Delayed bleeding following endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) remains a recognized adverse event. Despite observational studies suggesting lower delayed bleeding rates with the use of self-assembling peptide (SAP), randomized data have yielded inconsistent results, precluding routine prophylactic application. We aimed to evaluate the effectiveness of SAP in preventing delayed bleeding after ESD and EMR. We systematically searched PubMed, Embase, and the Cochrane Library through October 2025 for prospective or retrospective cohorts reporting delayed bleeding following ESD or EMR in direct association with adjunctive SAP application, with or without a comparator group. Random-effects meta-analyses estimated pooled delayed bleeding rates and, where applicable, risk ratios (RR), with prespecified subgroup analyses by resection technique. Eleven studies comprising 928 patients were included. Comparative analyses (five studies), SAP in conjunction with standard therapy was not associated with a reduction in delayed bleeding compared with standard care (RR 1.34, 95% CI 0.83-2.18; I2 = 0%). Findings were consistent in a sensitivity analysis restricted to randomized controlled trials (RR 1.53, 95% CI 0.85-2.76; I2 = 0%) and in a subgroup analysis of ESD-only studies (RR 1.16, 95% CI 0.65-2.08; I2 = 0%). In single-arm analyses, the pooled delayed bleeding rate following SAP application was 6.7% (95% CI 3.9-10.2%; I2 = 71.5%). Among anticoagulated patients (five studies; n = 108), the pooled bleeding rate was 11.5% (95% CI 6.3-18.0%; I2 = 0%). Procedure-specific analyses demonstrated similar bleeding rates after ESD and EMR, with substantial heterogeneity observed in EMR cohorts. Prophylactic SAP after ESD or EMR yielded delayed bleeding rates comparable to baseline, indicating no added benefit over standard practice. In anticoagulated patients, outcomes similarly matched historical benchmarks, with no evident protective effect. Further studies are required to define the patients most likely to benefit from SAP.

Appendiceal neoplasms are rare clinical entities often diagnosed incidentally during surgery for acute appendicitis. This study aims to investigate the incidence, histopathological diversity, and clinical characteristics of appendiceal neoplasms detected in patients undergoing appendectomy. We retrospectively analyzed the medical records and histopathological reports of 5001 patients who underwent appendectomy between January 2016 and December 2025 at a single tertiary center. Patient demographics, preoperative imaging findings, intraoperative observations, and detailed histopathological parameters (tumor type, grade, size, and margin status) were evaluated. Appendiceal neoplasms were identified in 63 patients (1.26%). The mean age was 52.8 ± 18.2years. The histological distribution included appendiceal neuroendocrine tumors (ANETs; 52.4%), appendiceal mucinous neoplasms (AMNs; 34.9%), adenocarcinomas (4.8%), goblet cell adenocarcinomas (4.8%), and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs; 3.2%). Preoperative radiological suspicion was present in only 11.1% of cases, while intraoperative macroscopic suspicion was noted in 14.3%. Complicated appendicitis was observed in 20.6% of neoplastic cases. Positive surgical margins were detected in 17.5% of the total cohort, reaching 22.7% in the AMN subgroup. Appendiceal neoplasms frequently present as acute appendicitis and are largely undetectable by preoperative imaging or intraoperative assessment. Given the significant incidence of incidental malignancies, routine histopathological examination of all appendectomy specimens is mandatory for accurate diagnosis and the initiation of appropriate multidisciplinary management.

Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement is commonly employed in patients with choledocholithiasis as part of a staged perioperative management strategy. In clinical practice, biliary stent migration is often observed at the time of planned postoperative ERCP. Characterizing the occurrence of biliary stent migration, its associated clinical factors, and its implications for postoperative management is therefore relevant to optimizing patient care. We conducted a single-center retrospective cohort study including adult patients who underwent a single preoperative ERCP with biliary plastic stent placement, followed by cholecystectomy and a planned postoperative ERCP for stent removal between 2012 and 2023. The primary outcome was biliary stent migration, defined as absence of the stent at postoperative ERCP, confirmed endoscopically and fluoroscopically. Demographic, clinical, and procedural variables were analyzed to explore factors associated with stent migration. A total of 208 patients were included. Biliary stent migration was observed in 51 patients (24.5%). At postoperative ERCP, choledocholithiasis was identified in 67.8% of cases. In univariate analysis, pancreatic stent placement during the index ERCP was associated with lower odds of biliary stent migration; however, this association did not remain statistically significant after multivariable adjustment. No other demographic or procedural factors were independently associated with migration. Individualized approach may be applied for selective patients referred to the biliary stent removal after cholecystectomy. Abdominal imaging before postoperative ERCP in asymptomatic patients with normal liver function tests may help in the decision-making process and potentially prevent unnecessary invasive procedures and reduce its complications.

Vaginal hysterectomy is the preferred approach when feasible, but technical limitations may restrict its use in complex cases. Robotic assistance combined with vaginal natural orifice transluminal endoscopic surgery (vNOTES) aims to overcome these limitations. The da Vinci® Single-Port (SP) system, designed for narrow spaces, may further optimize robotic-assisted vaginal surgery. We conducted a retrospective, single-center case series including all robotic-assisted vaginal hysterectomies performed using the da Vinci® SP system (RSP-vNOTES) between October 2024 and April 2026. Clinical, perioperative, and postoperative data were collected from medical records. Outcomes were analyzed using descriptive statistics. Seventeen RSP-vNOTES hysterectomies were performed by two experienced surgeons. Median total operative time was 74min (60.8, 96.8). The main surgical indication was uterine fibroids with large uterine volume; median uterine weight was 370g (61, 800). Estimated blood loss was minimal, with no conversions or intraoperative complications. Sixteen patients (94.1%) underwent same-day discharge; one patient required one night hospitalization due to anesthetic contraindications related to comorbidities. Postoperative pain was low, with a median VAS score of 0 at 4h (0-1). No postoperative complications were observed within 30days. Robotic-assisted vaginal hysterectomy using the da Vinci® Single-Port system is feasible and safe, with favorable short-term outcomes, including in cases with large uterine volume. Direct intravaginal insertion of the SP access port provides effective robotic assistance in a confined anatomical space. Larger prospective studies are needed to confirm these findings and further define the role of single-port robotic technology in vaginal gynecologic surgery.

Abstract Introduction Although minimally invasive (MIS) liver resections are associated with improved outcomes, uptake remains slow. Methods Using data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), adults who underwent elective liver resections (2016–2020) were identified. Approach was classified as MIS (laparoscopic or robotic-assisted) or open. Annual utilization was characterized by approach and association between approach and patient and hospital variables was estimated. Results Among 63,280 adult liver resections, 22.5% were MIS. MIS resections increased from 21.3% in 2016 to 22.5% in 2020. Laparoscopy alone decreased from 18.4 to 14.9%, while robotic-assistance increased from 2.9 to 7.6%. In multivariable analysis, patients were less likely to undergo MIS resection if they were in a county with < 250,000 people (vs. > 250,000, OR [95% CI], 0.82 [0.73–0.93]). Patients were more likely to undergo a MIS resection if they had a benign indication (vs. malignancy, OR [95% CI], 2.9 [2.49–3.38]), or were undergoing a partial hepatectomy (vs. lobectomy, OR, [95% CI], 2.62 [2.24–3.07]). Conclusion MIS liver resection increased between 2016 and 2020, driven by an increase in robotic-assisted surgery and despite a reduction in laparoscopic surgery. Rurality, indication, and resection type were contributors to a MIS vs. open approach.