Annals of Laparoscopic and Endoscopic Surgery

Current Issue Highlights

A narrative review of robotic approaches to bile duct injury: optimizing surgical outcomes
2026: 11
Background and Objective
Although very rare after cholecystectomy, iatrogenic bile duct injury (BDI) is the most feared complication. Rarely other causes such as abdominal trauma may cause a BDI. Management required high quality imaging, possibly biliary drainage, control of biliary sepsis, identification of concomitant vasculo-biliary injury (VBI) and referral to a specialty hepatobiliary (HPB) surgeon for definitive repair. Due to the complexity of the injury and possibly hostile operative field the literature often recommends open repairs. With current technical advances these BDI cases can often be repaired robotically. In this review, we aim to discuss an update on the basic principles, technical aspects, and limitations of robotic reconstruction of BDI and offer our conditional recommendations.
Methods
We used PubMed in search of original papers, reviews, and meta-analysis evaluating the diagnosis of and technical details around BDI from January 2015 to August 2025. We also searched specifically for robotic repair of BDI to compare to existing open and laparoscopic repair literature.
Key Content and Findings
Before offering surgery for BDI, high quality imaging that identifies the anatomy, level of injury according to Strasberg classification and possible concomitant VBI are critical for planning. Further, in jaundiced patients with biliary obstruction, or with bilomas must have adequate interventional drainage procedures to prevent sepsis and promote adequate biliary drainage. Excluding those with injuries to the hepatic artery or portal vein, who may require a formal hepatectomy, most patients may be offered a Roux-en-y hepaticojejunostomy for adequate biliary reconstruction. Percutaneous transhepatic biliary drainage catheters help in guiding the repair anatomically as we show in our case video. Prevention of anastomotic strictures is paramount with risk factors including lack of surgical expertise, concomitant VBI, and postoperative bile leaks. Maintenance of biliary drainage catheters and identifying delayed leaks is paramount to optimal outcomes.
Conclusions
Robotic repair of BDI is feasible with Roux-en-y hepaticojejunostomy, with good long-term outcomes. Optimizing outcomes requires patients that are well selected without biliary sepsis, or concomitant VBI. Although without a clear optimal operative window, early referral to and surgery performed at expert centers is paramount.
Extent of lymphadenectomy in small bowel neuroendocrine tumors: a scoping review of literature heterogeneity
2026: 11
Background
Small bowel neuroendocrine tumors (NETs) represent rare gastrointestinal malignancies with complex lymphatic dissemination. Although lymphadenectomy is central to curative surgery, its extent and terminology remain poorly standardized. This scoping review evaluates the anatomical variability of lymphadenectomy and nodal outcomes in small bowel NET surgery.
Methods
A literature review was conducted using PubMed, Scopus, Web of Science, and Embase to identify studies published between January 2005 and December 2025. Only English-language studies reporting surgical management of jejunal and ileal NETs were included. Duodenal tumors were excluded. The reported extent of lymphadenectomy was evaluated across all eligible studies, and lymph node yield (LNY) data were descriptively pooled without formal meta-analysis.
Results
Out of 680 screened studies, 16 studies were analyzed, encompassing series limited to NETs of the jejunum and ileum. Marked heterogeneity was observed in both the extent and terminology of lymphadenectomy. The level of dissection was identified in 12 articles, and only three articles discussed tumor feeding vessel ligation. Reported nodal yields ranged widely, with a pooled mean of 13.2 lymph nodes (LNs), while the lymph node ratio (LNR) varied from 0.14 to 0.72 across series. Terms such as “regional”, “locoregional”, and “extended” lymphadenectomy were inconsistently applied and lacked anatomical reproducibility.
Conclusions
The literature on small bowel NET surgery demonstrates substantial heterogeneity in the extent and reporting of lymphadenectomy, limiting cross-study comparability. Given the frequent involvement of central mesenteric LNs, this scoping review, based on the available literature and anatomical principles, proposes a conceptual framework for standardized reporting of lymphadenectomy extent, including D3-volume lymphadenectomy guided by individualized vascular anatomy, while acknowledging the need for prospective validation.
Single-port robotic colectomy: a literature review
2026: 11
Background and Objective
The first single-port laparoscopic right hemicolectomy was performed in 2008 at the Cleveland Clinic. In 2020, Marks and colleagues conducted the first single-port robot-assisted laparoscopic colectomy. The single-port technique involves inserting a single trocar through a 4–5 cm incision, with four trocar external ports. Recent studies reported benefits to single-port robotic colectomy over single-port laparoscopic and multi-port robotic and laparoscopic colectomy. These include reduced postoperative pain, shorter length of stay, lower costs, and improved cosmesis. Single-port robotic colectomy remains underutilized, potentially due to limited high-quality evidence supporting its safety and efficacy. This narrative with structured literature review aims to synthesize the literature published and underscores the need for further research to establish its patient benefit and clinical utility.
