Smoking is associated with higher complication and recurrence rates in ventral and inguinal hernia repairs, but evidence is fragmented. This study evaluated the efficacy of AI-based large language models (LLMs) for identifying literature on the impact of smoking on hernia repairs. ChatGPT 4.0, ChatGPT 4o, Microsoft Copilot, and Google Gemini were instructed to search PubMed, Embase, and Scopus for retrospective/prospective studies and randomized controlled trials regarding smoking's effects on ventral and inguinal hernia repairs. The models' outputs were cross-checked against previous systematic reviews to assess accuracy. The artificial intelligence (AI) tools generated 24 citations, of which only nine (37.5%) proved valid and relevant. Thirteen (54.2%) were fabricated references, and two (8.3%) cited studies that did not match the specified criteria. Additionally, the AIs identified two studies missed by previous systematic reviews but overlooked 35 (79.5%) recognized by those reviews. Although LLMs can quickly compile potentially relevant references, they are prone to fabricating or omitting crucial studies. Human verification remains essential for conducting reliable, comprehensive literature searches in systematic reviews and meta-analyses.

Benign prostatic hyperplasia is a leading cause of lower urinary tract symptoms in aging men. When medical therapy fails, surgery is indicated. This study evaluates the safety and efficacy of Aquablation compared with transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP) in patients with bladder outlet obstruction. A prospective analysis of 318 Aquablation patients (2023-2025) was conducted and compared with 83 TURP and 83 HoLEP patients from a retrospective database. Functional outcomes were assessed using International Prostate Symptom Score (IPSS), ICIQ-UI, EF-IIEF, and MSHQ-EJD SF. Complications were graded using the Clavien-Dindo classification. Follow-ups were performed at 3, 6, and 12 months. Aquablation patients had larger prostates than TURP (94 versus 54.7 cc; < .0001) but smaller than HoLEP (105 cc; = .002) patients. More Aquablation patients had indwelling catheters and were on anticoagulants ( < .0001). IPSS improvement was the greatest in Aquablation (18.9 points) versus TURP (13.8) and HoLEP (14.7; = .000). Erectile function was preserved in Aquablation ( = .859), with significantly better ejaculatory function (82.8% preserved) than TURP (36%) and HoLEP (18%). Furthermore, Clavien-Dindo grade 1-2 complications were higher in Aquablation, but serious events (CD 3-4) were comparable. Complication rates declined significantly after the first 30 Aquablation cases. Aquablation is an effective surgical option for medium to large prostates, offering superior symptom relief and preservation of sexual function. Although its learning curve is shorter than HoLEP's, proper training is essential to minimize early complications.

Laparoscopic gastrostomy (LG) tube placement is a minimally invasive technique increasingly used in pediatric patients requiring long-term enteral nutrition. While various approaches exist, technique standardization remains limited. This study aims to describe our institution's standardized LG technique and evaluate its surgical outcomes. We conducted a retrospective review of pediatric patients who underwent LG tube placement at a tertiary care center between August 2017 and September 2022. All procedures were performed using a uniform laparoscopic technique involving a purse-string suture and multiple fascial anchoring sutures. Clinical and perioperative data, including patient demographics, operative time, and time to first feed, were analyzed. Statistical analyses included Spearman correlation and Mann-Whitney U tests. Twenty-five patients (56% female) with a median age of 48 months (range: 7-204 months) underwent LG placement. Neurological impairment was present in 76% of cases. The median operative time was 71 minutes, and the median time to first feed was within the same postoperative day. Notably, no patients experienced intraoperative or postoperative complications. There were no conversions to open surgery, no aborted procedures, and no requirement for postoperative anti-reflux surgery. Mann-Whitney U analysis showed no statistically significant differences in operative time or time to first feed based on neurological status ( = .086 and = .568, respectively). Our standardized LG technique is safe, reproducible, and effective, with no complications and favorable outcomes across pediatric subgroups. This approach may offer a reliable alternative to percutaneous endoscopic gastrostomy or open gastrostomy placement in children.

