean follow-up of 36 months, all NCVUR were managed by observation only, with no renal damage or need for surgical intervention. CONCLUSIONS:TVUR was preferred by parents for higher grades of VUR with paraureteral diverticulum and had higher success. ET had lower morbidity, and for grades 2-3 VUR, ET and TVUR had comparable clinical efficacy. The overall incidence of NCVUR was low, with no increased risk of NCVUR after TVUR, and most NCVUR was benign and self-limiting.
BACKGROUND:Virtual reality (VR) is a key tool of modern surgical education, yet minimally invasive surgery training remains scarce in sub-Saharan Africa. We describe the first experience of VR laparoscopic simulation in a developing sub-Saharan country and assess the feasibility of such training in Togo and the financial barriers to its dissemination. METHODS:This was a cross-sectional, questionnaire-based survey of surgeons and trainees enrolled in two VR laparoscopic simulation workshops held in March and September 2022 at the skills-transfer centre of the Biasa Clinic in Lomé, using the Virtamed LaparoS anatomical-model simulator. Seven standardized tasks were used, and participants rated each task and the course design on Likert scales. The primary endpoint was feasibility, defined as successful completion of two workshops with locally trained faculty by the end of 2022. Data were analyzed with Epi Info 7.2. RESULTS:A total of 15 of 18 enrolled practitioners responded (participation rate 83.3%). The mean age was 34.2 ± 5.2 years, with a male-to-female ratio of 2:1; one-third were foreign nationals and two-thirds were gynecologists. Residents and surgeons in training accounted for 53.3% of participants, and 53.3% had never performed laparoscopic surgery. The overall impression was good for 73.3%. Circular cutting was the most difficult task. All participants considered that simulation could improve their practice, and 93.3% endorsed mandatory integration in residency curricula. Four participants (26.7%) considered the course expensive, and the main reported limitations were lack of funding, scarcity of laparoscopic towers, and absence of locally engineered solutions. CONCLUSION:VR laparoscopic simulation is feasible, well accepted, and locally sustainable in Togo and is seen by trainees as an essential component of surgical education. Its scale-up is chiefly constrained by the high cost of equipment and training, which calls for public investment, partnerships, and the development of affordable, locally adapted simulation tools.
PURPOSE:To evaluate the association between postoperative stent dwell time and stone-free status following retrograde intrarenal surgery (RIRS) in pediatric patients. METHODS:This retrospective study included pediatric patients who underwent RIRS for renal stones ≤20 mm. Residual stone fragments were assessed by low-dose computed tomography at 3 months postoperatively and defined as either a single fragment >2 mm or the presence of multiple residual fragments regardless of size. Logistic regression analyses were performed to identify factors associated with stone-free status, including postoperative stent dwell time. RESULTS:A total of 108 pediatric patients were included, with a mean age of 9.8 ± 4.5 years, and 74 patients (68.5%) were male. Residual fragments were observed in 40 patients (37.0%). In univariable logistic regression analysis, stone burden (P < .001), fragmentation time (P < .001), and the presence of multiple stones (P = .022) were associated with residual fragments. In multivariable analysis, stone burden (P = .007) and fragmentation time (P = .003) remained independent predictors of residual fragments, whereas postoperative stent dwell time was not independently associated with stone-free status (P = .381). CONCLUSION:No evidence was found to support an association between postoperative stent dwell time and stone-free status following pediatric RIRS. Earlier stent removal may therefore be feasible in uncomplicated pediatric patients without compromising stone-free outcomes. Further large-scale prospective studies are needed to establish clinical recommendations regarding stent duration.
