Background: Gastritis diagnosis via endoscopy remains highly subjective, often leading to inter-observer variability and the misdiagnosis of early inflammatory changes as congestive portal gastropathy. While Computer-Aided Diagnosis (CAD) shows promise, the "paucity of labelled data" remains a significant barrier to clinical implementation. Aim and Objectives: This study aimed to develop and validate a scalable deep-learning solution using a hybrid CNN-Vision Transformer (ViT) architecture to assist endoscopists in the real-time severity stratification of gastritis (Normal, Mild, Moderate, and Severe). Materials and Methods: We utilized 4,462 high-definition, anonymised endoscopic images annotated by expert gastroenterologists using the Kyoto Classification as a benchmark. A multi-branch parallel processing architecture was developed, combining a CNN-based branch for local feature extraction (texture and erythema) and a Vision Transformer (ViT) for global context learning. Data augmentation expanded the training set to over 68,000 images to prevent overfitting. Performance was evaluated using Accuracy, Precision, Recall, and the Matthews Correlation Coefficient (MCC). Results: The hybrid model achieved an Overall Classification Accuracy of 91.4% and a Matthews Correlation Coefficient (MCC) of 0.90, indicating a near-perfect correlation with clinical ground truth. The system demonstrated exceptional performance in the "Normal" category with 99% specificity, providing a highly dependable negative result. Precision (0.8892) and Recall (0.8481) remained robust across all categories, significantly reducing the risk of over-diagnosing gastropathy as gastritis. Conclusion: The proposed hybrid AI architecture provides a robust, real-time "second opinion" tool for endoscopists. By integrating local and global mucosal patterns, the system achieves high-precision severity stratification, potentially reducing unnecessary biopsies and minimizing diagnostic errors caused by inter-observer variability in the endoscopy suite.
Abstract Introduction: To evaluate the outcomes of robotic retroperitoneal lymph node dissection (R-RPLND) for post-chemotherapy residual retroperitoneal masses in patients with testicular non-seminomatous germ cell tumours. Open retroperitoneal lymph node dissection (O-RPLND) is associated with long skin incisions, increased post-operative pain and prolonged recovery. R-RPLND is a minimally invasive alternative, offering improved visualisation and precision, particularly in proximity to major vessels. Patients and Methods: A retrospective analysis of patients who underwent R-RPLND at our centre between January 2023 and January 2026 was conducted. Patient selection was based on imaging and technical feasibility following informed consent. Procedures were performed by a high-volume robotic surgeon using the da Vinci Xi system. Demographic, perioperative and pathological outcomes were evaluated. Results: Ten patients underwent R-RPLND during the study period. The median age was 27 years. Embryonal carcinoma was the predominant histology on orchiectomy (70%). Sixty percent of patients had clinical N3 disease. Post-chemotherapy serum tumour markers normalised in all but two patients who required second-line chemotherapy. The mean residual nodal mass size was 4 ± 1.58 cm. The median console time and estimated blood loss were 240 min (interquartile range [IQR]: 240–310) and 220 ml (IQR: 90–300), respectively. Three patients required open conversion. Histopathology revealed necrosis in 40%, teratoma in 40% and viable tumour in 20% of the cases. There were no recurrences at a median follow-up of 20 months. Conclusion: R-RPLND is a safe and feasible alternative to O-RPLND in carefully selected patients. Optimal outcomes depend on meticulous pre-operative planning, patient selection and surgical expertise.
Abstract Background: Bile duct injury during laparoscopic cholecystectomy (LC) remains an uncommon but serious complication, especially in the presence of inflammation and distorted biliary anatomy. Reported injury rates range from 0.26% to 0.7%, with conversion-to-open rates of 2.6%–10% when the critical view of safety (CVS) cannot be achieved. Indocyanine green fluorescence (ICG-F) imaging has been introduced to improve real-time biliary visualization. This study evaluates its role in complicated gallbladder disease. Methods: This prospective comparative study included 80 patients undergoing LC between May 2024 and October 2025. Patients were divided into ICG-assisted LC ( n = 40) and conventional LC ( n = 40). Difficulty was assessed using Nassar and Sugrue grading systems. Primary outcomes were time to biliary identification and total operative duration. Secondary outcomes included conversion rate, complications, hospital stay, and surgeon satisfaction. Results: Baseline characteristics were comparable ( P > 0.05). The ICG group had significantly shorter time to CVS identification (19.6 ± 5.36 vs. 35.5 ± 5.10 minutes) and total operative time (49.1 ± 11.20 vs. 80.2 ± 9.79 minutes; P < 0.05). Conversion occurred in four conventional cases and none in the ICG group ( P = 0.220). Surgeon satisfaction was higher with ICG ( P < 0.001). Hospital stay was shorter but not significant. Conclusion: ICG-F cholangiography facilitates earlier biliary identification and reduces operative time in difficult LC. Larger multicentre randomized studies are required to confirm its impact on conversion rates and clinical outcomes.
Abstract Non-intubated video-assisted thoracoscopic surgery (NIVATS) minimises airway trauma and ventilator-induced lung injury, yet its application in complex, multi-phase McKeown oesophagectomy is seldom reported. A 32-year-old female (40 kg, 140 cm and body mass index: 20.4 kg/m 2 ) presented for McKeown minimally invasive oesophagectomy following neoadjuvant chemoradiotherapy. We employed a ‘less invasive anaesthesia’ strategy combining T9–T10 thoracic epidural analgesia with Bispectral Index-guided target-controlled propofol infusion. Continuous pressure support ventilation (16 cmH 2 O above a positive end-expiratory pressure of 5 cmH 2 O) with preserved spontaneous breathing was maintained via a size 3 i-gel™ throughout surgery; neuromuscular blockade and controlled mechanical ventilation were not used at any stage. Surgical exposure was optimised via right-sided capnothorax. The resulting permissive hypercapnia was haemodynamically well-tolerated. Recovery was uneventful, and the airway device was removed after protective airway reflexes had returned. She was discharged from the hospital on post-operative day 6 without any complications. NIVATS for McKeown oesophagectomy may be feasible in carefully selected patients.
Abstract Introduction: Paediatric choledocholithiasis is increasingly encountered in clinical practice. The conventional two-stage strategy of endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy is effective but technically demanding and associated with procedure-related complications. Laparoendoscopic rendezvous (LERV) offers a single-stage minimally invasive alternative; however, paediatric evidence remains limited. Patients and Methods: This retrospective single-centre study included seven consecutive paediatric patients (4 males, 3 females; median age: 14 years; range: 9–17 years) with cholecysto-choledocholithiasis who underwent LERV between March 2021 and September 2025. The primary endpoint was complete common bile duct (CBD) stone clearance. Secondary endpoints included operative time, complications and length of hospital stay. Results: LERV was successfully completed in all patients, achieving complete CBD stone clearance without conversion to open surgery or the need for additional interventions. Median operative time was 110 min (range: 80–140), and median hospital stay was 2 days (range: 2–4). No intraoperative or post-operative complications occurred. Mean follow-up was 38.6 months, with no late biliary complications or recurrent stones. Conclusion: LERV appears to be a feasible and promising single-stage technique for selected paediatric patients with cholecysto-choledocholithiasis, providing high ductal clearance while avoiding additional procedures. The standardised step-by-step technique presented may facilitate reproducibility and broader adoption in paediatric surgical practice.
