PurposeTo evaluate the feasibility of indocyanine green (ICG) fluorescence as an intraoperative tool for abdominal lymph-node localization in cases where fine needle aspiration cytology (FNAC), is not feasible. ICG was administered either 24 hours before surgery or at anaesthesia induction, and fluorescence findings were descriptively compared with preoperative imaging and histology.Materials and methodsThis is a retrospective exploratory feasibility study. Patients undergoing excision of primary or metastatic lesions in areas not suitable for ultrasound-guided biopsy were included. Suspicious findings on computed tomography (CT) scan were confirmed with positron emission tomography (PET)-CT preoperatively. According to intravenous ICG administration, patients were divided into two groups: group A, 24-hours before surgery, and group B, at anaesthesia induction. Fluorescence visualization was descriptively assessed in relation to PET-CT findings and histology.ResultsEight patients were included in group A and nine in group B. ICG fluorescence enabled intraoperative visualization of 13 out of 17 lesions overall (76.5%), including six out of eight in group A (75%), and seven out of nine in group B (77.8%), including retroperitoneal, mesenteric, and supraclavicular locations. Because PET-CT positivity was part of the inclusion pathway, descriptive concordance indicators are reported for descriptive purposes only. Visualization rates were comparable between the two protocols.ConclusionsFluorescence appears to be a feasible and safe intraoperative adjunct for lymph-node identification in anatomically challenging regions. Administration at anaesthesia induction simplifies perioperative workflow while maintaining similar visualization rates. These findings are exploratory and hypothesis-generating and should be interpreted considering the small sample size and the selection bias related to PET-positive inclusion criteria.
BACKGROUND:This study aimed to evaluate the clinical feasibility, usability, and cognitive workload of a certified mixed reality (MXR) platform for preoperative planning and intraoperative navigation in liver surgery. Curative treatment of liver tumors requires precise comprehension of spatial relationships between tumors and vascular structures to achieve complete resection or ablation. Traditional two-dimensional imaging demands cognitive reconstruction of anatomy, posing challenges even for experienced surgeons. MXR technologies, such as Microsoft HoloLens 2 combined with HoloCare Studio™, enable immersive and interactive visualization that may improve spatial orientation, reduce cognitive load and support intraoperative decision-making. METHODS:Routine quality assurance data from five male patients (mean age 61 years; range 44-80), collected during the clinical introduction of a CE-certified MXR device, undergoing open liver resection for hepatic malignancies were retrospectively evaluated. Patient-specific imaging, including three-phase computed tomography (CT) and, in one case, magnetic resonance imaging (MRI), was processed using HoloCare Studio™ (HoloCare Oslo) to create interactive 3D holograms of liver parenchyma, tumors, and vascular structures. These holograms were employed for both preoperative planning and intraoperative navigation through the HoloLens 2 headset. Cognitive workload was assessed using the NASA Task Load Index (NASA-TLX) and usability was measured using the System Usability Scale (SUS). RESULTS:The HoloCare™ MXR system was seamlessly integrated into all five cases and improved tumor localization and understanding of vascular anatomy. Average NASA-TLX scores were 13.8 preoperatively and 14.7 intraoperatively, indicating low cognitive workload. Mean SUS scores were 96.0 preoperatively and 95.5 postoperatively, reflecting excellent usability. CONCLUSION:MXR integration into open hepatic surgery is feasible, fast, imposes minimal cognitive workload, and is well accepted. These findings support further evaluation of MXR as a valuable adjunct in hepatobiliary surgery.
BACKGROUND:This pilot study aimed to assess the feasibility, perioperative safety, and short-term outcomes of extraperitoneal versus transperitoneal vNOTES sacrocolpopexy. METHODS:Thirty-six patients with POP-Q stage III or higher who underwent simultaneous vNOTES hysterectomy, BSO, and sacrocolpopexy were retrospectively analyzed and categorized into extraperitoneal (Group A, n=14) and transperitoneal (Group B, n=22) groups. Anatomical success, quality of life, and recovery were evaluated using POP-Q, P-QOL, ICIQ-UI SF, QoR-15, and MESH-R scales. RESULTS:Baseline characteristics were comparable between groups. Six-month anatomical success rates were similar (extraperitoneal 90.8% vs. transperitoneal 91.6%). The most notable procedural difference was Trendelenburg positioning: Group A was maintained at 10°-15° throughout, whereas Group B required 25°-30° during the sacrocolpopexy phase. Numerical trends favoring the extraperitoneal approach were observed in operative time (99.6 vs. 110.4 min; p=0.185) and time to first stool (27.7 vs. 34.5 h; p=0.552), but neither reached statistical significance. No rectal injuries or intraabdominal abscesses occurred in either group. CONCLUSIONS:Extraperitoneal vNOTES sacrocolpopexy is feasible and safe, yielding anatomical outcomes equivalent to the transperitoneal approach at six months. Its most substantiated advantage is the reduced Trendelenburg angle, which may lower physiological burden in high-BMI patients. Remaining potential benefits require confirmation through larger prospective trials.
