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Objective: To identify strategies to prevent and treat delayed gastric emptying (DGE) after pancreatic surgery., Background: Among all complications of pancreatic surgery, DGE has the largest impact on prolonged hospital stay. Several randomized controlled trials (RCTs) have addressed DGE after pancreatic surgery, either as primary or as secondary outcome., Methods: RCTs involving pancreatic surgery with DGE as primary or secondary outcome were identified using the online database of the ISGPS Evidence Map of Pancreatic Surgery (2007-2023). Meta-analysis was performed for impact on DGE grade B/C for interventions studied by at least 2 RCTs., Results: Overall, 152 RCTs were included with 22,260 patients undergoing pancreatic surgery. The overall rate of DGE grade B/C was 11.9%, including 12.7% after pancreatoduodenectomy and 4.2% after left pancreatectomy. No RCT identified an effective treatment of DGE grade B/C. Strategies which reduced the rate of DGE in at least one RCT included: prehabilitation, pancreatico-jejunostomy, antecolic gastrojejunostomy, Billroth II technique, pylorus resection, modified Roux-en-Y technique, no intraperitoneal drainage in left pancreatectomy, minimally invasive left pancreatectomy, minimally invasive pancreatoduodenectomy, mERAS, nasojejunal tube, and early oral feeding. Additional meta-analyses identified minimally-invasive left pancreatectomy as preventive for DGE grade B/C compared to open left pancreatectomy., Conclusion: This systematic review of RCTs identified 12 strategies which reduced the rate of DGE grade B/C after pancreatic surgery but no effective treatment strategy. Of the 12 preventive strategies, only minimally-invasive left pancreatectomy was confirmed effective in a meta-analysis. Future RCTs should focus on both prevention and treatment of DGE after pancreatic surgery., Competing Interests: Conflicts of Interest and Source of Funding: PP is a founder of www.EVIglance.com. No source of funding is present., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Patients with painful chronic pancreatitis combined with a dilated main pancreatic duct and a normal size pancreatic head are treated according to guidelines by lateral pancreaticojejunostomy (LPJ). This systematic review compared outcomes of minimally invasive LPJ and open LPJ., Methods: From 1 January 2000 until 13 November 2023, series reporting on minimally invasive LPJ and open LPJ in patients with symptomatic chronic pancreatitis were included. This study was structured in accordance with the PRISMA guidelines. The primary outcome was intraoperative and postoperative complications. Secondary outcomes included long-term clinical outcomes., Results: Overall, 19 retrospective studies were included. Morbidity rate ranged from 0% to 57% after minimally invasive LPJ versus 4% to 68% after open LPJ (median: 25, i.q.r.: 23). Length of hospital stay ranged from 5 to 7 days after minimally invasive LPJ and from 6 to 16 days after open LPJ. The rate of pain relief ranged from 62% to 91% after open LPJ (median: 78.5, i.q.r.: 23) and from 71% to 100% (median: 82.5, i.q.r.: 12.5) after minimally invasive LPJ respectively. New-onset endocrine insufficiency ranged from 21% to 22% in minimally invasive LPJ and 19% to 26% after open LPJ. New-onset exocrine insufficiency was shown in 11% to 27% in minimally invasive LPJ versus 8% to 26% after open LPJ. Weight gain ranged from 60% to 100% (median: 97, i.q.r.: 23) after minimally invasive LPJ., Discussion: This systematic review suggested that minimally invasive LPJ can be performed safely in selected patients with symptomatic chronic pancreatitis. Phase 2 randomized trials should assess potential short-term benefits such as postoperative pain and length of hospital stay after minimally invasive LPJ., (© The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.)

