Liver cancer, as a globally prevalent malignant tumor, poses significant challenges to minimally invasive surgical treatment due to its complex anatomical structure and clinical characteristics. The rise of artificial intelligence (AI) technology offers a revolutionary solution to this predicament. This article systematically reviews the current application status of AI in the entire process of minimally invasive surgery for liver cancer, including preoperative planning, intraoperative navigation, and postoperative management. In the preoperative stage, AI integrates multimodal data to achieve three-dimensional liver reconstruction, surgical risk assessment, and prediction of tumor biological behavior (such as microvascular invasion), providing a quantitative basis for the formulation of individualized surgical plans. During the intraoperative phase, AI technologies such as augmented reality navigation, real-time anatomical structure recognition, and risk warning significantly enhance surgical precision and safety, while optimizing the surgical process to promote standardization. In postoperative management, AI models integrate multi-dimensional data to build high-precision prognosis prediction and complication risk assessment systems, combined with intelligent follow-up platforms, to achieve stratification of recurrence risk and full-course individualized management. Despite the significant potential of AI technology, issues such as insufficient data quality and standardization, limited model generalization ability, clinical integration obstacles, lack of decision interpretability, and data privacy and security concerns still restrict its large-scale clinical transformation. In the future, with the development of multimodal data fusion, federated learning, and explainable AI, AI is expected to drive minimally invasive liver surgery towards standardization, intelligence, and universalization, ultimately achieving the goal of precision medicine.

The surgical treatment of hepatocellular carcinoma (HCC) is undergoing a profound paradigm shift from traditional empirical models to digital and intelligent precision medicine. While minimally invasive liver resection (MILR) is widely accepted, it still faces challenges in complex vascular anatomy and depth perception. The participation of artificial intelligence (AI) technology will have a significant impact on perioperative management in MILR. In the preoperative phase, deep learning enables rapid quantitative reconstruction of vascular and biliary structures, combined with radiomics and explainable AI models to predict future liver remnant and the risk of post-hepatectomy liver failure. During the intraoperative phase, navigation technology has evolved from "static calibration" to "intelligent adaptive registration." Notably, the robotic "Brain-Eye-Hand" collaborative system and instrument deocclusion technology have significantly enhanced the precision of resecting tumors in complex locations. Postoperatively, AI promotes the transition from passive follow-up to active real-time monitoring. Despite existing bottlenecks in deformation compensation accuracy and algorithmic generalizability, the AI-driven "data-driven" paradigm will lead minimally invasive surgery into a new era of seamless, full-process intelligence.

Primary liver cancer is a highly prevalent malignant tumor worldwide. Its minimally invasive surgical treatment needs to balance precision and individualization, but the traditional diagnosis and treatment model has limitations in diagnostic efficiency, preoperative evaluation accuracy, and intraoperative navigation precision. This article focuses on the application of artificial intelligence (AI) in minimally invasive surgery for liver cancer, systematically expounding its specific application scenarios in the diagnosis of primary liver cancer, preoperative evaluation, intraoperative operation and systemic treatment. It also analyzes the current technical limitations and future prospects. Studies have shown that AI can improve the precision and individualization of minimally invasive diagnosis and treatment of liver cancer through data-driven approaches, providing a new path for liver cancer treatment.​

Angulation of the common bile duct caused by traction during laparoscopic cholecystectomy is one of the leading causes of iatrogenic bile duct injury. The mobility of the common bile duct refers to its flexibility for lateral swing and vertical stretching. Based on long-term clinical experience, the author classifies the common bile duct into two types: fixed type and lax type. The fixed type has poor mobility and is not prone to traction-induced angulation. In contrast, the lax type possesses considerable mobility and is easily angulated under traction, which may lead to common bile duct injury due to improper clipping and transection. Close vigilance against the lax common bile duct with high mobility is of great clinical significance for preventing iatrogenic bile duct injury and ensuring surgical safety.

laparoscopic liver resection has been widely adopted over the past decades, performing a laparoscopic isolated total caudate lobectomy for hepatocellular carcinoma (HCC) remains technically challenging, particularly in patients with underlying liver cirrhosis. With the accumulation of long-term follow-up data, the clinical advantages of laparoscopic liver resection have become increasingly evident. Compared with conventional open surgery, overall survival rates are comparable, while multiple studies have demonstrated that laparoscopic approaches can reduce intraoperative blood loss and shorten postoperative hospital stay. However, due to the deep anatomical location of the caudate lobe and its proximity to the inferior vena cava (IVC) and hepatic veins, laparoscopic caudate lobectomy remains a complex and high-risk procedure. In this report, we present a video demonstration of an isolated laparoscopic total caudate lobectomy performed in a cirrhotic patient, utilizing an anterior approach, with the tumor located adjacent to the caval portion of the caudate lobe.

