Hysteroscopy is considered the gold standard for the diagnosis and therapy of various genital tract lesions, especially intrauterine diseases. With the innovation of no energy hysteroscopic techniques and products, no energy hysteroscopic surgery has been widely applied in vaginal, cervical and uterine cavity lesions in recent years. To address the evolving needs of clinical diagnosis, treatment, and development, the expert group has formulated recommendations based on extension literature review and clinical experience, as well as considering the current status of no energy hysteroscopic technology in China.These recommendations include the entry criteria for hysteroscopic no energy hysteroscopic surgery,indications and contraindications, preoperative preparation, key points of operation, intraoperative monitoring, postoperative management, and complications management. It also provides the classification of no energy hysteroscopic surgery and their applications in genital tract lesions. It is anticipated that these recommendations will assist the application of no energy hysteroscopic technology in clinical practice.

Objective

To explore the feasibility of non-intubated uniportal video-assisted thoracic surgery(NI UVATS) sleeve lobectomy and summarize the surgical techniques and clinical outcomes.

Methods

From Mar. 2019 to Jul. 2023, a total of 18 non-intubated uniportal VATS sleeve lobectomy were performed by the single surgical team at the Thoracic Surgery Department of the Shanghai Pulmonary Hospital.

Results

All 18 patients successfully underwent radical resection and bronchial anastomosis. No patient was converted to thoracotomy during the entire operation.The 18 cases comprised lung squamous cell carcinoma (n=13), lung adenocarcinoma (n=2), adenoid cystic carcinoma (n=1), andcarcinoid tumor(n=2). The average operation time was 118.33±19.17 minutes. The average number of lymph node stations removed was 5.71±1.69, including station seven in all cases, and the median number of lymph nodes removed was 13.24±5.88.On the day of surgery, the drainage volume was 324.71±155.17 ml. The mean postoperative hospital stay was 4.22±1.48 days.Eight of the 15 patients diagnosed with malignancy received postoperative chemotherapy. One year after the operation, two patients experienced tumor metastasis. These two patients received postoperative chemotherapy combined with immunotherapy and achieved good tumor control.1.5 years after the operation,a local recurrence in a patient with a squamous cell carcinoma. The postoperative follow-up time was 25.7±10.7 months. The mortality was zero.

Conclusions

Non-intubated uniportal VATS sleeve resections on selected patients are feasible procedures in hands of experienced uniportal VATS surgeons,teamed up with experienced anesthetists.

Objective

To standardize and promote the clinical application of pancreatic duct(repair) surgery for benign and borderline/low-grade malignant pancreatic tumors, thereby improving surgical outcomes and reducing complications, this expert consensus was formulated.

Methods

Organized by the Minimally Invasive Surgery Committee and Intelligent Medicine Committee of the Chinese Research Hospital Association, domestic pancreatic surgery experts discussed key topics including pancreatic duct anatomy, repair concepts, surgical indications, preoperative evaluation, intraoperative techniques, and postoperative management, integrating literature evidence and clinical experience.

Results

The consensus delineates core techniques of pancreatic duct repair surgery, such as main pancreatic duct repair, end-toend pancreatic anastomosis, main pancreatic duct replacement, and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) local resection. It emphasizes preoperative multimodal imaging evaluation,intraoperative ultrasound guidance, and minimally invasive approaches. Recommendations include selecting repair strategies based on duct injury severity, standardized use of pancreatic stents, and postoperative pancreatic fistula prevention protocols.

Conclusion

Pancreatic duct (repair) surgery restores duct continuity, avoids traditional gastrointestinal reconstruction, and significantly reduces postoperative complications. It represents a major advancement in organ-preserving pancreatic surgery. Further studies are needed to validate long-term efficacy and refine technical details.

Objective

To compare and analyze the perioperative recovery and long-term postoperative prognostic outcomes between traditional laparoscopic surgery （TL） and transumbilical laparoendoscopic single-site surgery （TU-LESS） in patients with tubal ectopic pregnancy undergoing tubal preservation surgery.

Methods

A retrospective analysis was conducted on the clinical data of patients with tubal ectopic pregnancy who underwent tubal preservation surgery at the Third Affiliated Hospital of Zhengzhou University from Jan. 2019 to May 2024. Postoperative hysterosalpingography （HSG） results and follow-up data regarding subsequent pregnancies were also evaluated.