Intestinal perforation (IP) is one of the most critical surgical emergencies in neonates. It most often occurs in premature infants, with necrotizing enterocolitis (NEC) as the leading cause. Hirschsprung's disease (HD) is another important etiology. In this study, we aimed to investigate the frequency of HD among neonates with non-NEC IP and assessed the value of performing rectal biopsy in these patients. Neonates who were treated for non-NEC IPs between 2005 and 2021 were evaluated retrospectively. Demographic data, clinical features, operative details, and rectal biopsy results were collected. These features were compared according to the histopathological results of rectal biopsy (aganglionic versus ganglionic). Rectal biopsies were performed in 48 neonates with non-NEC IP (33 preterm [68.8%], 15 term [31.2%]). The most common perforation site was the ileum (52.4%). Rectal biopsy revealed aganglionosis in 12.5% of the patients. Gestational age was higher in aganglionic than ganglionic cases (36.7 versus 32.5 weeks; = .026). The perforations were colonic in all aganglionic cases ( = 6) and 47.6% ( = 20) of the ganglionic cases ( = .025). This study highlights the importance of considering HD in the differential diagnosis of neonatal IPs. Rectal biopsy should be considered in non-NEC perforations; particularly in term (or near-term) neonates and in cases of colonic perforation, to help identify underlying aganglionosis and guide timely management. Level 3 b.

Laparoscopic pyeloplasty (LP) for treatment of ureteropelvic junction obstruction (UPJO) in children offers advantages over open surgical correction, including reduced hospitalization times and lower perioperative morbidity, but presents a long learning curve. Robotic-assisted laparoscopic pyeloplasty (RALP) offers the same advantages with reduced technical operative complexity but entails higher costs. No clear superiority of laparoscopy versus robotic surgery has been established. We conducted a retrospective comparative cohort study including pediatric patients who underwent minimally invasive pyeloplasty at two tertiary-level centers, those at Evelina Children's Hospital in London (UK) receiving LP and those at Policlinico San Matteo in Pavia (Italy) undergoing RALP. Data concerning preoperative variables and obstruction severity; intraoperative variables and surgical techniques; degree of postoperative obstruction reduction, complications, and redo surgeries were analysed. A total of 75 patients were included, with 47 undergoing LP and 28 receiving RALP, with similar preoperative characteristics across groups. The Anderson-Hynes surgical technique was employed in 71/75 cases (94.7%) with universal stent use. No conversions were recorded. Mean operatives times and postoperative length of stay were longer for RALP. Complications took place in 7/28 (25.0%) of RALP patients and 6/47 (12.7%) of LP patients. Redo surgery was needed for 1/28 (3.6%) RALP and 3/47 (6.4%) LP patients. These differences were not statistically significant. Symptoms resolution and postoperative pelvic diameter decrease were comparable between groups. RALP and LP appeared comparable in terms of safety and efficacy. Adoption of one technique over the other may be justified by the surgeon's preference and the availability of a robot.

We describe a novel extracorporeal knotting approach (ECKA) that enables secure mesh fixation via extracorporeal suture manipulation, anchoring the mesh firmly within the abdominal cavity. A retrospective analysis was conducted on 17 patients (14 males, 3 females) who underwent laparoscopic herniorrhaphy with mesh fixation using the ECKA technique. Key parameters included patient demographics, method of hernia repair (totally extraperitoneal [TEP] or transabdominal preperitoneal [TAPP]), laterality, and operative duration. Hernias were classified by procedure, with each side analyzed independently. From April 2024 to July 2025, a total of 21 hernia procedures were performed on 17 patients using the ECKA technique. The average patient age was 70.3 years (range: 47.1-88.5 years), with a mean body weight of 65.9 kg. Of the hernia types, 15 were direct, 3 were indirect, and 3 were mixed. Laterality distribution was as follows: right-sided ( = 6), left-sided ( = 7), and bilateral ( = 4). Nine procedures utilized the TAPP approach, while 12 were performed using the TEP approach. The average operative time was 88.4 minutes (range: 60.4-145.4 minutes). Postoperative analgesia consisted of diclofenac sodium administered three times daily for three days. No recurrences were observed during a mean follow-up period of 10.3 months (range: 2-17 months). The ECKA technique provides a reproducible, minimally invasive solution for fixing mesh in direct, indirect, and combined hernias via either TEP or TAPP approaches. Its extracorporeal knotting system streamlines mesh fixation, ensures consistent clinical outcomes, and enhances operative efficiency across various hernia configurations.

