Abstract: Background/Objectives: Type II endoleak (T2EL) remains the most frequent complication after endovascular aortic aneurysm repair (EVAR), with uncertain clinical relevance and management. While most resolve spontaneously, persistent T2ELs can lead to sac enlargement and rupture risk. This study proposes a deep learning framework for preoperative prediction of T2EL occurrence and severity using volumetric computed tomography angiography (CTA) data.Methods: A retrospective analysis of 287 patients undergoing standard EVAR (2010–2024) was performed. Preoperative CTA scans were processed for volumetric normalization and fed into a 3D convolutional neural network (CNN) trained to classify patients into three categories: no T2EL, benign T2EL, or malignant T2EL. The model was trained on 224 cases, validated on 33, and tested on an independent cohort of 30 patients. Performance metrics included accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC).Results: The CNN achieved an overall accuracy of 76.7% (95% CI: 0.63–0.90), macro-averaged F1-score of 0.77, and AUC of 0.93. Class-specific AUCs were 0.93 for no T2EL, 0.91 for benign, and 0.96 for malignant cases, confirming high discriminative capacity across outcomes. Most misclassifications occurred between adjacent categories.Conclusion: This study introduces the first end-to-end 3D CNN capable of predicting both presence and severity of T2EL directly from preoperative CTA, without manual segmentation or handcrafted features. These findings suggest that preoperative imaging encodes latent structural information predictive of endoleak-driven sac reperfusion, potentially enabling personalized pre-emptive embolization strategies and tailored surveillance after EVAR.

Abstract: Wound complications such as delayed healing and infection remain a challenge in on-coplastic breast surgery, often prolonging recovery and affecting patient comfort. This study explored the use of innovative breast-shaped polyurethane and polyester dressings impregnated with an oxygen-enriched oleic matrix designed to release reactive oxygen species that support natural tissue repair. Sixty patients undergoing unilateral qua-drantectomy with contralateral breast remodeling were included. The advanced dressing was applied to the oncologic breast, while standard premedicated patches were used on the opposite side, allowing each patient to serve as their own control. Over the first po-stoperative month, outcomes such as wound dehiscence, infection, delayed healing, and user experience were assessed. The new dressing provided excellent skin hydration, comfort, and ease of use, with complication rates comparable to traditional treatments. No infections, hematomas, or reoperations were observed. Healthcare personnel reported that the device was simple to handle and replace, while patients appreciated the comfort and absence of adhesive irritation. These preliminary findings suggest that oxygen-enriched oleic matrix breast-shaped dressings offer a safe, practical, and pa-tient-friendly alternative for postoperative care in oncoplastic breast surgery. Larger prospective studies are warranted to confirm their potential in improving healing quality and patient experience.

Abstract: Full-endoscopic lumbar discectomy (FELD) has emerged over time as a minimally invasive alternative to conventional microdiscectomy. This narrative review summarizes the available evidence regarding the evolution, indications, techniques, and outcomes of FELD, with a particular focus on how different types of lumbar disc herniations influence the choice of surgical approach. The literature indicates that the transforaminal approach is most suitable for foraminal and upper lumbar disc herniations, whereas the interlaminar approach is preferred for central or migrated L5–S1 herniations due to the larger interlaminar window at this level. Unilateral biportal endoscopy (UBE) provides better flexibility, visualization, and instrument maneuverability, making it particularly useful in complex cases. Reported complication rates remain low overall but vary according to surgical technique and surgeon experience. The learning curve for FELD typically ranges from approximately 20 to over 50 cases, depending on the approach and individual proficiency. Overall, full-endoscopic techniques are redefining the management of lumbar disc herniations by offering less invasive alternatives with favorable clinical outcomes, and their role is expected to expand further as both technology and surgical expertise continue to evolve.