This video demonstrates the standardized workflow of a robotic right hepatectomy. A male patient was admitted with a liver mass detected during physical examination, diagnosed as primary hepatocellular carcinoma with an 8 cm tumor localized in the right liver lobe. Under general anesthesia and in a modified lithotomy position, robotic arms were docked. The first hepatic hilum was meticulously dissected, followed by the ligation of the right hepatic artery and right portal vein. Under the Pringle maneuver, the liver parenchyma was transected along the ischemic line using an ultrasonic scalpel, and the right hepatic vein was divided with a vascular stapler to achieve complete right hepatectomy. The total operative time was 165 minutes. The estimated blood loss was 20 ml with no blood transfusion required, and the procedure proceeded smoothly.

In recent years, with the continuous updating of laparoscopic equipment and instruments, as well as surgeons' persistent pursuit of minimally invasive techniques, single-port laparoscopic hepatectomy (SPLH) has emerged. Compared with traditional multi-port LH, SPLH offers significant advantages in terms of abdominal wall cosmesis and postoperative incisional pain. However, limited by the "direct vision restriction" and "chopstick effect," single-port surgery is associated with longer operative time and requires a higher level of technical skill from the surgeon, which restricts its widespread adoption. To address this challenge, our team independently developed a 1.98 mm super-minimally invasive grasper and a 0.2 mm T-shaped suture to assist SPLH. This technique reduces the difficulty of single-port surgery while preserving its favorable cosmetic outcomes. The authors define a surgical approach featuring no more than two umbilical incisions with a maximum diameter of 15 mm, and all other abdominal incisions less than 2 mm in diameter, all of which are concealed within the natural depression of the umbilicus, as "Super-minimally Invasive Laparoscopic Surgery (SMLS)." Hepatectomy performed using this approach is termed "super-minimally invasive laparoscopic hepatectomy.".

To compare the clinical efficacy of laparoscopic anatomical left hepatectomy via anterior approach versus tunnel approach for hepatocellular carcinoma (HCC).

A total of 114 patients with HCC who underwent laparoscopic anatomical left hepatectomy from December 2019 to December 2024 were retrospectively enrolled. The patients were divided into the anterior approach group (n=57) and the tunnel approach group (n=57) according to surgical access. Perioperative parameters, liver function indices and inflammatory factors were compared using the t test or χ² test. The 12-month postoperative disease-free survival curves were plotted by the Kaplan-Meier method, and the Log-Rank test was performed for intergroup comparison.

The tunnel approach group had less intraoperative blood loss, as well as shorter hepatic portal occlusion time, gastrointestinal function recovery time, drainage tube removal time and hospital stay than the anterior approach group (P<0.05). Compared with preoperative levels, alanine transaminase (ALT) and aspartate transaminase (AST) were elevated on postoperative day 3 and day 7 in both groups; these two indicators decreased on postoperative day 7 relative to day 3, and were significantly lower in the tunnel approach group (P<0.05). Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) increased on postoperative day 3 and decreased on postoperative day 7 in both groups, with lower levels observed in the tunnel approach group (P<0.05). There were no significant differences in the overall incidence of postoperative complications and 12-month disease-free survival between the two groups (P>0.05).

Compared with laparoscopic anatomical left hepatectomy via the anterior approach, the tunnel approach can reduce intraoperative blood loss and hepatic portal occlusion time, accelerate the recovery of gastrointestinal function, drainage tube removal and hospital discharge. It also alleviates surgical damage to liver function and postoperative inflammatory response with favorable safety, and facilitates short-term postoperative recovery of HCC patients.

To investigate the clinical value of hepatic venous pressure gradient (HVPG) in transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic variceal ligation (EVL) for the treatment of cirrhotic esophagogastric variceal bleeding.

A retrospective cohort study was conducted. A total of 152 patients diagnosed with cirrhotic esophagogastric variceal bleeding and receiving corresponding treatment from January 2022 to December 2024 were enrolled. The patients were divided into the TIPS group (n=74) and the EVL group (n=78) according to the actual intervention measures. The chi-square test and t-test were used to compare primary efficacy endpoints (including preoperative HVPG level, postoperative HVPG change amplitude, pressure reduction compliance rate and immediate hemostasis success rate) and secondary efficacy endpoints (1-year cumulative rebleeding rate, 1-year cumulative survival rate and median time to rebleeding) between the two groups. Perioperative indicators were also compared. P<0.05 was considered statistically significant.