Results

There were no significant differences in baseline characteristics between the two groups. Compared to the traditional laparoscopic group， the TU-LESS group had a shorter postoperative hospital stay （4 days vs. 5 days， P ＜0.001）， lower pain numerical rating scale （NRS） scores （4 vs. 5， P ＜0.001）， and longer operative time （75.50 minutes vs. 67.00 minutes，P=0.001），all differences being statistically significant. No significant differences were observed in other perioperative indicators. There were also no significant differences between the two groups in terms of tubal patency and subsequent pregnancy outcomes. Furthermore，in the TU-LESS group，patients with tubal ectopic pregnancy masses ＜40 mm had a significantly higher intrauterine pregnancy rate （76.9%vs. 42.9%， P ＜0.001） and a lower non-pregnancy rate （15.4% vs. 57.1%， P ＜0.001） compared to those with masses ≥40 mm.

Conclusion

TU-LESS is a safe and feasible method for treating tubal ectopic pregnancy in patients who require fertility preservation. In terms of perioperative recovery， TU-LESS demonstrates clear advantages， with long-term fertility outcomes comparable to traditional laparoscopic surgery. Additionally， TU-LESS may further improve the likelihood of intrauterine pregnancy in patients with smaller tubal ectopic masses. These findings provide new evidence for the selection of TU-LESS in the management of tubal ectopic pregnancy and highlight the potential for minimally invasive techniques in gynecological surgery.

Laparoscopic partial splenectomy （LPS），a minimally invasive surgical procedure，has gained increasing popularity in the treatment of splenic diseases. With advances in the understanding of splenic function and the widespread adoption of “precision medicine” and “enhanced recovery after surgery（ERAS）” principles，LPS has become the preferred surgical option for benign splenic lesions，selected hematologic disorders，and minor splenic trauma. LPS not only preserves spleen function，but also has advantages such as safety，damagecontrol，mildpain，and fast recovery. Thisconsensus，based on the latest research and clinical practice，outlines the indications，contraindications，surgicaltechniques，and postoperative management of LPS，accompanied by expert recommendations to guide clinical practice. It is intended for patients undergoing LPS and designed for use by surgeons，nurses，and healthcare professionals across all levels of medical institutions.

The caudate lobe is the deepest and most anatomically complex segment of the liver，often referred to as the “last fortress” in liver surgery.Reports on laparoscopic caudate lobectomy （LCL） in China are limited，and standardized surgical protocols have not yet been established.To address this，the Minimally Invasive Surgery Committee of the Chinese Research Hospital Association convened experts in hepatobiliary surgery to conduct an in-depth discussion.Based on clinical experience and a review of relevant literature，the committee proposed recommendations covering the anatomy of the caudate lobe，indications，preoperative preparation and planning，surgical team and learning curve，patient positioning and trocar placement，surgical approaches，as well as intraoperative and postoperative complications and their management.These efforts led to the formulation of the Chinese Expert Consensus on Laparoscopic Caudate Lobectomy （2024 Edition）.The consensus aims to standardize and streamline the application of LCL and provide high-level evidence-based guidance for its clinical implementation.

Objective

To standardize robotic radical resection for perihilar cholangiocarcinoma and improve perioperative safety and long-term survival of patients, this expert consensus is formulated.

Methods

The Minimally Invasive Surgery Professional Committee and the Intelligent Medicine Professional Committee of the Chinese Research Hospital Association initiated and organized experts in minimally invasive surgery for biliary tract tumor in China. This expert consensus was drafted based on literature and practice,followed by several rounds of voting, feedback, discussion and revision.

Results

Eleven recommendations were put forward covering six aspects of this operation including preoperative evaluation and surgical planning, indications and contraindications, perioperative safety and efficacy, feasibility of cases requiring vascular reconstruction, survival and recurrence, as well as learning curve.

Conclusion

After thorough evaluation and comprehensive planning, it is safe and eligible for surgical centers with adequate experience in robotic hepatobiliary and pancreatic surgery to carry out this operation. The advantages of robotic approach over other approaches in terms of complications, prognosis and learning curve, still need to be supported and clarified by evidence with higher quality obtained via more application and practice.

Objective

To explore the method of laparoscopic anatomical liver resection with biliary tree pedicle transaction in the treatment of intrahepatic stones.