Abstract: Background/Objectives: High-frequency ultrasonography (US) is increasingly used to guide closed reduction of nasal bone fractures, but near-field resolution over the curved nasal dorsum depends critically on the acoustic coupling medium. We aimed to determine whether a semi-solid standoff gel pad (PAD) provides superior image contrast and signal stability compared with a liquid gel barrier (LGB) during intraoperative nasal bone fracture sonography. Methods: In this prospective, single-center, within-subject crossover study, 30 adults with isolated nasal bone fractures underwent intraoperative high-frequency US of the nasal dorsum under two coupling conditions differing only in the medium: a 7-mm hydrogel standoff pad (PAD) and a custom 7-mm liquid gel barrier (LGB). All scans were acquired on the same platform using fixed B-mode presets (10 MHz, 4.0 cm depth, single focal zone at the cortex). Rectangular regions of interest (ROIs) were placed on the cortical interface (bone ROI) and adjacent soft tissue (soft-tissue ROI) at matched depth. For each subject and condition, contrast-to-noise ratio (CNR) and two signal-to-noise ratios (SNR_bone, SNR_bg-ref) were derived from ROI gray-level statistics and compared using paired t-tests. Results: PAD yielded significantly higher CNR at the cortical interface than LGB (3.46 ± 0.17 vs. 2.50 ± 0.19; mean paired difference 0.96, 95% CI 0.88–1.04; p < 0.0001). SNR_bone was also higher with PAD (4.31 ± 0.35 vs. 3.63 ± 0.34; difference 0.68, 95% CI 0.52–0.83; p < 0.0001). Using the soft-tissue ROI as the noise reference (SNR_bg-ref), PAD again outperformed LGB (7.64 ± 0.73 vs. 6.68 ± 0.78; difference 0.96, 95% CI 0.59–1.33; p = 0.000012). Conclusions: Compared with a liquid gel barrier of similar thickness, a semi-solid standoff gel pad provides higher near-field CNR and SNR at the nasal cortical interface, supporting its routine use as a practical and effective coupling medium for real-time ultrasound guidance during closed reduction of nasal bone fractures.

Abstract: Fournier's gangrene is a rare and aggressive necrotizing fasciitis that affects the external genitalia, perineum, and perianal areas. Early diagnosis and prompt intervention are crucial for the management of this life-threatening condition. Treatment of Fournier's gangrene typically involves radical debridement of the necrotic tissue, often leading to significant perineal defects. Several approaches can be considered to cover the defect resulting from Fournier's gangrene, including split-thickness skin grafting, negative-pressure wound therapy, free flaps, and perforator flaps. Perforator flaps have several advantages over other methods. Herein, we present a case of Fournier's gangrene caused by underlying colon cancer in a patient scheduled for chemotherapy. Successful reconstruction of the defect resulting from wide excision and debridement was achieved using a deep external pudendal artery perforator flap.

Abstract: Background and Clinical Significance: Synchronous gastrointestinal tumors are ex-ceptionally rare, particularly when combining histologically distinct benign and ma-lignant components. Schwannomas represent uncommon mesenchymal tumors of the gastrointestinal tract, most frequently arising in the stomach, while rectal localization is exceedingly unusual. Papillary adenocarcinoma of the gallbladder is an aggressive malignant entity derived from intracholecystic papillary-tubular neoplasms (ICPNs). The coexistence of these two unrelated neoplasms has not been previously reported, making this case of dual tumor pathogenesis clinically and academically significant. Case Presentation: A 68-year-old female was admitted for surgical management of grade IV uterovaginal prolapse. Preoperative imaging incidentally revealed a well-circumscribed rectal wall mass and gallstones. A combined abdominopelvic op-eration was performed, including total hysterectomy with bilateral adnexectomy (Wiart procedure), rectosigmoid resection with colorectal anastomosis, and bipolar cholecystectomy. Intraoperatively, a firm intramural rectal lesion and a friable papil-lary mass in the gallbladder fundus were identified. Histopathologic examination con-firmed a benign rectal schwannoma (S-100 positive, CD117/DOG-1 negative) and a papillary adenocarcinoma of the gallbladder, pT3N0M0, with clear resection margins and no lymphovascular or perineural invasion. The postoperative course was une-ventful, and the patient remained disease-free at six-month follow-up. Conclusions: This case represents an exceedingly rare benign–malignant synchronous tumor association. The simultaneous occurrence of rectal schwannoma and gallblad-der papillary adenocarcinoma underscores the importance of thorough intraoperative exploration and histopathologic evaluation. Complete resection with negative margins and multidisciplinary follow-up remains crucial for optimal outcomes and contributes to understanding dual tumor pathogenesis within the gastrointestinal tract.

