In Kyu Park

Objective : This study was conducted to investigate the safety and feasibility of a newly designed single-port trocar that allows peritoneal catheter placement without the need for additional abdominal puncture during laparoscopy-assisted ventriculoperitoneal shunt surgery.Methods : This prospective, single-arm pilot study included patients who underwent ventriculoperitoneal shunt surgery using a newly designed trocar system between March and December 2024. The new trocar features a lateral opening, a transparent body, and builtin gas insufflation capability, enabling both laparoscopic visualization and final catheter placement through a single port. Its design allows the entire trocar to be removed along with the catheter without disrupting its position. Demographic and operative data of patients were collected, and the primary outcomes were procedural feasibility and intraoperative safety. Institutional review board approval was obtained before study initiation.Results : This study enrolled 16 patients (median age, 63.5 years [interquartile range (IQR), 58–72]; median body mass index, 23.6 kg/m2 [IQR, 21.8–25.1]). The most common diagnosis was posttraumatic hydrocephalus (87.5%), followed by posthemorrhagic hydrocephalus. The incision length for trocar insertion was a median of 1.2 cm (IQR, 0.95–1.5). The trocar insertion time varied (median, 40.5 seconds [IQR, 19.5–61]). The total operative time (from skin incision to closure) was a median of 52.5 minutes (IQR, 50–60). Importantly, there were no intraoperative technical difficulties or trocar-related adverse events. No early postoperative complications related to trocar insertion or distal catheter placement were observed. One patient was readmitted with fever, which was subsequently attributed to pneumonia and was not related to the surgical procedure.Conclusion : This pilot study demonstrates the safety and feasibility of the newly designed trocar system for laparoscopy-assisted ventriculoperitoneal shunt surgery.

Background: Restorative colorectal surgery after emergency stoma formation is challenging because of adhesions, altered anatomy, and pelvic dissection. We evaluated the technical feasibility of stoma‐site single‐port robotics restorative colorectal surgery using the da Vinci SP system. Methods: Six patients underwent restorative colorectal surgery through the previous stoma site between January 2023 and December 2024. The Institutional Review Board of Ulsan University Hospital approved this study (2026‐02‐018). Results: Five patients underwent Hartmann's reversal and one underwent completion proctocolectomy with ileal pouch–anal anastomosis. All procedures were completed robotically without open conversion; one required an additional port. Median operative time was 287.5 min and median blood loss was 25 mL. One intraoperative small‐bowel injury required resection, and one postoperative abscess required percutaneous drainage. No leakage, reoperation, readmission or mortality occurred. Conclusions: This approach was technically feasible in selected patients, but safety events highlight the difficulty of reoperative pelvic surgery. Further studies are required.

Postoperative pain management is one of the significant components of patient care, with the reduction of the risks of complications. However, there is a perceived unmet need for pain management due to both the adverse effects of systemic analgesics and the shortcomings of local anaesthetics. In this study, ropivacaine (RPC)- and ascorbic acid (AA)-loaded hyaluronic acid/Pluronic F127 (HA/F127) composite thermosensitive hydrogels were prepared for sustained analgesia and antioxidant activity. The HA/F127 hydrogels showed temperature-responsive sol–gel behavior with injectable properties at 4° C–20 °C. In addition, the hydrogels showed sustained release of RPC and AA over 72 h with significant radical scavenging activity. In vivo studies indicated that the HA/F127 hydrogels resulted in increased mechanical withdrawal thresholds compared to free RPC, without causing motor impairment, and plasma levels of IL-1 β and IL-6 were reduced. In addition, hematological, biochemical, and histological analyses showed acceptable ranges of biocompatibility without evidence of systemic toxicity or adverse local tissue reactions. Thus, the thermosensitive HA/F127 composite hydrogels provided sustained drug release, prolonged analgesic effects, reduced inflammatory responses, and acceptable biocompatibility. These findings indicate that these thermosensitive composite hydrogels may be a promising strategy for local drug delivery in managing postoperative pain and inflammation.

Kwon JA, et al. Ann Surg Treat Res. 2025 Nov;109(5):310-317. https://doi.org/10.4174/astr.2025.109.5.310

Background Transanal minimally invasive surgery (TAMIS) is widely used for rectal lesion excision. Robot-assisted TA TAMIS (R-TAMIS) may improve surgical ergonomics. The introduction of the da Vinci Single-Port (SP) robot, designed for endoluminal surgery, has brought new possibilities. Our primary objective herein was to assess the technical and oncological feasibility and efficacy of Single-port robotic TAMIS (SPR-TAMIS) in rectal cancer excision. The secondary objective was to analyze the perioperative outcomes. Materials and methods We included 14 consecutive patients with rectal cancer who underwent SPR-TAMIS between April 2021 and February 2023. Patient data, surgical details, and clinical outcome data were collected to assess the safety and feasibility of SPR-TAMIS. Results The median participant age was 72 years, and full-thickness excision was performed without specimen fragmentation in all cases. The median tumor diameter was 2.7 cm, positioned between 10 cm proximally and 7 cm distally from the anal verge. Negative margins were achieved in 93% of cases, with one case requiring further resection. The median operative time was 175 min, and the median hospital stay was 5 days. No intraoperative conversion from SPR-TAMIS to laparoscopic or conventional transanal excision was required. No mortalities or major postoperative complications occurred; however, one patient (7.1%) experienced minor morbidity manifesting as wound dehiscence (Clavien–Dindo grade I). No recurrence was observed during the 24-month follow-up. Conclusions In our early experience, SPR-TAMIS is a safe and feasible surgery for selected early stage rectal cancers, offering enhanced visualization and stable maneuverability transanally. This platform may have potential advantages for the excision of larger or more proximal lesions. Graphical abstract

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts in the gastrointestinal tract and is associated with numerous conditions. Benign PCI can occur secondary to certain medications, such as anticancer-targeted therapies. Here, we report a rare case of PCI that developed following sunitinib therapy for metastatic RCC and was successfully managed with conservative treatment without surgery. Patient concerns: A 57-year-old woman with a medical history of metastatic renal cell carcinoma (RCC) referred to the Department of General Surgery after completion of the 16th cycle of sunitinib because of abnormal findings on abdominopelvic computed tomography (CT), suggesting necrotizing enteritis with pneumoperitoneum involving the ileum. At the time of presentation to the Department of General Surgery, she was asymptomatic and had no abnormal findings on examination other than the imaging findings. Diagnosis: Sunitinib-induced PCI, metastatic RCC, liver cirrhosis, and diabetes mellitus. Interventions: She was admitted to the general ward for conservative treatment, and sunitinib was discontinued. Conservative treatments included nil per os, total parenteral nutrition, antibiotics, H2-blockers, and oxygen therapy. Outcomes: On the fifth day of hospitalization, the PCI showed moderate resolution on plain radiography, and she was discharged on the seventh day. Follow-up CT imaging 3 months later demonstrated complete resolution of PCI. Conclusion: This case emphasizes that the decision between conservative versus surgical treatment for PCI should be based not solely on radiological findings but rather on a comprehensive assessment, including the underlying condition, vital signs, physical examinations, and blood tests.

Yang SS, et al. Ann Surg Treat Res. 2024 Aug;107(2):59-67. https://doi.org/10.4174/astr.2024.107.2.59

Park IK, et al. Ann Surg Treat Res. 2023 Aug;105(2):107-113. https://doi.org/10.4174/astr.2023.105.2.107