Methods

Clinical data of 75 patients who underwent biliary tree pedicle transaction approach for intrahepatic stones from Jan. 2018 to Sep. 2022 at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School were retrospectively analyzed，including 64 cases of laparoscopic anatomical liver resection and 11 cases of robot-assisted surgery.

Results

Among the patients， left hepatectomy was performed in 48 cases （64.0%）， left lateral sectionectomy in 3 cases， right posterior sectionectomy in 7 cases， combined left lateral and right posterior sectionectomy in 4 cases， right hepatectomy in 8 cases， combined caudate lobe resection in 1 case， segmental liver resection in 3 cases； intraoperative diagnosis revealed bile duct cancer at the porta hepatis region in 1 case； 2 cases conversion to open surgery； 6 cases underwent biliary-enteric anastomosis （8.0%）， 24 cases （32.0%）underwent common bile duct exploration. The operation time ranged from 125-525（260 ±75.8） minutes，portal occlusion time ranged from 15-120（46 ±24.9） minutes， target liver pedicle transection time ranged from 5-20 （9.8 ±2.8） minutes， dorsal parenchymal transection time ranged from 1-10 （5.4 ±2.1） minutes， ventral parenchymal transection time ranged from 10-115（40.0 ±24.0） minutes， length of liver cut surface was between 4-17 （9.4 ±2.5） cm and width between 2-8 （5.1 ±1.4） cm. Intraoperative blood loss varied between 50-1 300（325.6 ±302.5） ml； 5（6.7%） cases received blood transfusions；postoperative complications included 5 cases with bile leakage；8 patients with fluid accumulated around surgical site；5 patients underwent ultrasound-guided puncture and drainage；16 cases with postoperative fever， 2 cases with postoperative bleeding，There were no deaths during the perioperative period. Follow-up was conducted for 18-24 months postoperatively， with 2 cases undergoing stone removal through T-tube sinus tract while the remaining patients had no residual stones requiring intervention.

Conclusion

The use of laparoscopic anatomical liver resection with biliary tree pedicle transaction technique for hepatobiliary calculi facilitates surgical procedures and complete removal of lesions in the bile duct tree，reducing residual stones and complications.

Objective

To report a case of severe intravenous leiomyomatosis (IVL) managed through robotic surgery and multidisciplinary collaboration.

Methods

In Aug. 2023, a patient with intravenous leiomyomatosis was admitted to the First Medical Center of Chinese PLA General Hospital. The patient presented with multiple uterine leiomyomas and a markedly enlarged uterine corpus. The IVL lesion involved the left parametrium and pelvic floor vasculature, with tumor thrombus extending upward along the left ovarian vein, left renal vein, inferior vena cava, and terminating in the right atrium. A multidisciplinary consultation was convened, involving departments of gynecology, urology, cardiothoracic surgery,ultrasound, radiology, anesthesiology, and other relevant specialties. The lesion was completely resected through robotic surgery and multidisciplinary collaboration. The operative duration was 356 minutes, with an estimated blood loss of 500 ml.

Results

The patient experienced no severe complications during the perioperative period and had an uneventful recovery. She was discharged in improved condition 12 days postoperatively and remained free of recurrence and long-term complications during a 1-year follow-up period.

Conclusion

This case highlights the successful management of IVL through robotic surgery and multidisciplinary collaboration, achieving complete resection of the lesion in a single surgical stage.Minimally invasive surgery, particularly leveraging the advantages of the robotic surgical system and high-level multidisciplinary collaboration, has enabled the effective treatment of such complex and challenging cases.

Objective

To compare the therapeutic effect of robot-assisted and traditional open surgery in caudate lobectomy.

Methods

A total of 77 patients with hepatocellular carcinoma in the caudate lobe who underwent robotic or open resection in the First Medical Center of Chinese PLA General Hospital from May 2010 to May 2024 were retrospectively enrolled, 61 males and 16 females. There were 50 patients in the open group and 27 patients in the robotic group, with an average age of 58.03±9.64 years.Demographic data, perioperative outcomes and differences in survival outcomes were collected. Propensity scoring match (PSM) was used to balance the baseline data. After PSM, 28 patients were included in the laparotomy group and 18 patients were included in the robot group. The differences in perioperative and prognostic indicators between the two groups were compared after matching.