Background: Online video consultation (OVC) is increasingly used in patient-surgeon pre-surgical and follow-up consultation but a comprehensive review assessing its benefits and downsides as compared to face-to-face (F2F) consultation is currently lacking. This systematic review evaluated the effectiveness of OVC as compared to F2F consultation., Methods: A literature search (Ovid/Medline, Embase, and Clarivate Analytics/Web of Science Core Collection) was conducted including studies comparing efficacy, patient and surgeon satisfaction, and information recall between OVC and F2F patient-surgeon consultation (inception-December 4, 2023)., Results: Out of 1021 studies, 14 studies with 13,564 patients met the eligibility criteria, consisting of seven RCTs, three prospective, and four retrospective studies. Various types of surgical consultations were evaluated, including new referrals, routine follow-ups, postoperative follow-ups, and mixed consultations (both pre- and postoperative). None of the randomized trials exclusively compared OVC with F2F consultations in the high-demand preoperative setting, or assessed patient information recall. Efficacy outcomes were reported by seven studies. Among these, three RCTs showed that OVC improved efficacy in terms of waiting time (8.2 vs. 20.7 min, P = 0.01) and total appointment time (24 vs 71 min, P = 0.001, and 21.9 vs. 154.8 min, P = 0.001). Patient satisfaction was reported by 10 studies. Regarding patient satisfaction, one "mixed design" study favoured OVC (92% vs. 63%, P = 0.04), while eight studies reported similar outcomes., Conclusions: This systematic review identified some benefits of OVC such as shorter waiting and total appointment times as compared to F2F patient-surgeon consultation, although the true value of OVC remains unknown due to the limited available evidence. Future pragmatic RCTs are needed, which should include the pre-surgical consultation and assess patient information recall., Competing Interests: Declarations. Disclosures: ten Haaft, Montorsi, Barsom, Kazemier, Schijven, and Besselink declare no competing interests., (© 2024. The Author(s).)

Background: Postpancreatectomy hemorrhage (PPH) is a leading cause for surgical mortality after pancreatic surgery. Several strategies for the prevention and management of PPH have been studied in randomized controlled trials (RCTs) but a systematic review is lacking. The authors systematically reviewed RCTs regarding the impact of treatment strategies on the incidence and outcome of PPH., Material and Methods: Eligible RCTs reporting on impact of treatment on the rate of PPH were identified through a systematic literature search using the Evidence Map of Pancreatic Surgery (2012-2022). Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool for RCTs. Various definitions of PPH were accepted and outcome reported separately for the International Study Group for Pancreatic Surgery (ISGPS) definition., Results: Overall, 99 RCTs fulfilled the eligibility criteria with a pooled 6.1% rate of PPH (range 1-32%). The pooled rate of PPH defined as ISGPS grade B/C was 8.1% (range 0-24.9%). Five RCTs reported five strategies that significantly reduced the rate of PPH. Three concerned surgical technique: pancreatic anastomosis with small jejunal incision, falciform ligament wrap around the gastroduodenal artery stump, and pancreaticojejunostomy (vs pancreaticogastrostomy). Two concerned perioperative management: perioperative pasireotide administration, and algorithm-based postoperative patient management. No single RCT specifically focused on the treatment of patients with PPH., Conclusion: This systematic review of RCTs identified five strategies which reduce the rate of PPH; three concerning intraoperative surgical technique and two concerning perioperative patient management. Future studies should focus on the treatment of patients with PPH as RCTs are currently lacking., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Robotic suturing training is in increasing demand and can be done using suture-pads or robotic simulation training. Robotic simulation is less cumbersome, whereas a robotic suture-pad approach could be more effective but is more costly. A training curriculum with crossover between both approaches may be a practical solution. However, studies assessing the impact of starting with robotic simulation or suture-pads in robotic suturing training are lacking., Methods: This was a randomized controlled crossover trial conducted with 20 robotic novices from 3 countries who underwent robotic suturing training using an Intuitive Surgical ® X and Xi system with the SimNow (robotic simulation) and suture-pads (dry-lab). Participants were randomized to start with robotic simulation (intervention group, n = 10) or suture-pads (control group, n = 10). After the first and second training, all participants completed a robotic hepaticojejunostomy (HJ) in biotissue. Primary endpoint was the objective structured assessment of technical skill (OSATS) score during HJ, scored by two blinded raters. Secondary endpoints were force measurements and a qualitative analysis. After training, participants were surveyed regarding their preferences., Results: Overall, 20 robotic novices completed both training sessions and performed 40 robotic HJs. After both trainings, OSATS was scored higher in the robotic simulation-first group (3.3 ± 0.9 vs 2.5 ± 0.8; p = 0.049), whereas the median maximum force (N) (5.0 [3.2-8.0] vs 3.8 [2.3-12.8]; p = 0.739) did not differ significantly between the groups. In the survey, 17/20 (85%) participants recommended to include robotic simulation training, 14/20 (70%) participants preferred to start with robotic simulation, and 20/20 (100%) to include suture-pad training., Conclusion: Surgical performance during robotic HJ in robotic novices was significantly better after robotic simulation-first training followed by suture-pad training. A robotic suturing curriculum including both robotic simulation and dry-lab suturing should ideally start with robotic simulation., (© 2024. The Author(s).)