Following a previous study focused on the status of robotic surgery in Italy in 2020, we aimed to present the updated study reflecting data up to 2025. An online questionnaire has been sent to robotic pediatric centers in Italy. The duration of robotic activity, the number of surgeons performing robot-assisted surgery (RAS), the modality of training, volume, type, and outcome of RAS in each participating center have been collected and analyzed. The number of centers practicing robotic surgery in Italy increased by 55.5% rate. All 14 centers adopted the Da Vinci Intuitive console. Three out of 14 centers have a dedicated console, while 11 out of 14 centers share the robotic platform with adult surgeons. Nine out of 14 centers routinely adopted a fourth 5-mm laparoscopic trocar for the bedside surgeon. About 1105 robotic procedures have been performed, the majority were still urological (46.7%). The others were gastrointestinal 18%, oncological 17.1%, gynecological 10.9%, and thoracic 3.6%. The rest (3.7%) were considered varia. All centers prefer to operate patients weighing more than 10-15 kg. Robotic pediatric activity in Italy has had an important development in the last 5 years. Although there has been a significant increase, the majority of centers (78.6%) have a minimal robotic activity. Future directions are going to be the presence of robotic platforms in every pediatric centers; in this way, the robots can be adopted routinely in the pediatric surgical practice as laparoscopy. For pediatric surgery, we also need smaller instruments because 8 mm cannot be adopted in neonates and smaller infants.

Traditional open surgical repairs, including flap techniques, are associated with high recurrence rates and significant morbidity. Robotic-assisted techniques have emerged as promising alternatives to conventional methods due to improved visualization, precision, and reduced postoperative complications. The robotic transanal minimally invasive surgery (R-TAMIS) technique offers a new route for rectovaginal fistula (RVF) repair, providing enhanced dexterity and access through the transanal approach. An R-TAMIS technique was employed for same-day repair of RVF using the da Vinci Xi® system. After bowel preparation and prophylactic antibiotics, the patient was positioned in prone Jackknife. The GelPOINT Path was used for transanal access, and robotic ports were placed. The fistula tract was identified and dissected circumferentially. The vaginal wall was closed with absorbable barbed sutures, reinforced with fibrin sealant and acellular dermal mesh. The rectal wall was then closed, and patency was confirmed via endoscopic inspection. The procedure was well tolerated, and the patient was discharged the next day. Minimal postoperative pain was reported but didn't require analgesics. No major complications were observed in the immediate postoperative period. The robotic approach provided enhanced visualization and dexterity, facilitating precise dissection and suturing. The technique has already been successfully applied to benign RVFs and select rectourethral fistulas. Robotic-assisted transanal repair using the R-TAMIS technique is a feasible and effective minimally invasive option for selected patients with benign RVFs. With proper patient selection and dedicated surgical technique, this approach may reduce morbidity and improve outcomes compared to traditional open or laparoscopic methods.

Postoperative leakage at the esophagogastric anastomosis is a well-recognized and significant complication following esophagectomy. In the past, treatment options were largely confined to either conservative, nonsurgical management or removal of the gastric conduit with construction of a cervical esophagostomy. Over the last decade, the development of endoluminal stents and endoscopic clipping techniques has provided a less invasive alternative, enabling effective closure of leaks without the need for further surgery and preserving the continuity of the reconstructed esophagus. This report presents our initial clinical experiences with the combined use of stents and clips. It also reviews up-to-date evidence on patient selection, available stent designs, treatment success rates, procedure-related considerations, and the anticipated role of endoscopic approaches in managing postoperative esophagogastric anastomotic leakage. We report 3 cases who underwent endoscopic management for esophagogastric anastomotic leak with a combination of stent and clips. The success of the procedure was determined on the extent of the defect and source management, which frequently necessitated concurrent drainage and antibiotic therapy. Conservative approaches have become increasingly significant in the treatment of anastomotic leaks following esophageal surgery. Our experience demonstrates that some challenging cases can be treated with a combination of endoscopic therapy methods.