BACKGROUND:A deep understanding of anatomy is essential for the professional education of competent clinicians, especially surgeons. This study explores an innovative format of live surgery on body donors complemented by interactive digital technologies and assesses its perceived educational value among students. By evaluating the individual digital technologies, this study also evaluates the format's practical feasibility as a testing platform for digital technologies in surgical anatomy education. METHODS:Operations were performed on body donors by experts in a live format in front of an audience of 40-80 medical students. Surgeons and anatomy specialists interacted with students and explained procedures step by step. Students actively participated in the operations, gaining direct practical experience. In addition, the latest digital interactive technologies, such as virtual reality (VR) and augmented reality (AR), were continuously used and evaluated. RESULTS:Evaluations demonstrated that 96% of 412 participants were 'very enthusiastic' about the concept and appreciated the use of multimedia teaching methods. The Touch Surgery app was well received (mean 3.2 ± SD 1.3; Likert scale 1-5, where 5 indicated 'fully applies'). By using interactive platforms such as Slido and TED, the contents could be repeated and prepared, which was highly appreciated (mean 4.4 ± SD 1.1; Likert scale 1-5, where 5 indicated 'fully applies'). In particular, the use of computed tomography (CT) scans of the body donors was rated positively (mean 3.6 ± SD 1.4; Likert scale 1-5, where 5 indicated 'fully applies'). CONCLUSIONS:Live surgery using body donors improved not only the students' self-reported anatomical knowledge but also the innovative digital technologies with a focus on VR and, in particular, the complementary use of CT datasets of body donors, were perceived positively. This new format is a valuable addition to the standard medical curriculum, providing students with further tools for a better understanding of surgical anatomy and potentially supporting greater confidence in long-term clinical practice.
Background: There are several biliary drainage procedures for biliary strictures, including endoscopic ultrasound-guided hepaticoduodenostomy (EUS-HDS). This multicenter retrospective study evaluated the safety and clinical outcomes of EUS-HDS for intrahepatic bile duct drainage. Methods: Consecutive patients who underwent EUS-HDS at 12 Japanese referral centers between January 2010 and December 2024 were enrolled. The primary endpoint was clinical success. Secondary endpoints were technical success, stent patency, and adverse events. Results: Thirty-five patients were analyzed. Perihilar biliary stenosis was observed in 91.4%, and right posterior sectoral bile ducts were targeted in 80.0%. Technical and clinical success rates were 88.6% and 68.6%, respectively. The cumulative incidence of stent occlusion was 6.7% at 30 days, 13.3% at 90 days, and 20.0% at 180 days. One case of mild peritonitis occurred. Conclusions: EUS-HDS appears to be a feasible and safe option for selected patients with malignant intrahepatic biliary obstruction and may provide clinical benefit as part of a complementary drainage strategy.
BACKGROUND:At present, traditional minimally invasive thermal ablation technologies are all derived from electromagnetic radiation energy generated by high-frequency, high-energy physical sources. Consequently, they all share common issues, such as poor conformability, carbonization, difficulty controlling temperature, and electromagnetic radiation. METHODS:This paper proposes a steam thermal ablation (STA) technology that utilizes the internal energy of saturated steam to replace traditional electromagnetic radiation-based energy sources. Using a self-built, minimally invasive steam thermal ablation precision treatment system for liver tumors and a steam ablation needle designed via COMSOL simulation, ex vivo pig liver experiments were conducted. Based on STA characteristics, a real-time monitoring scheme for the ablation boundary has been proposed using fluorescence imaging. RESULTS:The results of STA are characterized by a maximal ablation axis ratio (short diameter/long diameter) and the absence of carbonization. The fluorescence-based monitoring effectively eliminated artifacts and radiation constraints typical of ultrasound or CT-guided procedures. CONCLUSIONS:Steam thermal ablation (STA) technology offers a novel thermal ablation method, featuring good conformability and no carbonization. Combined with real-time fluorescence imaging monitoring, it provides a feasible solution for the limitations of traditional minimally invasive thermal ablation techniques.
