Background: Recurrent weight gain after Roux-en-Y gastric bypass (RYGB) has become increasingly common. This study aimed to compare short-term surgical outcomes between patients undergoing Limb Lengthening (LL) versus Biliopancreatic Diversion with Duodenal Switch (BPD/D) after RYGB. Methods: A retrospective analysis of the MBSAQIP database (2020-2023) was performed, including patients that underwent revisional surgery with LL or BPD/DS following RYGB. Thirty-day postoperative outcomes including overall postoperative complications (OPC) and unplanned health care utilization (UHCU), were analyzed. A multivariable logistic regression analysis and subgroup analysis were used to assessed for Bias. Results: A total of 1456 patients were included: 58.8% (n = 857) underwent LL and 41.1% (n = 599) BPD/DS. Female patients (88.0%, n = 1,282), mean age of 49.5 +/- 9.4 years. Patients undergoing BPD/DS had higher BMI (47.3 versus 42 kg/m(2)), ASA class III-V (91.1% versus 80.7%), drain placement (31.7% versus 9.2%), and robotic approach (40.2% versus 18.7%), longer procedure time (212.2 versus 119.5 minutes), hospital length of stay (2.9 versus 1.5 days), (all P < .001). BPD/DS patients had higher OPC (15.2% versus 4.9%), including higher leaks, surgical site infections, and ICU admission, adjusted OR = 3.22 (95% CI = 1.81-5.72); they also had higher UHCU (27.2% versus 14.5%). On multivariate analysis, besides BPD/DS revision, BMI > 50, history of pulmonary embolism, and drain placement were identified as independent risk factors for OPC. Conclusions: Compared with RYGB-LL, patients undergoing RYGB-BPD/DS had longer operative time, hospital stay, and OPC. BPD/DS as a conversion technique, BMI > 50, history of pulmonary embolism, and drain placement were identified as independent risk factor for OPC.
Purpose: Recently, staplers have been introduced for the management of diastasis recti; however, current literature primarily reports transabdominal or infraumbilical open approaches. This study aims to describe in detail a totally endoscopic sublay repair technique using staplers for diastasis recti and to present its preliminary clinical outcomes.Methods: Clinical data were retrospectively analyzed from patients who underwent laparoscopic retromuscular mesh repair for postpartum diastasis recti using staplers at the Department of Hernia and Abdominal Wall Surgery, The First People's Hospital of Foshan, between September 2022 and January 2026. Collected variables included age, sex, body mass index, operative time, width of diastasis recti, intraoperative blood loss, postoperative complications, visual analog scale (VAS) pain score, length of hospital stay, recurrence rate, and follow-up findings.Results: A total of 22 patients successfully completed the surgery. The mean inter-rectus distance was 4.04 cm (range: 2.9-8.0 cm). One patient with severe diastasis recti (8 cm) experienced intraoperative dislodgement of posterior sheath staplers due to high fascial tension, necessitating medial release of the posterior rectus sheath relative to the neurovascular bundles to reduce tension and achieve secure closure. Five patients underwent concomitant abdominoplasty following laparoscopic repair. The mean operative time was 190 minutes (range: 100-371 minutes), with a mean blood loss of 27.5 mL (range: 5-150 mL). The average length of hospital stay was 5.2 days (range: 3-8 days). Postoperatively, 4 patients (18.2%) developed seromas, all of which resolved with conservative management. No recurrences were observed during the follow-up period.Conclusions: Totally endoscopic sublay repair using staplers is a feasible, safe, and effective option for the correction of mild-to-moderate postpartum diastasis recti. While short-term outcomes are favorable, long-term efficacy and durability require validation through larger studies with extended follow-up.