Historically, open surgery has been the treatment of choice for soft tissue lesions. This study aims to report an innovative soft tissue endoscopic surgery for subcutaneous and intramuscular lesions at our center. For this retrospective review, data on sex, age, symptoms, diagnosis, sites of surgery, previous treatment, surgery, and follow-up were collected from our Vascular Anomalies Center database. Patients with soft tissue lesions who had undergone endoscopic surgery between September 2019 and March 2024 were included. Soft tissue endoscopic surgeries included totally endoscopic surgery, endoscopy-assisted surgery, and conversion to open surgery. In total, 122 patients were included: 74 females and 48 males, with ages ranging from 1 to 38 years (median, 7.5 years). Conditions for endoscopic surgery included various vascular anomalies and benign soft tissue tumors. Surgical sites included the lower extremity, upper extremity, abdominal wall, thoracic wall, back, gluteal region, and face. One hundred patients underwent totally endoscopic surgery, and 22 underwent endoscopy-assisted or conversion to open surgery. The operative duration was 40-530 minutes (median, 222 minutes). Blood loss was 1-1400 mL (median, 30 mL). No hemorrhage or wound dehiscence was observed within 30 days after surgery. Various subcutaneous and intramuscular conditions can be successfully managed with soft tissue endoscopic surgery. We think that this novel treatment approach can provide valuable references for clinicians of many specialties, encompassing general surgery, pediatric surgery, vascular surgery, plastic surgery, dermatologic surgery, and orthopedics.

This study aimed to compare the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) in patients aged 60 and older, focusing on postoperative weight loss, improvement in obesity-related comorbidities, and perioperative outcomes. This was a retrospective analysis of data from three bariatric surgery centers with surgeries performed between January 2019 and September 2024. The study included patients aged ≥60 years who underwent either LSG or RYGB. The primary outcome was the comparison of weight loss metrics (excess weight loss [%EWL] and total weight loss [%TWL]) between LSG and RYGB. Secondary outcomes included the remission or improvement of type 2 diabetes mellitus (T2DM) and hypertension (HTN), 30-day postoperative complications, operative time, and length of hospital stay. A total of 168 patients aged ≥60 who underwent LSG ( = 130) or RYGB ( = 38) were included. Both procedures resulted in similar weight loss outcomes, with a median %EWL of 58.6% for LSG and 61.2% for RYGB. The median %TWL was 23.1% for LSG and 26% for RYGB, with no significant differences between the groups ( = .275). The operative time was significantly shorter for LSG (60 minutes versus 110 minutes for RYGB, < .001), and LSG patients had a shorter hospital stay (2 versus 3 days, < .001). The 30-day complication rate was low for both groups, with no significant difference in complications between LSG and RYGB. Regarding comorbidity resolution, 90.7% of patients with T2DM and 93.6% with HTN experienced improvement or remission. Complete remission was achieved in 39% of all T2DM cases (37.5% in LSG, 42.9% in RYGB) and in 33% of all HTN cases (33.3% in LSG, 31.6% in RYGB), with no statistically significant differences between the groups. Bariatric surgery appears safe in older adults when guided by careful patient and procedure selection through multidisciplinary assessment. Both LSG and RYGB yielded comparable weight loss and remission outcomes for T2DM and HTN in this population.