Abstract: Background: Laparoscopic-guided subcostal transversus abdominis plane (TAP) block has been introduced as a surgeon-performed alternative for postoperative analgesia in laparoscopic cholecystectomy (LC). This technique provides direct visual confirmation of anesthetic delivery without the need for ultrasound guidance. Evidence in patients with complicated gallstone disease remains limited. This study evaluated the clinical outcomes and factors associated with postoperative opioid requirement following laparoscopic-guided subcostal TAP block. Methods: A prospective observational study was conducted between November 2023 and October 2024 at Srinakharinwirot University Hospital, Thailand. Adult patients (18–80 years) undergoing LC for uncomplicated or complicated gallstone disease received a laparoscopic-guided subcostal TAP block with 0.25% bupivacaine. Pain was assessed using the Visual Analogue Scale (VAS) at 2, 4, 6, 8, 12, and 24 hours postoperatively. Morphine administration within 24 hours was recorded. Perioperative variables were analyzed using univariate and exploratory multivariable logistic regression. Results: Forty-two patients were analyzed; half of patients did not require postoperative opioids, while the remainder received a mean cumulative morphine dose of 3.86 ± 1.39 mg. Pain scores were significantly lower at 2, 4, and 12 hours in the morphine-free group (p < 0.05). Higher ASA classification independently predicted morphine requirement (OR = 6.51; 95% CI, 1.37–30.96; p = 0.018). No major complications or local anesthetic toxicity were observed. Conclusion: Laparoscopic-guided subcostal TAP block appears to provide effective early postoperative analgesia and a meaningful opioid-sparing benefit after LC, including in patients with gallstone-related complications. Higher ASA class was associated with greater opioid demand, underscoring the importance of individualized, risk-adapted analgesic strategies. These findings support the feasibility and potential integration of surgeon-performed TAP block into ERAS pathways to enhance multimodal analgesia and postoperative recovery.

Abstract: The application of bioabsorbable PhasixST™ mesh in the laparoscopic repair of large hiatal hernias has emerged as a promising strategy to address the limitations associated with permanent synthetic meshes, particularly the risk of mesh-related complications and long-term morbidity. Recent studies have demonstrated that PhasixST™ mesh, composed of poly-4-hydroxybutyrate (P4HB), is slowly absorbed over 12 to 18 months, providing a scaffold that supports native tissue integration and healing during the critical postoperative period. This gradual absorption profile may confer an advantage over more rapidly degrading bioabsorbable meshes, as it allows for more robust tissue ingrowth and potentially enhances the durability of hiatal reinforcement. The association between P4HB mesh use and low recurrence rates has been highlighted, with an average of 2.82 hernia recurrences per 100 patients within one year, and no mesh-related complications in the current literature [1,2]. The surgical technique for PhasixST™ mesh placement involves meticulous crural reinforcement, with careful attention to mesh orientation and fixation to minimize the risk of migration or erosion. The primary objective is to restore the anatomical integrity of the hiatus, reduce the size of the defect, and prevent recurrence, while minimizing perioperative morbidity [3].

Abstract: Background/Objectives: Posterior vaginal wall prolapse (rectocele) significantly im-pairs bowel function and quality of life (QoL). This study evaluated the short-term functional, QoL, and safety outcomes of transvaginal Prolene mesh–augmented recto-cele repair and examined predictors of recurrence. Methods: A retrospective cohort of 120 women (mean age 49.5 ± 11.0 years) who underwent transvaginal mesh-augmented rectocele repair between January 2020 and July 2023 was analysed. Functional and QoL outcomes were assessed using the Constipation Scoring System (CSS), Obstructed Defecation Syndrome (ODS) score, Patient Assessment of Constipa-tion Quality of Life (PAC-QOL), and Visual Analogue Scale (VAS) for pelvic/rectal pain. Results All functional and QoL scores improved significantly at 12 months (all p < 0.001): CSS decreased from 9.5 ± 2.8 to 6.0 ± 3.1 (−36.8%), ODS from 22.3 ± 7.5 to 15.4 ± 5.2 (−30.9%), PAC-QOL from 58.6 ± 15.5 to 39.1 ± 18.2 (−33.3%), and VAS pain from 7.38 ± 1.73 to 4.61 ± 1.67 (−37.5%). The overall complication rate was 11.7%, with mesh exposure (5.0%), retraction (4.2%), and infection (1.7%). Multiparity (p = 0.004) and higher BMI (p = 0.011) were independently associated with recurrence. Conclusions: Transvaginal mesh–augmented rectocele repair provides substantial short-term im-provements in bowel function, pain, and QoL with an acceptable safety profile. Multi-parity and obesity are important predictors of recurrence, underscoring the need for individualized risk assessment and long-term follow-up.