BACKGROUND:This study evaluated the feasibility of lipiodol marking using the left radial artery (LRA) approach prior to cryoablation for small renal cell carcinoma (RCC). METHODS:This retrospective study included 59 patients who underwent transarterial lipiodol marking before cryoablation between August 2022 and December 2023. The LRA approach was attempted in 46 patients; 13 patients ineligible for LRA underwent femoral artery (FA) puncture as a descriptive comparator. The primary endpoint was technical success without crossover among attempted LRA cases; secondary endpoints included overall feasibility among candidates, failure reasons, adverse events (AEs), and procedural metrics. RESULTS:Technical success without crossover was 91.3% (42/46), with overall feasibility of 71.2% (42/59). All four LRA failures resulted from arterial anatomical variation/tortuosity (n = 3) or brachial artery dissection (n = 1), completed via FA crossover. Grade I AEs included forearm haematoma (26.1%), LRA occlusion (2.2%), and brachial artery dissection (2.2%). Procedure and fluoroscopy times were longer in the successful LRA cases than in the FA cohort (median 86 vs. 63 min and 1256 vs. 851 s, respectively). CONCLUSIONS:LRA-based lipiodol marking achieved technical success in most attempted cases. AEs were manageable but not negligible. Prospective studies are warranted to clarify patient-centred benefits and optimal selection criteria.
BACKGROUND:We aimed to evaluate diagnostic performance of preoperative hydrodissection and grey-scale imaging (US) in predicting extra-thyroidal extension (ETE) of subcapsular thyroid lesions. METHODS:The retrospective study evaluated hydrodissection between September 2023 and March 2025 for subcapsular thyroid nodules. Biopsy specimen with atypia of undetermined significance and thyroid tumors without surgery were excluded. For US, ETE was determined based on following features: capsule disruption, bulging contour, and perithyroidal infiltrations. For hydrodissection, ETE was determined positive if resistance was encountered. Diagnostic performance comparing US and hydrodissection in predicting ETE was performed for K-TIRADS 5 nodules and thyroid tumors. RESULTS:A total of 40 nodules per 33 patients (age: 50.2 ± 12.7; female: 28/33, 84.9%) were included. Out of 40 nodules, 18 nodules were tumors, of which 15 nodules (83.3%) were malignant. Four malignant nodules demonstrated ETE. For K-TIRADS 5 nodules (n = 28), hydrodissection demonstrated better diagnostic performance in terms of specificity (0.96 vs. 0.63, p = 0.008), accuracy (0.93 vs. 0.61, p = 0.004), and AUC (0.854 vs. 0.563, p = 0.013). For thyroid tumors (n = 18), hydrodissection demonstrated higher accuracy (0.89 vs. 0.56, p = 0.031) and higher AUC (0.839 vs. 0.536, p = 0.016). CONCLUSION:Hydrodissection demonstrated better specificity, better accuracy, and higher AUC in predicting ETE than US.
BACKGROUND:To evaluate the implementation and clinical impact of a standardised workflow for laparoscopic right hemicolectomy (LRH) with complete mesocolon excision (CME) using a cranial approach in colon cancer, the so-called 'Marginal Gains' project. METHODS:This is a single-centre retrospective before-and-after cohort study of prospectively collected data. Outcomes of 29 patients undergoing LRH from 2022 to 2023 (control group) were compared with 34 patients treated between 2023 and 2024, after implementation of a structured CME-oriented workflow (intervention group). The primary outcome was the rate of workflow application and its clinical impact (secondary outcomes) in terms of CME rate (performed when clinically indicated), intraoperative events, 30-day postoperative complications, and lymph nodes harvested. RESULTS:Baseline characteristics were comparable between groups. Workflow was applied in all cases. CME, performed according to predefined clinical criteria, was more frequent in the intervention group (13/34, 38.2%) than in the control group (1/29, 3.4%; p = .001), reflecting structured workflow adoption and potentially introducing selection bias. Overall postoperative complications occurred in 6/34 (17.6%) patients in the intervention group and 13/29 (44.8%) in the control group (p = .027), mainly driven by low-grade (Clavien I-II) events, particularly paralytic ileus (0 vs. 4 cases) and minor anastomotic bleeding (0 vs. 4 cases). One anastomotic leak occurred in the intervention group (2.9%), requiring reoperation with redo anastomosis (Clavien III-b). No significant differences were observed in tumour stage. The mean number of harvested lymph nodes was higher in the intervention group (22.18 ± 6 vs. 18.83 ± 6.50; p = .021). CONCLUSIONS:Implementation of the standardised CME-oriented workflow was feasible and associated with lower short-term postoperative morbidity and higher lymph node harvest. Given the non-randomised before-and-after design and limited sample size, these findings should be considered exploratory and hypothesis-generating rather than evidence of definitive improvement in surgical or oncological outcomes. Prospective multicentre validation is warranted.