Background: Hyperspectral imaging (HSI), combined with machine learning, can help to identify characteristic tissue signatures enabling automatic tissue recognition during surgery. This study aims to develop the first HSI-based automatic abdominal tissue recognition with human data in a prospective bi-center setting., Methods: Data were collected from patients undergoing elective open abdominal surgery at two international tertiary referral hospitals from September 2020 to June 2021. HS images were captured at various time points throughout the surgical procedure. Resulting RGB images were annotated with 13 distinct organ labels. Convolutional Neural Networks (CNNs) were employed for the analysis, with both external and internal validation settings utilized., Results: A total of 169 patients were included, 73 (43.2%) from Strasbourg and 96 (56.8%) from Verona. The internal validation within centers combined patients from both centers into a single cohort, randomly allocated to the training (127 patients, 75.1%, 585 images) and test sets (42 patients, 24.9%, 181 images). This validation setting showed the best performance. The highest true positive rate was achieved for the skin (100%) and the liver (97%). Misclassifications included tissues with a similar embryological origin (omentum and mesentery: 32%) or with overlaying boundaries (liver and hepatic ligament: 22%). The median DICE score for ten tissue classes exceeded 80%., Conclusion: To improve automatic surgical scene segmentation and to drive clinical translation, multicenter accurate HSI datasets are essential, but further work is needed to quantify the clinical value of HSI. HSI might be included in a new omics science, namely surgical optomics, which uses light to extract quantifiable tissue features during surgery., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Duodenal stenosis is a condition that can be related to several diseases, being either intrinsic, such as neoplasm and inflammatory stenosis, or extrinsic, such as pancreatic pseudocyst, superior mesenteric artery syndrome, and foreign bodies. Current treatments range from endoscopic approaches, such as endoscopic resection and stent placement, to surgical approaches, including duodenal resection, pancreaticoduodenectomy, and gastrointestinal bypass. Minimally invasive robot-assisted surgery is gaining importance due to its potential to decrease surgical stress, intraoperative blood loss, and postoperative pain, while its instruments and 3D-vision facilitate fine dissection and intra-abdominal suturing, all leading to a reduced time to functional recovery and shorter hospital stay. We present a case of a 75-year-old female who underwent robotic D3 partial duodenal resection with primary side-to-side duodeno-jejunal anastomosis for a 5 cm adenoma with focal high-grade dysplasia.

Background: The cost-effectiveness of minimally invasive distal pancreatectomy (MIDP) is still a matter of debate. This study compares the cost-effectiveness of open (ODP), laparoscopic (LDP) and robotic distal pancreatectomy (RDP)., Methods: Pubmed, Web of Science and Cochrane Library databases were searched. Studies comparing cost-effectiveness of ODP and MIDP were included., Results: A total of 1052 titles were screened and 16 articles were included in the study, 2431 patients in total. LDP resulted the most cost-efficient procedure, with a mean total cost of 14,682 ± 5665 € and the lowest readmission rates. ODP had lower surgical procedure costs, 3867 ± 768 €. RDP was the safest approach regarding hospital stay costs (5239 ± 1741 €), length of hospital stay, morbidity, clinically relevant pancreatic fistula and reoperations., Conclusion: In this meta-analysis MIDP resulted as the most cost-effective approach. LDP seems to be protective against high costs, but RDP seems to be safer., (Copyright © 2021 Elsevier Inc. All rights reserved.)