Abstract: Background: Preoperative localization of non-palpable breast lesions is critical for accurate resection and margin control in breast-conserving surgery. Traditional methods, such as wire or radioguided localization, have limitations in terms of logistics, patient comfort, and procedural flexibility. SCOUT® is a wireless, radar-based alternative that may improve surgical precision and workflow. Methods: We conducted a retrospective cohort study of 427 patients undergoing breast-conserving surgery after preoperative localization using the SCOUT® system between January 2023 and May 2024 at a tertiary academic hospital. Variables included lesion type, location, neoadjuvant treatment, device detection, seed deactivation, MRI interference, margin status, and reoperation rate. Results: The mean age was 58 years (SD 12.7), with malignant pathology in 88.5% of cases. SCOUT® achieved a 100% detection rate in axillary localizations and 98.1% in breast lesions. Seed deactivation occurred in 1.17% of cases, all successfully managed intraoperatively. MRI artefacts were observed in 1.59% of patients, without diagnostic interference. Positive margins were reported in 8.3% of cases, representing an improvement compared with the institution’s historical 12% rate, with 5.9% requiring reoperation. The device remained functional after neoadjuvant therapy in all applicable cases. Conclusions: SCOUT® demonstrated high detection rates, low complication incidence, and reduced positive margin rates, supporting its reliability for the localization of non-palpable breast lesions. These findings reinforce SCOUT® as an effective alternative to conventional localization techniques, with potential to optimize breast-conserving surgery and reduce reoperations.

Abstract: Background: The management of complex hepato-pancreato-biliary (HPB) pathologies demands exceptional surgical precision. Traditional two-dimensional imaging has limitations in depicting intricate anatomical relationships, potentially complicating preoperative planning. This review explores the synergistic application of three-dimensional (3D) reconstruction and artificial intelligence (AI) to enhance surgical management in complex HPB cases. Methods: This narrative review comprehensively synthesized the existing literature on the applications, benefits, and limitations of 3D reconstruction and AI technologies in the context of HPB surgery. Results: The literature demonstrates that 3D reconstruction provides patient-specific, interactive models that significantly improve surgeons' understanding of tumor resectability and vascular anatomy, contributing to reduced operative time and blood loss. Building upon this, AI algorithms automate image segmentation for 3D modeling, enhance diagnostic accuracy, and offer predictive analytics for postoperative complications, such as liver failure. By analyzing large datasets, AI can identify subtle risk factors to guide clinical decision-making. Conclusion: The convergence of 3D visualization and AI-driven analytics is creating a paradigm shift in HPB surgery. This powerful combination is fostering a move toward a more personalized, precise, and data-informed surgical approach, with the potential to optimize outcomes for the most challenging patient cohorts.

Abstract:

Background: The older adult population is at increased risk for burn injury due to normal age-related physiological changes. This population experiences higher rates of mortality, increased length of stay, and greater complications compared to younger patients. The goal of this study was to examine how frailty impacts acute care discharge location and long-term functional outcomes following burn injury. Methods: A prospective study was performed at a single U.S. ABA-verified burn center. Patients >55 years old admitted from September 2019 to 2021 were enrolled. Patient and injury demographics, including the Clinical Frailty Scale (CFS), were collected. Discharge disposition was recorded. Long-term functional status was assessed via the Barthel Index and a functional questionnaire completed at 6 months to 1.5 years post-discharge. Results: Fifty patients were enrolled, with average age of 71 (SD 10.44) years and an average Total Body Surface Area (TBSA) of 7.44% (SD 13.22). Mean CFS score was 3.4 (SD 1.65). Patients discharged to a Skilled Nursing Facility (SNF) had significantly higher mean CFS scores (5.0, SD 0.94) compared to those discharged to Home (2.2, SD 1.2) or to Inpatient Rehabilitation Facility (IRF) (3.0, SD 1.3), with a statistically significant difference across groups (F = 15.97; P < .0001). At follow-up, 90% (n=30) of patients returned to self-reported baseline and prior living environment. Conclusions: Frailty can be used as a predictor of discharge destination and outcomes in the older adult burn population. A higher CFS was associated with discharge to a higher level of care (SNF), even in patients who were younger and had a smaller TBSA compared to those discharging to IRF. The CFS can be a valuable tool for burn providers in prognostication, setting realistic expectations, and guiding discharge planning.