BACKGROUND:Evidence for completely off-clamp robot-assisted partial nephrectomy (RAPN) in older patients is limited. We compared age-stratified short-term outcomes. METHODS:We reviewed 146 consecutive patients who underwent off-clamp RAPN between June 2022 and March 2026: 99 were aged <65 years and 47 were aged ≥65 years. Outcomes included perioperative measures, 90-day major complications, postoperative day 1 (POD1) hemoglobin (Hb) decline, estimated glomerular filtration rate (eGFR) change, and surgical margin status. Parsimonious linear models adjusted for age group, baseline Hb or eGFR, tumor size, and RENAL score; expanded models were sensitivity analyses. RESULTS:Older patients had more hypertension, diabetes mellitus, and cardiovascular disease and lower baseline Hb and eGFR (all P < .05). Console time, estimated blood loss, and length of stay did not differ significantly, and no major complication occurred. Positive margins occurred in 5/85 younger and 1/44 older patients with evaluable data (P = .663); margin status was unassigned in 17 nonmalignant cases. The median POD1 Hb decline was 1.0 versus 1.2 g/dL (P = .779), and the median 1-month eGFR change was 1.0 mL/min/1.73 m2 in both groups (P = .746). In parsimonious models, neither age-group coefficient reached statistical significance: Hb decline, β = -0.01 (95% confidence interval [CI], -0.30 to 0.28; P = .937); 1-month eGFR change, β = -3.21 (95% CI, -6.80 to 0.38; P = .080). CONCLUSIONS:No statistically significant age-group differences were detected in the evaluated short-term perioperative and functional outcomes. However, the confidence intervals, particularly for 1-month eGFR, did not exclude clinically relevant disadvantage in older patients and do not establish equivalence.
BACKGROUND:Early laparoscopic cholecystectomy is recommended for acute calculous cholecystitis (ACC), although the optimal timing within the recommended early treatment window remains uncertain. This study evaluated whether different time intervals from symptom onset to surgery influence operative difficulty and perioperative outcomes in routine emergency surgical practice. METHODS:A retrospective multicenter study was conducted including consecutive patients who underwent LC for Tokyo Grade I or II ACC between January 2021 and December 2025. Patients were stratified according to Tokyo severity grade and further categorized into five predefined intervals according to time from symptom onset to surgery (≤6 hours, 6 to 12 hours, 12 to 24 hours, 24 to 72 hours, and > 72 hours). Demographic characteristics, comorbidities, operative findings, postoperative outcomes, and length of hospital stay were analyzed. Multivariable regression models were used to evaluate the independent association between surgical timing and perioperative outcomes after adjustment for relevant clinical confounders. RESULTS:A total of 306 patients were included, including 235 (76.8%) with Tokyo Grade I and 71 (23.2%) with Tokyo Grade II ACC. Delayed surgery was independently associated with greater intraoperative blood loss (adjusted mean ratio 1.29, 95% CI: 1.19 to 1.40; P < .001). In contrast, no independent association was observed between surgical timing and conversion to open surgery, overall postoperative complications, major complications (Clavien-Dindo grade ≥III), operative time, or length of hospital stay after multivariable adjustment. Although severe postoperative events were numerically more frequent in delayed subgroups, these differences were not statistically significant. CONCLUSIONS:Within a real-world emergency surgery setting, surgical timing appears to influence technical complexity more than postoperative morbidity. Delayed intervention was associated with increased intraoperative blood loss but not with worse adjusted postoperative outcomes. These findings support an individualized, patient-tailored approach to early laparoscopic cholecystectomy rather than strict adherence to fixed temporal thresholds.
Minimally invasive partial gastrectomies for incidentally identified gastrointestinal stromal tumors (GISTs) are increasingly more common, and most patients have an uneventful perioperative course. The surgical resection is not technically demanding, especially when a wedge resection is performed. Although the majority of relatively small- or intermediate-sized GISTs have low mitotic rates, postoperative surveillance intervals should be shorter for GISTs with higher mitotic rates. Although pleomorphism has not dictated metastatic potential, the addition of dedifferentiation may alter postoperative management. This perspective article details a patient with a pleomorphic gastric GIST that was successfully resected via a wedge resection. The pleomorphic lesion did not show dedifferentiation, so a longer surveillance interval was instituted. This case reaffirms that surgeons should actively review their patients' pathology results in conjunction with oncology, as subtle findings may alter patient surveillance.