The total procedural time, puncture/ligation time and sedation/anesthesia time in the TIPS group were significantly longer than those in the EVL group, with more intraoperative blood loss and higher dosage of sedatives. The 24-hour postoperative Visual Analogue Scale (VAS) pain score of the TIPS group was markedly lower than that of the EVL group (P<0.001). Statistically significant differences were observed in postoperative HVPG, absolute HVPG reduction and HVPG reduction rate between the two groups (P<0.001). Among patients with successful pressure reduction, the TIPS group presented a lower 1-year cumulative rebleeding rate, higher survival rate and longer median time to rebleeding (P<0.05). For patients with failed pressure reduction, the TIPS group had a higher 1-year cumulative rebleeding rate, lower survival rate and shorter median time to rebleeding (P<0.05). Significant differences were found between the two groups in the incidence of postoperative complications including hepatic encephalopathy, stent stenosis/occlusion, esophageal ulcer/stenosis and recurrent varices (P<0.05).

The improvement of HVPG after TIPS and EVL is directly correlated with the risk of postoperative rebleeding. TIPS is technically demanding, but it shows superior performance in long-term rebleeding prevention and survival benefit. EVL is simple to perform but associated with a higher long-term rebleeding risk. Therefore, TIPS is recommended for patients with elevated HVPG who require long-term reduction of rebleeding risk. EVL is preferable for patients with relatively low HVPG, intolerance to prolonged procedures and acceptance of short-term local complication risks.

To explore the risk factors for lymph node metastasis and the prognosis of patients with early gastric cancer.

The clinical data of 243 patients with early gastric cancer who underwent radical gastrectomy from January 2015 to January 2020 were retrospectively analyzed. Risk factors for lymph node metastasis were identified. All patients were followed up for 3-year overall survival, and Kaplan-Meier survival curves were plotted to evaluate the impact of lymph node metastasis on prognosis. Binary Logistic regression was used to analyze qualitative outcome data. Survival curves were generated with the Kaplan-Meier method. Nomograms and receiver operating characteristic (ROC) curves were established using R software.

Among the 243 patients with early gastric cancer, the overall lymph node metastasis rate was 20.2% (49/243). The metastasis rate was 7.3% (8/109) in T1a stage and 30.6% (41/134) in T1b stage. Univariate analysis showed that poor tumor differentiation, submucosal invasion, tumor diameter > 2 cm and tumor ulceration were correlated with lymph node metastasis. Multivariate analysis revealed that poor tumor differentiation, submucosal invasion and tumor diameter > 2 cm were independent risk factors for lymph node metastasis. The 3-year overall survival rate was 96.2%. There was a statistically significant difference in 3-year overall survival (OS) between patients with and without lymph node metastasis (LNM) (P<0.05). A nomogram was constructed based on the independent risk factors to preliminarily predict the risk of lymph node metastasis.

Poor tumor differentiation, submucosal invasion and tumor diameter > 2 cm are independent risk factors for lymph node metastasis in early gastric cancer. The nomogram can be used to roughly assess the risk of lymph node metastasis. Lymph node metastasis significantly worsens the prognosis of patients with early gastric cancer.

To explore the influencing factors of technical difficulty in laparoscopic conformal sphincter-preserving operation (CSPO) for low rectal cancer.

A retrospective cohort study was conducted. A total of 62 patients with low rectal cancer who underwent laparoscopic CSPO between January 2022 and June 2025 were enrolled. Clinical data and intraoperative parameters of all patients were collected. Operative duration and intraoperative blood loss were adopted as quantitative indicators of technical difficulty. Univariate analysis and multivariate linear regression models were used to screen independent influencing factors. Statistical analyses were performed using SPSS 26.0 software. Measurement data conforming to normal distribution were expressed as mean (

The operative duration of all patients ranged from 100 to 280 minutes, with a median of 185 minutes; intraoperative blood loss varied from 20 to 350 ml, with a median of 85 ml. When operative duration was used to reflect surgical difficulty: tumor distance from the anal verge, clinical TNM (cTNM) stage, history of neoadjuvant chemoradiotherapy, and pelvic stenosis index were all correlated with operative duration (all P<0.05). Multivariate linear regression analysis demonstrated that tumor distance from the anal verge, pelvic stenosis index and cTNM stage were closely associated with operative duration (all P<0.05). When intraoperative blood loss was used to evaluate surgical difficulty: body mass index (BMI), tumor distance from the anal verge, cTNM stage and pelvic stenosis index were all correlated with intraoperative blood loss (all P<0.05). Multivariate linear regression further verified that tumor distance from the anal verge, pelvic stenosis index and cTNM stage were independent factors closely related to intraoperative blood loss.