The aim of this study is to compare the postoperative outcomes of laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique with the defect closure technique using sutures and intraperitoneal mesh (IPOM plus), evaluating recurrence and bulging rates at least one year postoperatively. The secondary objective is to compare postoperative complications: seroma and pain at 30 days, 6 months, and 1 year post-surgery. Patients with midline primary ventral and incisional hernias between 4 and 10 cm were included. A CT scan was performed on all patients to assess the correct spatial values preoperatively and at 1 month, 6 months, and 12 months postoperatively. Pain was evaluated using the visual analog scale. A total of 50 patients underwent LIRA, and 48 patients underwent IPOM plus between January 2022 and May 2023. The mean defect area in the LIRA group was larger than in the IPOM plus group (63.5 ± 37.5 cm versus 55.2 ± 33.9 cm). In the LIRA group, 2/48 instances of bulging (4.4%) occurred, whereas in the IPOM plus group, there were 6/50 instances of bulging (21.3%) and 2/50 recurrences (6.4%). One month post-surgery, a clinical seroma was observed in 8/48 patients (16%) and 9/50 patients (18.7%) in the LIRA and IPOM plus groups, respectively, with complete resolution at 6 months. Postoperative pain was found to be lower in the LIRA group. In this study, the LIRA technique demonstrated lower rates of bulging, recurrence, and postoperative pain compared with IPOM plus at 1 year of follow-up. Further multicentric prospective studies with a larger patient sample and longer follow-up are necessary to draw definitive conclusions.

A steady increase in the prevalence of obesity in patients over 50 years old has led to a growing number of laparoscopic sleeve gastrectomy (LSG) in this population. Yet the efficacy for those patients is still debated. We evaluated the impact of age on the short-term results of LSG. This retrospective study analyzed patients who underwent LSG between 2013 and 2020. Patients were divided into three groups: young (≤35 years, = 35), intermediate (36-49 years, = 58), and older age (≥50 years, = 52). Body mass index (BMI), total weight loss (TWL), excess weight loss (EWL), and obesity-related comorbidities (ORC) were assessed 2 years after LSG. The mean reduction in BMI, TWL, and EWL was 9.5 kg/m, 21%-51.7% in the "older age" group, 11.9 kg/m, 26.3%-64.6% in the "intermediate" group, and 13.3 kg/m, 30.1%-74.4% in the "young" group, respectively. The LSG failure rate (EWL <50%) was 48.1% in the "older age" group, higher than in the "young" group (14.3%) ( = .001). The rate of remission or improvement in hypertension (HTN) was 31% in the ≥50 age group, significantly lower than in the other groups (36-49 years: 58%, ≤35 years: 100%) ( = .034). There was no significant difference between the groups in terms of other ORC. 10.5% of patients were lost to follow-up. Age appears to have a significant negative impact on weight loss results two years after LSG, with no impact on remission or improvement in ORC other than HTN.

The RefluxStop (RS) is an innovative surgical procedure for the treatment of gastroesophageal reflux disease (GERD). Prior research has demonstrated encouraging results in medium-term follow-ups, suggesting that this procedure is a worthwhile alternative to conventional laparoscopic antireflux surgery (LARS). Despite the standardization of the surgical technique, the procedure may be laborious and demanding even for an expert foregut surgeon. Evaluate the surgeon learning curve for the RS procedure. A single-center prospective study (December 2023-January 2025) was conducted. All the procedures were performed by one surgeon experienced in LARS. The cumulative summation (CUSUM) methodology was applied to visualize the learning curve. A broken-line regression model was employed to identify transitions between phases, thus defining competency (phase 1), proficiency (phase 2), and mastery (phase 3). Fifty consecutive RS procedures were included. The mean age was 46.7 years (standard deviation [SD]: 11.4), and 68% patients were females. Heartburn (100%), regurgitation (88%), and dysphagia (28%) were common symptoms. Hiatal hernia axial length ranged from 2 to 5 cm. The mean preoperative GERD-HRQL was 39.1 (SD: 9.2). None of the patients underwent concomitant procedures, and the mean operative time was 70.6 minutes (SD: 17.3). The regression analysis found breakpoints at case 9.32 (95% CI: 8.5-9.9) and case 23.27 (95% CI: 22.9-23.8). Thus, the competency phase was achieved after 9 cases, followed by the proficiency phase, which was completed after an additional 14 cases (up to case 23). The surgeon achieved mastery of the RS procedure upon completing 23 cases. The CUSUM learning curve for the laparoscopic RS procedure demonstrates that a surgeon experienced in LARS requires 9 cases to overcome competency and 23 cases to master the technique.