BACKGROUND:Emergency ventral hernia repair remains a challenging procedure due to patient instability, contaminated surgical fields, and heterogeneity in hernia types and operative techniques. Predicting postoperative complications in this setting is difficult using traditional statistical methods. Machine learning (ML) may offer improved predictive accuracy by recognizing nonlinear patterns among multiple perioperative factors. METHODS:A retrospective multicenter analysis was performed using data from the ACTIVE (Acute Treatment for Incisional Ventral Hernias) study, including 557 adult patients undergoing emergent ventral hernia repair between 2018 and 2021 in 31 Italian surgical centers. Demographic, preoperative, intraoperative, and postoperative variables were analyzed. Three ML algorithms-Decision Tree, Random Forest, and Deep Learning Neural Network-were trained and validated using five-fold cross-validation after class balancing with SMOTE. Model performance was compared with traditional logistic regression using accuracy, area under the ROC curve (AUC), and F1 score. RESULTS:Postoperative complications occurred in 181 patients (32.5%), while major complications (Clavien-Dindo ≥ II) occurred in 10%. Random Forest achieved the best performance (AUC 0.95, accuracy 0.88, F1 score 0.86), outperforming logistic regression (AUC 0.82, accuracy 0.78). The most influential predictors were operative duration, ASA score, and sepsis for overall complications, while bowel obstruction and BMI were key factors for major complications. Surgical approach (open vs. laparoscopic) did not independently correlate with adverse outcomes, highlighting the complexity of patient- and case-specific interactions. CONCLUSIONS:Machine learning models can accurately predict postoperative complications following emergent ventral hernia repair, surpassing traditional regression methods. These findings suggest that ML-based decision tools could support risk stratification and optimize surgical planning in high-risk emergency settings. Prospective validation is warranted to integrate AI-assisted prediction into perioperative clinical workflows.
BACKGROUND:Three-dimensional (3D) virtual models are increasingly used to support minimally invasive partial nephrectomy (PN), but their clinical value remains uncertain. We assessed whether 3D guidance improves perioperative, oncological, and early functional outcomes and evaluated its cost. METHODS:We retrospectively analyzed 159 patients who underwent laparoscopic or robot-assisted PN between 2022 and 2024. Propensity score matching generated two comparable groups (35 patients each) treated with or without 3D virtual model guidance, according to age, PADUA score, and surgical approach. Perioperative, pathological, early oncological, and early functional outcomes were compared using non-parametric tests. RESULTS:Although matching improved comparability, some residual imbalance remained. The 3D group had longer operative times (median 200 vs 170 min; p=0.008). No significant differences were found in clamping strategy, warm ischemia time, estimated blood loss, hospital stay, pathological stage, surgical margins, postoperative complications, or early recurrence. Changes in haemoglobin, serum creatinine, and estimated glomerular filtration rate from baseline to discharge were similar between groups. Each 3D virtual model cost €800. CONCLUSIONS:In this propensity score-matched cohort, 3D virtual model guidance during minimally invasive PN was associated with longer operative time, added cost, and no measurable benefit in perioperative, oncological, or early functional outcomes.