The technical difficulty of laparoscopic CSPO is jointly affected by anatomical and pathological factors. Tumor distance from the anal verge, pelvic stenosis index and cTNM stage are strongly correlated with operative duration and intraoperative blood loss, and can serve as core indicators for the preoperative assessment of surgical difficulty.

To analyze the risk factors for postoperative anastomotic leakage (AL) and construct a corresponding risk prediction model in patients who underwent radical resection for rectal cancer after neoadjuvant chemoradiotherapy.

The clinical data of 29 patients who developed AL within 30 days after radical rectal resection following neoadjuvant chemoradiotherapy from January 2021 to January 2024 were selected and assigned to the AL group; another 131 patients without AL were enrolled as the non-AL group. Statistical analyses were performed using SPSS 24.0 software. Measurement data were expressed as mean (

The AL group had significantly higher proportions of patients with diabetes history, operative duration ≥ 3 hours, non-preservation of the left colic artery, tumor distance from the anal verge < 6 cm, and preoperative serum albumin < 35 g/L than the non-AL group. The levels of C-reactive protein, white blood cell and procalcitonin in the AL group were also markedly elevated relative to the non-AL group (P<0.05). Multivariate analysis demonstrated that operative duration ≥ 3 hours, non-preservation of the left colic artery, tumor distance from the anal verge < 6 cm, elevated C-reactive protein, and preoperative serum albumin < 35 g/L were independent risk factors for postoperative AL in rectal cancer patients (P<0.05). The nomogram model yielded a concordance index (C-index) of 0.885 (95%CI: 0.834~0.937) and an area under the curve (AUC) of 0.896 (95%CI: 0.848~0.942), with a specificity of 67.9% and a sensitivity of 93.1%.

Operative duration, preservation status of the left colic artery, tumor distance from the anal verge, C-reactive protein level and preoperative serum albumin are influencing factors of postoperative AL for rectal cancer patients receiving radical resection after neoadjuvant chemoradiotherapy. The nomogram model constructed based on these indicators exhibits excellent predictive value.

This study aims to summarize the onset characteristics, risk factors, feasible prevention measures, and corresponding management strategies of common complications after laparoscopic radical gastrectomy for gastric cancer, providing evidence-based references for reducing the occurrence probability of complications and improving the postoperative recovery quality of patients.

This study collated and summarized relevant research literature published in the past 5 years. Using bibliometric, evidence-based medicine, and standardized statistical methods, the specific classification of complications, risk factors were systematically analyzed, and feasible prevention paths and corresponding management plans were summarized.

The overall incidence of postoperative complications in patients undergoing laparoscopic radical gastrectomy for gastric cancer ranged from 18.3% to 27.6% (Meta-analysis combined effect size OR=0.280, 95% CI: 0.190~0.420, P<0.001). The most common clinical complications included infectious, anastomotic-related, intra-abdominal bleeding, and pancreatic fistula, etc. Personal variables of patients, surgical process-related triggers, and perioperative management all belong to independent risk variables for the occurrence of complications (all P < 0.05); Establishing a standardized three-level prevention system can reduce the incidence of complications (intervention group 12.3% vs. control group 26.7%, χ²=14.520, P<0.001). Conclusion: This study found that the postoperative complications of patients undergoing laparoscopic radical gastrectomy for gastric cancer are influenced by multiple variables.

Establishing a full-process prevention system combined with individualized intervention plans is the core support for reducing complications, ensuring surgical outcomes, and optimizing the postoperative recovery quality of patients.

To analyze the clinical efficacy of prophylactic central lymph node dissection for clinical node-negative (cN0) differentiated thyroid carcinoma (DTC).

The clinical data of 165 patients with cN0 DTC who received surgical treatment between January 2022 and May 2024 were retrospectively analyzed. Patients were divided into the observation group (n=93), receiving thyroid lobectomy combined with prophylactic central lymph node dissection) and the control group (n=72), receiving thyroid lobectomy alone). Statistical analysis was performed using SPSS 23.0 software. Measurement data including perioperative indicators and parathyroid gland function parameters were expressed as (mean ± standard） deviation and compared between groups via the t test. Enumeration data such as postoperative complication rates and recurrence rates were presented as [cases (%)], and intergroup comparisons were conducted with the chi-square test. The Kaplan-Meier method was applied for survival analysis, and the Log-Rank test was used to verify the validity of the survival model. A P value less than 0.05 was defined as statistically significant.