Introduction: Robotic-assisted ventral hernia repair has expanded over the last decade, largely driven by the widespread adoption of the da Vinci platform. Although this system offers advantages in visualization, precision, and dexterity, concerns regarding cost, accessibility, and platform design have stimulated the development of alternative robotic systems. However, evidence evaluating the clinical implementation and technological impact of these emerging platforms in abdominal wall surgery remains limited. We conducted a systematic review to assess new robotic platforms used for ventral hernia repair.Methods: This mixed-methods systematic review was conducted in accordance with PRISMA 2020 guidelines. Studies reporting robotic ventral hernia repair performed using non-da Vinci platforms were included. PubMed/MEDLINE, Embase, LILACS, Cochrane Library, SciELO, and Web of Science were systematically searched from database inception to July 2025. Qualitative thematic synthesis served as the primary analysis, complemented by descriptive evaluation of perioperative clinical outcomes. Extracted data included study characteristics, robotic platform, surgical approach, operative and docking times, postoperative complications, conversion, and length of hospital stay. Due to clinical and methodological heterogeneity, quantitative meta-analysis was not performed.Results: From 218 records identified, 10 studies (6 case series, 3 case reports, and 1 cohort), comprising 95 patients, met inclusion criteria. Three robotic platforms were evaluated: Hugo, Versius, and SSI Mantra. Qualitative synthesis identified consistent domains influencing platform adoption, primarily related to intrinsic robot strengths and limitations, surgeon-robot interaction, intraoperative characteristics, and economic considerations. A secondary qualitative analysis further contextualized these findings within ventral hernia surgery, highlighting domains related to abdominal wall reconstruction, mesh-based repair, workflow adaptability, and learning-curve progression. Across studies, emerging platforms demonstrated clinical feasibility with four conversions reported overall (3 in Hugo and 1 in Versius). Operative time ranged from 39 to 450 minutes, while docking time varied from 10 to 30 minutes. Perioperative outcomes were generally favorable, with isolated complications reported, including seroma, hematoma, urinary retention, wound infection, and drain-related complications, and no recurrences observed during short-term follow-up (7-310 days).Conclusion: New robotic platforms for ventral hernia repair demonstrate early clinical feasibility with favorable short-term outcomes. Current evidence remains limited, and further prospective comparative studies are required to clarify their role in robotic abdominal wall surgery.
Purpose: To describe a GelPOINT Mini-enabled access configuration for single-port posterior retroperitoneoscopic adrenalectomy (SPRe-Ad) using the da Vinci SP system, with emphasis on floating docking, posterior abdominal-wall tenting, and early perioperative outcomes.Materials and Methods: Two consecutive adults underwent unilateral SPRe-Ad through a 3-cm posterior incision. The GelPOINT Mini accommodated the SP cannula and a 12-mm assistant trocar through the same GelSeal cap. Aggregate perioperative data from 32 multiport robotic PRA procedures performed within the same institutional program were reviewed as a descriptive benchmark; no inferential comparison was undertaken.Results: The cases involved a 17-mm left pheochromocytoma and a 9-mm right aldosterone-producing adenoma. Docking, console, and total operative times were 4, 40, and 71 minutes and 6, 50, and 83 minutes, respectively. In the multiport cohort, corresponding median times were 6.0 (IQR, 4.3-7.8), 18.0 (12.3-22.8), and 57.5 (45.3-74.3) minutes. Neither SPRe-Ad case required conversion or developed intraoperative or 30-day postoperative complications, and hospital stay was 2 days in both patients.Conclusion: GelPOINT Mini-enabled floating docking provided single-incision assistant access and mechanical posterior abdominal-wall tenting during da Vinci SPRe-Ad. These first two cases support technical applicability within an established robotic PRA program; prospective comparative studies should determine whether this configuration increases operative workspace, reduces insufflation-pressure requirements, or improves operative efficiency and clinical outcomes.
Background: Laparoscopic adrenalectomy is the standard surgical approach for most adrenal tumors. Although three-dimensional (3D) transperitoneal laparoscopic adrenalectomy (TLA) is increasingly used, size-stratified perioperative outcomes remain incompletely characterized. We evaluated perioperative outcomes following 3D TLA by comparing patients with adrenal tumors <5 cm and >= 5 cm. Methods: A retrospective cohort study was conducted on 57 consecutive patients who underwent 3D TLA at Hospital Episcopal San Lucas between 2018 and 2025. Patients were stratified into a small category (SC) (<5 cm) and a large category (LC) (>= 5 cm). Primary outcomes included operative time, estimated blood loss (EBL), perioperative complications, conversion to open surgery, and length of hospital stay. Results: Twenty-two patients had tumors <5 cm and 35 had tumors >= 5 cm. Median operative time was significantly longer in the large-tumor group (80 versus 60 minutes; P < .001). EBL was not significantly different between groups, and median hospital stay was 28.27 hours in the SC group and 29.46 hours in the LC group (P = .554). More than 90% of patients were discharged within 48 hours. No patients required blood transfusion or conversion to open surgery, and no intraoperative or postoperative complications were observed. Conclusions: In this single-center cohort, 3D TLA was feasible for both small and large adrenal tumors. Tumors >= 5 cm were associated with longer operative time but not with significantly greater EBL or longer hospitalization. More than 90% of patients were discharged within 48 hours, and no conversions, transfusions, or perioperative complications were observed. Because this study lacked a contemporaneous 2D comparator, no conclusions regarding the incremental benefit or superiority of 3D visualization can be drawn.