BACKGROUND:Surgery for benign prostatic obstruction (BPO) is often associated with postoperative ejaculatory dysfunction. Traditional techniques like transurethral resection of the prostate (TUR-P) or open prostatectomy (OP) effectively relieve lower urinary tract symptoms (LUTS) but usually compromise antegrade ejaculation. Minimally invasive surgical techniques (MISTs), such as Rezūm® or modified endoscopic surgeries, like the ejaculation-sparing anatomical photoselective vaporization of the prostate (ESa-PVP), were developed to preserve sexual function while ensuring symptom relief. However, few comparative data are available. Our study aims to compare the early functional and sexual outcomes of Rezūm® and ESa-PVP in BPO. METHODS:This prospective, non-randomised study analysed two cohorts of men with LUTS unresponsive to medication or an indwelling catheter, surgically treated at our centre between December 2022 and December 2023. The primary outcome of the study was the assessment of postoperative antegrade ejaculation. Secondary outcomes included LUTS evaluation and surgical complications. Postoperative outcomes were assessed after three months by administering validated questionnaires: International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and Male Sexual Health Questionnaire-Ejaculatory Dysfunction, short form (MSHQ-EjD). RESULTS:A total of 54 patients were evaluated (31 Rezūm, 23 ESa-PVP). After three months, the ESa-PVP showed a better improvement of both IPSS scores (p = 0.009) and patient-perceived quality of life (p = 0.008). No significant differences were found in erectile function (IIEF-5 scores, p = 0.340), while the MSHQ-EjD scores were significantly higher in the Rezūm group (p = 0.001). Ejaculation was maintained in 26 out of 31 (83%) Rezūm patients versus 14 out of 23 (60%) ESa-PVP patients (p = 0.056). CONCLUSIONS:Rezūm® and ESa-PVP are both effective and safe procedures for the treatment of BPO. While the ESa-PVP seems to provide better symptom relief in the short term, Rezūm® showed higher rates of immediate antegrade ejaculation preservation. Personalised counselling is crucial to achieve optimal patient satisfaction.
BACKGROUND:Piezosurgery has emerged as an innovative technique with minimal soft tissue injury, making it useful for complex spinal procedures. However, its efficacy in small-animal spinal surgery needs further evaluation. This study assessed the safety and effectiveness of a piezoelectric ultrasonic bone cutter (PUBC) in a rabbit vertebral defect model. METHODS:Twenty New Zealand white rabbits were assigned to two groups: one undergoing surgery with a traditional rotary drill (TRD) and the other with a PUBC device. Cervical corpectomy defects were created using the respective osteotomy tools, and intraoperative and postoperative complications were carefully monitored. RESULTS:Three rabbits (3/10, 30%) in the TRD group experienced both intraoperative and postoperative complications, whereas no complications were observed in the PUBC group. Compared to the TRD, the PUBC device minimized bleeding and effectively protected surrounding soft tissue structures from damage. Additionally, the PUBC produced more uniform and precise bone defects, potentially facilitating proper bone graft implantation. However, micro-computed tomography and histological analysis revealed no significant differences in bone healing between the devices. CONCLUSIONS:This study suggests that the PUBC is a safe and effective tool for spinal surgery in small animal models, and can be used as an alternative approach to the TRD device.
BackgroundProstaglandins and other uterotonics are first-line medical management for retained products of conception (RPOC), with transcervical surgery reserved for failed conservative management. In the rare setting of invasive retained products of conception (iRPOC), however, these approaches may not achieve complete evacuation. This study assessed laparoscopic resection as a fertility-preserving treatment for iRPOC.MethodsThis case series included all eligible patients who underwent laparoscopic resection for iRPOC at a single tertiary centre between January 2012 and June 2024. Effectiveness was defined as complete resection on intra-operative transvaginal ultrasound scan (TVUS), no requirement for re-intervention, and no evidence of residual RPOC on follow-up TVUS 4-6 weeks post-operatively. Safety and post-operative fertility were evaluated as secondary outcomes.ResultsSixteen patients with iRPOC were included, with a mean age of 34.9 years and a mean follow-up of 61 months. Eight cases followed miscarriage or termination of pregnancy, and eight followed birth. Ultrasound-guided laparoscopic resection with uterine reconstruction was successful in all cases. Mean operative time, blood loss, and hospital stay were 69.6 min, 271.9 mL, and 1.9 days, respectively. Three patients attempting pregnancy subsequently conceived uneventfully.ConclusionsLaparoscopic management of iRCOP seems to be a feasible, effective and safe management option.