Abstract: Accurate calculation of toric intraocular lenses (IOLs) remains challenging, particularly in accounting for posterior corneal astigmatism. This study compared the prediction accuracy of two industry-standard toric calculators using ray-traced total corneal astigmatism (TCA). In a two-year retrospective chart review at an academic outpatient center, patients undergoing femtosecond laser-assisted cataract surgery with toric IOL implantation were included, excluding those with corneal pathology, irregular astigmatism, prior ocular surgery, or maculopathy. Tomographic and ray-traced TCA along with swept-source OCT (SS-OCT) biometry were entered into the Tecnis Toric Calculator (TTC), while SS-OCT values were entered into the Barrett Toric Calculator (BTC) using both predicted posterior corneal astigmatism (P) and measured posterior corneal astigmatism (M). Absolute prediction errors (PE) of spherical equivalent and cylinder power were compared, with subgroup analysis of with-the-rule (WTR) and against-the-rule (ATR) astigmatism. Sixty eyes of forty patients were analyzed. TTC with TCA achieved lower mean absolute cylinder PE (0.52 D) than BTC with P (0.59 D, p=0.016) and M (0.56 D, p=0.024), with significant advantages in WTR eyes but not ATR eyes. Across calculators, ATR eyes showed greater residual error and overcorrection. These findings support incorporating ray tracing and tomography to improve toric IOL prediction accuracy.

Abstract: Background: Recent trials, including JCOG0802/WJOG4607L and CALGB140503, con-firmed the oncological adequacy of segmentectomy for early-stage non-small cell lung cancer (NSCLC). This shift emphasizes the preservation of pulmonary function and minimal invasiveness. Robot-assisted thoracic surgery (RATS) offers enhanced anatomi-cal precision and potentially improves segmentectomy outcomes. Methods: We reviewed the current evidence comparing sublobar resection and lobectomy for early-stage NSCLC, focusing on RATS segmentectomy. Clinical trials, perioperative and long-term outcomes, technical innovations, and patient selection criteria were analyzed. Comparative data among RATS, video-assisted thoracoscopic surgery (VATS), and open approaches were synthesized, including the emerging roles of AI and 3D imaging. Results: Segmentectomy yields survival outcomes equivalent or superior to lobectomy for stage IA peripheral NSCLC ≤2 cm, with better pulmonary function despite higher locoregional recurrence. RATS enhances visualization, dexterity, and ergonomics, thereby enabling precise dissec-tion and lymph node assessment. Compared to VATS and open surgery, RATS shows lower conversion rates, reduced pain, and comparable oncological control. Innovations, such as indocyanine green imaging, 3D modeling, and AI-guided navigation, support margin accuracy and personalized care. Conclusions: Segmentectomy has redefined the surgical standards for early-stage NSCLC. RATS maximizes the minimally invasive bene-fits by combining oncological safety and functional preservation. Its technical precision facilitates complex resections and integration with digital planning tools to advance per-sonalized thoracic surgery. RATS represents the next evolution of minimally invasive thoracic surgery, redefining the balance between oncological safety and functional preservation in early-stage NSCLC.

Abstract:

Background and Objectives: The best method for reconstructing the stomach after distal gastrectomy surgery in gastric cancer patients continues to be a subject of ongoing discussion. The most beneficial surgical option for patients is Billroth I (BI), yet surgeons may perform Billroth II and Roux-en-Y (BII/RY) procedures because they are easier to execute, although their impact on recovery complications and postoperative function remains unclear. This prospective observational cohort study compares the short- and mid-term surgical outcomes between BI and BII/RY reconstructions. Materials and Methods: We included 150 patients who received curative intent distal gastrectomy at the General Surgical Clinic of Emergency County Hospital in Târgu Mureș, Romania, between October 2021 and December 2024 (72 BI and 78 BII/RY patients), with a mean age of 61.5 ± 10.8 years (60.7% male). The outcomes included recovery parameters, postoperative complications (Clavien–Dindo), and mid-term functional results (PPI use, Los Angeles classification esophagitis, bile reflux gastritis, Sigstad dumping score). Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline covariates. Results: The results indicated that IPTW adjustment did not change the baseline demographics, tumor characteristics, or perioperative factors. The baseline characteristics were comparable between groups (p > 0.05). There were no significant differences in time to flatus (p = 0.12), oral diet (p = 0.70), or hospital stay (p = 0.69). Major morbidity (Clavien–Dindo ≥ III) occurred in 12.7% overall (p = 0.17), and the 90-day mortality was 5.3% (p = 1.00). At 6 months, bile reflux gastritis was more frequent after BII/RY (p = 0.16), whereas dumping syndrome occurred more often after BI (p = 0.16). Conclusions: The short-term surgical results together with the total postoperative complications showed no difference between the BI and BII/RY reconstruction methods. The study revealed distinct functional results between the two groups during the mid-term assessment, which demonstrates that surgeons should maintain their practice of choosing reconstruction techniques according to patient-specific requirements.