BACKGROUND:Partial nephrectomy is the preferred treatment for localized renal cell carcinoma when technically feasible. Tumor excision can be performed by either enucleation or resection. The impact of these techniques on parenchymal preservation and clinical outcomes remains controversial. This study aimed to compare tumor enucleation and tumor resection techniques in terms of volumetric, functional, and oncological outcomes. METHODS:We retrospectively analyzed 142 patients who underwent partial nephrectomy between 2020 and 2024. Patients were grouped according to excision technique: enucleation (n = 54) and resection (n = 88). Tumor volume, specimen volume, and excised tumor-free renal parenchymal volume were calculated from pathological specimens. Renal function was assessed using serum creatinine and estimated glomerular filtration rate (eGFR) preoperatively and postoperatively. Oncological outcomes were evaluated based on pathological findings and postoperative imaging. RESULTS:Baseline demographic, clinical, and surgical characteristics were comparable between groups. Specimen volume and excised tumor-free parenchymal volume were significantly greater in the resection group (P < .001). Both groups demonstrated a significant postoperative decline in renal function, with subsequent stabilization during follow-up. Early eGFR decline tended to be greater in the resection group but did not reach statistical significance. Positive surgical margin rates were similar between the enucleation and resection groups (16.7% versus 18.2%, P = 1.000). No local recurrence or distant metastasis was observed during the 2-year follow-up. CONCLUSION:Tumor enucleation and resection demonstrated comparable short-term oncological outcomes. Enucleation was associated with reduced excision of tumor-free renal parenchyma and may offer a functional advantage. Larger prospective studies are needed to confirm these findings.
Introduction: Single-incision laparoscopic common bile duct exploration (SIL-CBDE) with primary duct closure is technically demanding. This study evaluated a standardized SIL-CBDE protocol using a guidewire-pusher-single-bend internal biliary stent delivery system designed to permit spontaneous dislodgement. Materials and Methods: We retrospectively analyzed 112 consecutive patients who underwent SIL-CBDE with internal biliary drainage between April 2025 and April 2026. A guidewire-pusher-stent delivery system with a 5 Fr single-bend plastic stent was used for temporary transpapillary decompression. Technical proficiency was assessed using risk-adjusted cumulative sum (RA-CUSUM) analysis adjusted for age, body mass index, common bile duct (CBD) diameter, and stone characteristics. Results: Technical success was achieved in all patients. The mean operative time was 124.9 ± 19.9 minutes. The RA-CUSUM analysis identified an inflection point at case 55. Operative time decreased from 133.3 ± 21.7 minutes to 116.8 ± 13.7 minutes after this point ( P < .001). Prophylactic abdominal drainage was omitted in 58 patients (51.8%). Bile leakage occurred in 7 patients (6.2%) and was managed without reoperation. Spontaneous stent dislodgement was confirmed in 101 patients (90.2%). Retained CBD stones occurred in 4 patients (3.6%) and were successfully treated by endoscopic retrograde cholangiopancreatography-based endoscopic stone extraction. Conclusion: In selected patients, SIL-CBDE with a single-bend internal biliary stent appeared feasible and safe. This protocol may support temporary transpapillary decompression, spontaneous stent passage, and selective abdominal drain omission in enhanced recovery after surgery-oriented biliary surgery.
AIM:To investigate postoperative inflammatory response as assessed by C-reactive protein (CRP) levels in patients undergoing anterior resection (AR) for rectal cancer by minimally invasive surgery (MIS). METHOD:All patients diagnosed with rectal cancer between 2011 and 2021 undergoing AR by MIS without conversion at one university hospital were included. Open surgery was not included. Patient data were obtained from the Swedish Colorectal Cancer registry and from local patient charts, including CRP levels preoperatively and postoperative day (POD) 1-5. RESULTS:A total of 123 patients were identified with rectal cancer, of which the proportion of laparoscopic surgery (LAP) was 31% (n = 38) and robotic assisted rectal cancer surgery (ROBOT) 69% (n = 85). The proportion of women was 37%, median age 69, median body mass index 26, 25% had ASA class ≥3, 27% had neoadjuvant radiotherapy, 12% had neoadjuvant radiotherapy combined with chemotherapy, and 59% had a planned defunctioning stoma. No complications were noted in 44.7% of LAP and in 51.8% of ROBOT. Complications defined as Clavien-Dindo grade ≥IIIb were 10.5% in LAP and 9.4% in ROBOT. Hospital stay was a median 9.5 days in LAP and 10 in ROBOT. The median CRP values in LAP and ROBOT preoperatively were 3 and 4 (P = .845), on POD 1: 100 and 110 (P = .865); POD 2: 218 and 145 (P = .159); POD 3: 181 and 141 (P = .097); POD 4: 128 and 95 (P = .502), and on POD 5: 73 and 71 (P = .785), respectively. CONCLUSION:Postoperative inflammatory response as assessed by postoperative CRP values was not statistically different between LAP and ROBOT. CRP levels on POD 2-4 were numerically lower in ROBOT. The clinical relevance of this finding warrants further investigation.