BACKGROUND:With the increasing age of patients and the higher incidence of proximal gastric tumours, it is important to offer early gastric cancer (EGC) treatments that minimise post-operative morbidity and preserve quality of life. While several endoscopic and laparoscopic approaches have been established as standard treatments, total or subtotal gastrectomy with D2 lymphadenectomy remains the standard in Western countries, except for T1a lesions smaller than 2 cm. This study aims to explore the feasibility of stomach-preserving techniques combined with fluorescence-guided nodal basin harvesting in a Western setting for EGC. METHODS:From July 2021 to November 2023, 12 patients (mean age 75, range 59-87) with cT1N0M0 gastric cancer underwent sentinel nodal basin harvesting after peritumoral injection of indocyanine green (ICG). Stomach-preserving surgery was performed in all patients: intraoperative endoscopic resection in two cases, stapler resection in four, and partial gastrectomy via gastrotomy in six cases. Lymphatic basins were dissected according to tumour location, and fluorescent nodes were separately analysed. Follow-up included CT scans and upper gastrointestinal (GI) endoscopy every six months for two years. RESULTS:A total of 151 nodes were harvested (mean 12 per patient, range 5-22). Eleven cases were staged pT1N0; one 82-year-old patient with severe schizophrenia had pT3N2 disease, for which a completion total gastrectomy was suggested but declined. One patient experienced a Clavien-Dindo grade II complication. Mean hospitalisation was four days. After a median follow-up of 21.9 months (range 8-36), no recurrence was observed. Mapping confirmed that all metastases remained within the sentinel basin. CONCLUSIONS:Fluorescence-guided nodal basin harvesting combined with limited gastric resection is technically feasible in a Western context and does not compromise short-term oncological outcomes. Patient selection, meticulous staging, and consideration of possible secondary surgery are essential. Long-term oncological safety requires further investigation.
BACKGROUND:There is still no clear consensus on long-term follow-up data for uterine leiomyoma (UL) recurrence and the major risk factors for recurrence after UL resection. This study aimed to investigate UL recurrence and related factors after laparoscopic myomectomy (LM). METHODS:The local and international literature on UL recurrence rates and related factors after LM was systematically collected, with the search period up to December 31st, 2024. Stata 16.0 software was used for meta-analysis. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment, regardless of the I2value. RESULTS:A total of eight studies were included, and 2,160 patients receiving LM were followed up for more than 12 months. The total number of recurrence cases was 497, and the crude recurrence rate was 23.0%. The meta-analysis results indicated that preoperative UL size ≥ 10 cm (OR = 2.15, p < 0.001), uterine size >10 or 14 weeks (OR = 2.40, p = 0.001), and preoperative UL number ≥2 (OR = 2.46, p < 0.001) were risk factors for UL recurrence after LM. There was no statistically significant association between age ≥35 years, BMI ≥ 24 or 25 kg/m2, postoperative delivery or pregnancy, and post-LM UL recurrence. CONCLUSIONS:In this study, the risk factors for UL recurrence after LM were obtained through meta-analysis, which is more stable and reliable than the results of a single study and can provide a reference and basis for clinically identifying the risk factors related to LM recurrence after surgery, fully evaluating the risk of recurrence before surgery and predicting high-risk groups.
BACKGROUND:The incidence of rectal neuroendocrine tumors (rNETs) is increasing due to widespread colonoscopy screening. Conventional endoscopic techniques have difficulties in achieving complete resection of rNETs with deep submucosal invasion. Endoscopic intermuscular dissection (EID) enables removal of the mucosa, submucosa, and inner circular muscle layer while preserving rectal wall integrity. METHODS:We retrospectively analyzed the patients diagnosed with rNETs between May 2022 and May 2025 at our hospital. Clinical data, endoscopic findings, histopathological results, and follow-up outcomes were reviewed. RESULTS:A total of 13 patients underwent EID for rNETs were enrolled, with 13 ESD cases included for paired comparison. Both groups demonstrated sufficient histologically complete resection rates (92.3% vs 100%, p>0.99). EID required longer procedure time (38.31 ± 12.84 vs. 29.54 ± 4.75 min, p=0.036). Hospitalization costs showed no significant difference (14795.92 ± 2946.61 vs. 12363.00 ± 2585.15, p=0.105).1 case of delayed bleeding occurred in each group, respectively, with no other serious adverse events. No recurrence was reported in 25 cases that achieved histologically complete resection. CONCLUSIONS:EID is safe and effective for rNET resection without increasing costs compared to ESD. It may be a feasible option for selected rNETs with suspected deep submucosal invasion requiring adequate vertical margins.