Methods
The literature was surveyed on PubMed and Cochrane Library for English-language peer-reviewed articles (up to October 30, 2025) documenting single-port minimally invasive surgery.
Key Content and Findings
Preliminary data from smaller studies included in this review suggest that single-port robotic colectomy is safe and feasible, but it presents new challenges not encountered in multiport robotic colectomies. Challenges reported in the literature include collisions and instrument trapping, longer docking and operational times, lack of retraction, and inadequate exposure. Additionally, the single-port robotic system does not yet include a vessel sealer, stapler, suction device, or advanced energy delivery device. Adoption of single-port robot-assisted laparoscopic surgery has been slow.
Conclusions
Limited data are available for comparison with laparoscopic and multi-port robotic techniques, which poses a challenge for drawing significant conclusions. More studies should be performed, on a larger scale, to achieve adequate statistical significance for this data. As it stands, single-port colectomies are not being performed frequently, likely due to ergonomic challenges, limited access to specific instruments, and limited exposure to the technique. If further research, namely randomized controlled trials (RCTs), demonstrates superiority and/or advantages over multi-port procedures, surgeons may attempt single-port colectomies more frequently.
Endoscopic vacuum therapy for the management of esophageal perforations: a narrative review
2026: 11
Background and Objective
Esophageal perforations were traditionally managed surgically, while an endoscopic approach with stent placement has been the mainstay of treatment over the past years. Both approaches have variable success rates and are accompanied by either high morbidity or need additional interventions. Endoscopic vacuum therapy (EVT) has recently emerged as an important alternative, potentially providing increased effectiveness in the management of esophageal perforations while averting the need for supplementary therapeutic measures. While EVT has been reviewed previously, limited data integrate clinical, technical, and comparative efficacy outcomes while addressing novel platforms. This paper comprehensively reviews the mechanism of action, indications, technical considerations, adverse events and comparative outcomes with stenting and surgery. It also highlights gaps in practice and emerging innovations, including Eso-Sponge and VACStent.
Methods
We searched original papers, reviews, retrospective studies, case series and meta-analyses published in English, evaluating the technical and clinical applications of EVT in esophageal perforations ranging from April 2006 until July 2025, using electronic databases, including PubMed and Google Scholar.
Key Content and Findings
EVT uses similar principles of negative pressure wound therapy by utilizing a nasogastric tube attached to a sponge at its tip and applying negative pressure to the area of perforation. This promotes wound debridement, tissue approximation and perforation closure through a minimally invasive approach. Surgical approaches are associated with significantly higher complication rates and equivalent success rates. When comparing EVT to endoscopic stent placement, studies showed variable outcomes, either favoring EVT for improved efficacy or reduced hospital stay. Adverse events of EVT include stricture and fistula formation, bleeding and dislocation of the nasogastric tube.
Conclusions
With the increasing implementation of minimally invasive procedures across most specialties, surgical interventions are being used less frequently. Both EVT and endoscopic stent placement have demonstrated superior outcomes compared to surgery when assessed across various parameters. The choice between EVT and stenting remains individualized due to evolving comparative evidence. Nonetheless, recent studies suggest a potential advantage for EVT, supporting the need for standardized techniques and protocols for its application.
Performance and interpretation of intraoperative cholangiography and the role of selective vs. routine intraoperative cholangiography: a narrative review
2026: 11
Background and Objective
Intraoperative cholangiography (IOC), historically fluoroscopic, serves as a modality in laparoscopic cholecystectomy to identify biliary anatomy, injury, and pathologies. There has been debate between the routine and selective use of IOC. This article reviewed the literature to describe IOC performance, interpretation, and alternatives, as well as explore the debate between routine and selective use.
Methods
We performed a literature review of articles describing IOC, both selective and routine, from 1990 to September 2025. Literature search was performed during the dates of 8/18/2025–8/20/2025, 10/6/2025, and 1/21/2026. Search terms included “intraoperative cholangiogram”, “selective cholangiogram”, “routine cholangiogram”, “cholangiogram interpretation”, “laparoscopic ultrasound”, “robotic cholecystectomy cholangiogram”, “light cholangiography”, “near-infrared fluorescence cholangiography”.
Key Content and Findings
We found that the procedural steps and radiographic interpretation of IOC are well described, as well as alternatives to IOC including laparoscopic ultrasound and indocyanine green cholangiography. We also found literature supporting both selective and routine IOC. Proponents of selective IOC described the increased cost of IOC and the need for additional training and resources. Those who support routine IOC demonstrated the benefit of bile duct injury and gallstone identification, as well as the ability to act on these pathologies during the same procedure. We also found that Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has recently recommended routine IOC.
Conclusions
There are risks and benefits to IOC. Given the evidence in the literature and recent changes to SAGES recommendations, the authors support the routine use of IOC and advocate for improved training in this area.