Large hepatic cysts can cause abdominal pain, pressure symptoms, or liver dysfunction. Although laparoscopic fenestration is the standard surgical approach, recurrence remains a concern. As laparoscopic hepatectomy techniques have advanced, we have adopted laparoscopic left lateral segmentectomy as a curative treatment for symptomatic cysts located in the left lateral segment. Between 2018 and 2023, 4 patients underwent laparoscopic left lateral segmentectomy for symptomatic hepatic cysts at our institution. All procedures were performed using five ports. Cystic fluid was aspirated as much as possible, and hepatic transection was conducted under the total Pringle maneuver using ultrasonic dissectors. Small vessels were sealed, while larger vessels and Glissonean pedicles were clipped or divided with linear staplers. Resected specimens were retrieved via an extended umbilical incision. Surgical and postoperative parameters were analyzed to evaluate the safety and efficacy of the procedure. The cohort included 1 male and 3 female patients, with a mean age of 63 years. Presenting symptoms included abdominal pressure (3 cases) and epigastric pain (1 case). The mean maximum cyst diameter was 16.3 cm, and the average aspirated volume was 950 mL. The mean operative time was 232 minutes, and the mean blood loss was 48 g. No postoperative complications were observed. The average postoperative hospital stay was 6 days. All patients experienced symptom resolution without delayed complications during follow-up. Laparoscopic left lateral segmentectomy might be a safe and curative surgical option for symptomatic hepatic cysts located in the left lateral segment.

This piece reflects on the significant evolution in liver surgery over the past five years, building upon a previous series we published in your journal in 2020. We discuss the current state of robotic liver surgery, presenting data on its adoption in Italy and the United States, outcomes compared to open and laparoscopic techniques, and its groundbreaking potential in liver transplantation. The editorial is based on robust, recent literature and aims to provide a balanced and insightful perspective for your readership.

This study aims to perform a comprehensive systematic review and meta-analysis to evaluate the impact of anticoagulation (AC) therapy on clinical outcomes during ventral hernia repair (VHR). A thorough online search was conducted using PubMed, Cochrane, and Embase databases. Studies comparing the use of AC therapy following VHR were included. The results analyzed were bleeding-related reoperation, hemorrhagic/thrombotic complications, length of stay, and transfusion rates. Statistical analysis was performed with Review Manager 5.4 using a random-effects model. From 1278 records, 4 studies were included, encompassing 41,868 patients (anticoagulants use = 4804; no AC = 32,649), with 25% on anticoagulant therapy submitted to minimally invasive surgery (MIS). Additionally, 90% of patients using anticoagulants underwent mesh placement. Overall analysis showed increased hemorrhagic/thrombotic complications (risk ratios [RR]: 2.3; 95% confidence interval [CI]: 1.13-4.8; = .02), bleeding-related reoperation (RR: 6.5; 95% CI: 4.3-9.9; < .00001), and longer hospital stays (mean difference: 1.69 days; 95% CI: .66 to 2.72 days; = .001) in patients using anticoagulant medications. However, there was no increased risk of transfusion (RR: 2.14; 95% CI: 0.58-7.95; = .26) between groups. The use of anticoagulant therapy following VHR is associated with increased hemorrhagic/thrombotic complications, bleeding-related reoperations, prolonged hospitalization, and similar transfusion rates. Further research is still required to validate these findings and explore the impact of MIS on anticoagulated patients following VHR.