BACKGROUND:The objective of this study was to evaluate the technical feasibility, perioperative safety, and surgical workflow of the Toumai® Laparoscopic Surgical Robot System in gynecology by reporting the first Robot-Assisted Total Hysterectomy (RATH) using this platform in Europe. METHODS:A total hysterectomy with bilateral salpingo-oophorectomy was performed on a patient with recurrent HPV-related CIN 3 at AZORG Hospital (Aalst, Belgium) in May 2025. The procedure was conducted by a surgeon with > 200 prior robotic hysterectomies. All surgical team members underwent formal system training. Preoperative, intraoperative, and postoperative data were collected, including operative times, complications, estimated blood loss, and hospital stay. The setup, port placement, and docking process were detailed to serve as a reference for future users. RESULTS:The procedure was completed without intraoperative complications, conversions, or need for additional ports. Total operative time was 70 min: 6 min for port placement, 9 min for docking, 46 min of console time, and 9 min for closure. Estimated blood loss was 30 mL The patient was discharged on postoperative day one, and follow-up at 14 days was unremarkable. The surgical setup provided adequate ergonomics and workflow efficiency, with all robotic arms functioning without issue. Instrumentation was comparable to existing platforms. CONCLUSION:In this first European experience, Toumai® enabled a safe and efficient multi-port RATH with 70 min' total time and 30 mL blood loss, without complications or conversion. These feasibility data warrant a prospective series to assess reproducibility, learning curve, and cost-effectiveness.
BACKGROUND:Performing an intestinal anastomosis is a challenging part of laparoscopic surgery, and ensuring adequate closure is essential to prevent anastomotic leakage. The aim of this study was to develop an objective method for quantitative assessment of laparoscopic intestinal anastomosis during simulation training. METHODS:A modular intraluminal air leakage device, the LeakChecker, was designed and validated by comparing laparoscopic intestinal anastomoses performed by laparoscopic novices and experts. The MaxForce, MeanNon-zero force, PathLength and DepthPerception parameters from the Lapron box-trainer vs MaxPressure and PressureArea from the LeakChecker were used for comparison. RESULTS:A functional prototype was built and the data of 10 laparoscopic novices and seven experts were included. Anastomoses made by the experts tolerated a higher MaxPressure (3,10(2,51-7,24)kPa vs 0,98(0,81-1,35)kPa; p=0.010) and showed a higher pressureArea (24,89(16,13-100,04)kPa*t vs 5,99(4,78-9,23)kPa*t; p=0.032). The Lapron box trainer data showed significant differences between the experts and novices for almost all including force and motion parameters. CONCLUSION:The LeakChecker can quantify anastomotic leakage during training as it objectively distinguishes between novices and experts. Implementing this kind of smart training task in a training program with objective skill assessment would inform participants of both their instrument handing skills and the quality of their execution.
BACKGROUND:The aim of this study was to evaluate factors causing difficulty in internal carotid artery (ICA) access using the left transradial approach for diagnostic cerebral angiography. METHODS:This was a prospective, single-centre, analytical study (n = 32 enrolled, n = 31 analysed) with an indication for diagnostic cerebral angiography. Diagnostic angiography via left transradial access was performed in all cases. Factors influencing the bilateral ICA catheterisation were evaluated. RESULTS:Diagnostic angiography was successfully completed in all 31 analysed patients (100%). Successful RICA catheterisation was observed in 25 (80.6%) cases, and LICA catheterisation was observed in 77.43% (24/31) of cases. Reflecting the hydrophilic guidewire off the aortic root/valve to gain support and advance the catheter into the ICA was required in 17/24 (70.8%) of LICA and 9/25 (36%) of RICA cases to facilitate catheterisation. Positive correlation was observed between BCA-LCCA, left CCA-left subclavian artery angles and inability to cannulate LICA. A Type III arch was associated with an increased LICA cannulation time. The presence of a bovine aortic arch necessitated the use of the reflected-wire technique to cannulate the LICA. CONCLUSIONS:The reflected-wire technique can be used to facilitate ICA catheterisation via the left radial approach.