Results

There were no significant differences in baseline data between the two groups. After PSM, the median (inter quartile range,IQR) operation time and blood loss were 117.50 (107.00, 185.00) min and 50.00 (20.00, 100.00) ml in the robot group, respectively. The postoperative hospital stay was 5.00 (4.00, 6.00) days. There was no conversion to open surgery and no serious postoperative complications. In the open surgery group, the median operation time was 180.50(160.75, 240.00) min, the blood loss was 300.00 (100.00, 425.00) ml, the postoperative hospital stay was 8.50 (7.00, 11.00) d, and 2 patients (7.14%) had severe ascites. Then abdominal puncture and drainage were performed under ultrasound guidance. However, the recurrence free survival (RFS) was (29 months vs. 31 months, P=0.798), the overall survival (OS) was (55 months vs.60 months, P=0.974), and the recurrence free survival (RFS) was (29 months vs. 31 months, P=0.798) in the two groups. The difference was not statistically significant. Multivariate Cox analysis showed that AFP>400 μg/L (P=0.008), tumor diameter >5 cm (P=0.020), multiple tumors (P=0.010), and poor tumor differentiation (P=0.009) were independent risk factors for RFS. microvascular invasion (MVI)and poor tumor differentiation were independent influencing factors for OS (P<0.05).

Conclusion

Robot-assisted caudate lobectomy is superior to open surgery in terms of operation time, blood loss and postoperative hospital stay. There was no significant difference in RFS and OS between the two surgical methods. Robotic hepatic caudate lobectomy is a safe, effective and minimally invasive procedure.

Objective

To explore the feasibility and perioperative considerations of total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery （vNOTES） in patients after cesarean delivery.

Methods

Clinical data of 34 patients who underwent vNOTES total hysterectomy after cesarean section were collected from Jun. 2017 to Jun. 2023 in the First Affiliated Hospital of Shandong First Medical University for retrospective analysis.

Results

Thirty-three cases were successfully completed，and one case was referred to open surgery due to severe local adhesions，and none of 34 cases presented with complications after surgery.

Conclusion

A history of previous cesarean section is not a contraindication to vNOTES total hysterectomy，and the operator should have rich surgical experience，anatomical knowledge and skilled surgical technique， and adequate preoperative evaluation is required.

Objective

To investigate the establishment of posterior peritoneal space in transumbilical single-site laparoscopic （TU-LESS） extraperitoneal path lymphadenectomy for staging of endometrial cancer.

Methods

Retroreview of five cases of endometrial cancer patients admitted to the Gynecological Department of the First Affiliated Hospital of Nanjing Medical University from Jan. 2024 to Mar. 2024. In all patients， posterior peritoneal cavity was established by the above procedure and abdominal paraaortic lymph node resection was performed by TU-LESS extraperitoneal approach.

Results

All 5 patients successfully established the extraperitoneal cavity and performed TU-LESS para-aortic lymph node resection. During pelvic lymph node resection， we completed three extraperitoneal route and two peritoneal cavity route surgeries.

Conclusion

TU-LESS extraperitoneal route lymphadenectomy possess the advantages of less trauma and faster rehabilitation. After adjusting the operation， we simplified the construction steps of the extraperitoneal cavity. therefore， the operation was more convenient and the success rate was higher，which was conducive to the promotion of this surgical method.

Objective

To standardize robotic radical resection for gallbladder cancer thereby reducing postoperative complications and improving patient prognosis, this expert consensus is formulated.

Methods

The Minimally Invasive Surgery Professional Committee and the Intelligent Medicine Professional Committee of the Chinese Research Hospital Association initiated and organized experts in minimally invasive surgery for biliary tract tumor in China. Based on literature and practice, this expert consensus was drafted,followed by several rounds of voting, feedback, discussion and revision.

Results

Fourteen recommendations were put forward in five aspects of this operation including preoperative evaluation and surgical planning,indications and contraindications, perioperative safety and efficacy, survival and recurrence as well as learning curve.

Conclusion

It is safe and effective for surgical centers with adequate experience in minimally invasive surgery to carry out robotic radical resection for gallbladder cancer following thorough evaluating and surgical planning. The advantages of robotic approach over other surgical approaches in terms of efficacy, prognosis and learning curve, still need to be confirmed and revealed by studies with higher quality.