Inguinoscrotal hernia (ISH) hernias pose higher risk of complications. Traditionally, complete dissection of the hernia sac has been considered the standard approach but, more recently, primary abandonment of the sac (PAS) has emerged as simpler alternative and potentially reduced complications. Seromas are common postoperatively, but their association with sac abandonment remains debatable. To evaluate the long-term impact of PAS in minimally invasive ISH repairs. A total of 29 patients, in a prospective observational study, who underwent minimally invasive IHS repair with PAS technique were included. ISH was defined as hernia sac longer than 7 cm from the deep inguinal annulus. Primary outcome was seroma incidence and its impact in at least 1 year follow-up. Seroma was observed in 62.1% of patients at 7 days, decreasing to 31.0% at 30 days, 10.3% at 90 days, 6.9% at 6 months, and 3.4% at 12 months. No drainage procedure was required. One patient developed ischemic orchitis, and no postoperative hematoma or recurrence was observed. Patients with longer hernia sacs had a significantly higher risk of seroma, particularly those with sacs over 10 cm. L3 hernia classification was also associated with increased seroma rates compared with L2. No other patient-related or surgical factors were linked to seroma risk. Since seroma is usually an acute postoperative complication, 1 year of follow-up may be considered adequate for this outcome. Despite a higher early seroma rate, most resolved spontaneously within 3 months, and none required intervention. PAS does not increase long-term seroma risk and may represent a simple and promising alternative for ISH repair.

The aim of this study is to evaluate whether the number of linear stapler firings used during rectal division influences the rate of anastomotic leakage (AL) in patients undergoing left hemicolectomy, sigmoidectomy, or anterior resection for cancer. This is a retrospective analysis of prospectively collected data. All consecutive patients with left or sigmoid colon or rectal cancer who underwent elective resection with primary anastomosis from 2013 to 2025 were included. Patients were categorized into three groups according to the number of linear stapler firings used to divide the rectum: rectal division with one stapler firing (group A), rectal division with two stapler firings (group B), and rectal division with three or more stapler firings (group C). One hundred and sixty patients were included in group A, 68 patients in group B, and 17 patients in group C. The overall AL rate was 8.2% and rose significantly when multiple stapler firings were used (4.4% versus 13.2% versus 23.5% in groups A, B, and C, respectively; A versus B: = .04; A versus C: ≤ .01; B versus C: = .55). Multivariate analysis confirmed multiple firings as an independent predictor of AL (two stapler firings: odds ratio [OR] = 3.06, = .04; three or more stapler firings: OR = 5.04, = .02). Multiple stapler firings during rectal transection are linked to increased rates of AL compared with the use of a single stapler firing. Prospective, multicenter trials are needed to validate these findings and to improve anastomotic safety in left colon, sigmoid, and rectal cancer surgery.

Single-port robotic surgery (SPRS) provides a single-incision alternative to multiport robotic surgery (MPRS), preserving benefits such as enhanced visualization, dexterity, and ergonomics while reducing the number of incisions. Earlier single-site platforms were limited by instrument mobility and steep learning curves. The da Vinci SP® system addresses these limitations with independently articulated robotic arms that improve precision and maneuverability. We retrospectively reviewed 5 adolescent patients who underwent SPRS using the da Vinci SP® system at our institution between November 2024 and March 2025. Perioperative and postoperative outcomes were assessed, with follow-up conducted in the clinic within 3 weeks. Data were analyzed using Microsoft Excel. Procedures included cholecystectomy ( = 3), femoral hernia repair ( = 1), and left ovarian cystectomy ( = 1). All procedures were completed via a single 20-25 mm umbilical incision without additional ports or conversion to open. The mean age was 16.4 years (range: 14-18), and the mean weight was 60.8 kg (range: 45.5-77.6). Console times ranged from 32 to 54 minutes (mean 41). All patients were discharged the same day, received no narcotics, and experienced no postoperative complications at 3 weeks. SPRS using the da Vinci SP® system appears technically feasible in carefully selected adolescent patients, with favorable short-term outcomes in this small case series. While encouraging, these results should be interpreted as preliminary. Further studies with larger cohorts and longer follow-up are needed to determine long-term safety, outcomes, and cost-effectiveness.