Abstract: Background/Objectives: Pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are the two most frequently employed reconstruction techniques following pancreaticoduodenectomy (PD), yet the optimal method remains debated. The objective of this study was to compare perioperative outcomes of PG versus PJ in patients undergoing PD for resectable periampullary tumors at a high-volume center. Methods: We conducted a retrospective cohort study including 604 consecutive patients who underwent PD between January 2019 and May 2025. Reconstruction of the pancreatic remnant was achieved by binding PG in 415 patients and duct-to-mucosa PJ in 189 patients. Demographics, intraoperative data, and postoperative outcomes were analyzed using standardized ISGPS/ISGLS definitions. Results: The overall complication rate was similar between groups (43.9% vs. 47.1%; p = 0.481). However, PG was associated with significantly lower rates of postoperative pancreatic fistula (12.3% vs. 18.5%; p = 0.042), and postoperative biliary fistula (2.9% vs. 6.3%; p = 0.044) compared with PJ. No significant differences were observed in delayed gastric emptying, postpancreatectomy hemorrhage, intra-abdominal abscess, relaparotomy, length of postoperative stay, or 90-day mortality. Conclusions: PG was associated with reduced rates of anastomotic fistulas compared with PJ, while most other perioperative outcomes were comparable. These findings suggest that PG may be preferable in patients at higher risk of fistula, whereas PJ remains an acceptable option in selected cases. Prospective multicenter randomized trials are required to validate these results.

Abstract: Introduction: There are many well described approaches to symptomatic hernia management; however, there remains a significant patient population with limited options for a durable ventral hernia repair with reasonable risk of infection and recurrence. Drawing from orthopedic literature, we changed our approach to this clinical problem and developed a palliative ventral herniorrhaphy pathway. Methods: An IRB approved retrospective review (January 2017-June 2019) of patients’ palliative ventral herniorrhaphy was performed. Results: 43 patients included with female preponderance (58.6%) , mean age 61.5 years. The mean BMI was 38.1kg/m2 (IQR: 25.4-62) and 28 patients (65.1%) had a history of prior wound/mesh infection. Repair within 48 hours was performed in 14 patients. Overall polypropylene prosthetic was implanted in 26 patients, and bioprosthetic/absorbable mesh was used in the remaining; , the mean surface area of implanted mesh was 561 cm2. The most common wound complications identified were skin separation (30.2%) and seroma formation (48.8%). Hernia recurrence occurred in 4 (9.3%) patients with mean followup 24.1 months (9-37). Three patients had central lightweight mesh rupture and 1 had recurrence (bioprosthetic mesh); all were subsequently repaired. Conclusion: Despite a small volume of patients, our palliative ventral hernia repair pathway offers durable repair with an acceptable risk of recurrence and mesh infection in patients who would otherwise be considered non-operative. Local surgical site complications were frequent but did not appear to affect the risk of recurrence or long-term complications.

Abstract:

Background/Objectives: To identify independent predictors of free peritoneal cancer cells (FPCC), and to investigate survival outcomes relative to peritoneal cytology status among patients underwent intended curative gastrectomy for adenocarcinoma of stomach or esophagogastric junction. Methods: Medical record of patients underwent radical surgery during January 2005-December 2020 were retrospectively reviewed. Clinical data and cytology results were evaluated. Multivariate Cox regression analysis was used to identify independent predictors of FPCC. Kaplan-Meier survival analysis was used to estimate disease recurrence and survival outcomes. Results: Of the 349 enrolled patients, 188 (53.8%) had negative cytology, 32 (9.2%) had positive cytology, and 129 (36.9%) had atypical cells in peritoneal cytology. Multivariate analysis revealed poor differentiation (adjusted odds ratio [aOR]: 2.63, 95% confidence interval [95%CI]: 1.04-6.82; p=0.015), pT4 (aOR: 4.62, 95%CI: 1.28-14.34; p=0.018), pN3 (aOR: 4.13, 95%CI: 1.14-15.03; p=0.031), and metastatic lymph node ratio >0.40 (aOR: 6.49, 95%CI: 1.44-29.14; p=0.015) as independent predictors of FPCC. Median survival duration of patients with negative, positive, and atypical cell cytology was 34.1, 13.1, and 28.7 months, respectively (p<0.001). 5-year OS was 27.2%, 8.3%, and 25.3%, respectively (p<0.001). 3-year DFS was 17.8%, 0.0%, and 17.4%, respectively (p<0.001). Median time to disease recurrence was 20.5, 4.9, and 11.3 months, respectively (p<0.001). Survival outcome and disease recurrence were comparable between atypical cell and negative peritoneal cytology patients. Conclusions: Poorly differentiated histology, pT4, pN3, and metastatic lymph node ratio >0.40 are independent predictors of FPCC. The presence of FPCC was significantly associated with poor survival and disease recurrence outcomes.

Abstract: Conventional bowel resection requires external incisions and extraluminal tissue manipulation, resulting in substantial morbidity, prolonged recovery, and aesthetic concerns. We present the technical design and preliminary validation of the Endoluminal Invagination and Transluminal Resection via Autonomous Eversion (EITRA) system, a novel surgical platform enabling complete bowel resection entirely from within the intestinal lumen. The system integrates three synergistic components: an artificial intelligence-guided navigation module utilizing shape memory alloy actuators for autonomous pathfinding, a pressure-actuated everting conduit incorporating granular jamming for progressive rigidification, and specialized endoluminal instruments performing invagination-based resection with laser ablation and circular stapling. Computational modeling predicts substantial improvements over conventional approaches: operative time reduction of 50-70% (estimated 50-80 versus 180-240 minutes), blood loss minimization to less than 30 mL versus 300-500 mL, and anastomotic leak risk reduction to under 3% versus 8-12%. Phantom model validation demonstrates feasibility of core mechanisms. EITRA represents a paradigm innovation in gastrointestinal surgery with potential applications in colorectal cancer, inflammatory bowel disease, and complex intestinal pathology requiring segmental resection.

Abstract:

Background and Aim: Standardisation is crucial for outcomes in minimally invasive colorectal surgery. Debate continues regarding the comparative efficacy of robotic versus laparoscopic platforms. This study evaluates perioperative outcomes for both approaches, performed by a single surgeon using an identical standardised technique to isolate the platform's effect. Methods: A retrospective cohort study of 250 patients undergoing colorectal resection (2019-2023) was conducted. Patients were divided into laparoscopic (n=121) and robotic (n=129) groups. Data included demographics, ASA grade, conversion rates, operative times, Clavien-Dindo complications, resection margin status (R0/R1), mortality, and length of stay. R software was used for analysis. Results: Demographics were matched, but fewer high-risk (ASA III) patients were in the robotic cohort (38.7% vs. 51.3%; p<0.05). The robotic approach showed a significantly lower conversion rate (0% vs. 6.6%). A non-significant trend toward higher-grade complications existed in the laparoscopic group (median grade II vs. I; p=0.12), with a significantly higher R1 resection rate (n=8 vs. n=2). Laparoscopic 30-day (2 vs. 0) and 90-day (4 vs. 0) mortality was higher. Anastomotic leak rates (1.6% each) and median hospital stay (5 days; p=0.71) were similar in both groups. Conclusion: Using a standardised technique, outcomes are comparable except for a significantly reduced conversion rate with robotics. The observed difference in R1 resection rates may be influenced by baseline differences in patient populations. For skilled surgeons, the choice of platform may be influenced more by economic factors and preference than by major differences in clinical efficacy. What does this paper add to the literature? Debate continues regarding the comparative efficacy of robotic versus laparoscopic platforms. This single-surgeon study compares outcomes in colorectal cancer using minimally invasive procedures and a standardised technique. The result of similar clinical efficacy suggests that standardisation reduces outcome variability and demonstrates that cost and preference may influence platform choices more.