The observation group had longer operative duration and greater intraoperative blood loss than the control group (P<0.05). No significant difference in hospital stay was detected between the two groups (P>0.05). On postoperative day 7, the levels of parathyroid hormone (PTH), serum calcium, CD4⁺ and CD8⁺ lymphocytes in the observation group were lower than those in the control group (P<0.05). There was no statistically significant intergroup difference in the overall incidence of postoperative complications (P>0.05). The postoperative recurrence rate was lower and progression-free survival was longer in the observation group relative to the control group (P<0.05).

Compared with thyroid lobectomy alone, thyroid lobectomy combined with prophylactic central lymph node dissection for cN0 DTC prolongs operative time, increases intraoperative blood loss and impairs immune function. However, this combined procedure does not raise the incidence of postoperative complications, and can reduce tumor recurrence rate and extend patients' progression-free survival.

To explore the predictive value of combined detection of BRAF^V600E, platelet-to-albumin ratio (PAR) and fibrinogen-to-prealbumin ratio (FPR) for central lymph node metastasis in clinically node-negative (cN0) papillary thyroid carcinoma (PTC).

The clinical data of 196 patients with cN0 PTC admitted from January 2022 to December 2024 were retrospectively analyzed. Patients were divided into the metastasis group (n=57) and non-metastasis group (n=139) according to the presence or absence of postoperative central lymph node metastasis. Clinical data, BRAF^V600E status, PAR and FPR were compared between the two groups. Statistical analysis was performed using SPSS software version 28.0, Binary Logistic regression analysis was performed to identify influencing factors for central lymph node metastasis in cN0 PTC. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of BRAF^V600E mutation abundance, PAR and FPR for central lymph node metastasis of cN0 PTC.

The metastasis group showed significantly higher male proportion, maximum tumor diameter, BRAF^V600E mutation abundance, platelet count (PLT), PAR, fibrinogen (FIB) and FPR than the non-metastasis group (P<0.05). Meanwhile, age, proportion of left-sided tumors, albumin (ALB) and prealbumin (PAB) levels were markedly lower in the metastasis group (P<0.05). Male gender, age, maximum tumor diameter, BRAF^V600E mutation abundance, PAR and FPR were independent risk factors for central lymph node metastasis in cN0 PTC (odds ratio OR=1.287, 0.523, 1.164, 1.984, 2.265, 1.724, all (P<0.05). The combined panel of BRAF^V600E mutation abundance, PAR and FPR achieved superior predictive efficacy for central lymph node metastasis in cN0 PTC, with an area under the curve (AUC) of 0.897 (P<0.05).

BRAF^V600E mutation abundance, PAR and FPR are all correlated with central lymph node metastasis in cN0 PTC. Preoperative combined detection of these three indicators exhibits favorable predictive value for central lymph node metastasis.

To investigate the expression characteristics of myeloid-derived suppressor cell (MDSC)-related genes in breast cancer, construct a risk prediction model, and evaluate its risk stratification and predictive performance.

RNA-seq data and clinical information of 1216 breast cancer patients were downloaded from the TCGA database, and randomly divided into a training set (n=851) and a validation set (n=365) at a ratio of 7∶3. A total of 494 MDSC-related genes were retrieved from the GeneCards database. In the training set, univariate Cox regression (P<0.05) was used to preliminarily screen prognosis-related genes, followed by LASSO-Cox regression for variable compression, and a multi-gene risk score (Riskscore) model was finally established. Kaplan-Meier curves and time-dependent ROC curves were adopted to assess the risk stratification ability and predictive efficacy of the model. Independent prognostic factors were integrated to construct a nomogram for predicting 2-, 3- and 5-year survival rates, which was comprehensively validated via calibration curves, decision curve analysis (DCA) and the C-index.

Forty-nine hub genes were screened out by LASSO regression to establish the Riskscore model. The model exhibited favorable predictive power in both the training and validation sets (3-year and 5-year AUC values of 0.785 and 0.787 in the training set, versus 0.691 and 0.765 in the validation set). Multivariate Cox regression analysis verified that Riskscore was an independent prognostic factor beyond conventional clinical indicators including age and tumor stage (HR=3.552, 95% CI: 2.933~4.301, P<0.001). The nomogram built on Riskscore, age and tumor stage achieved excellent predictive accuracy (5-year AUC=0.814 in the training set and 0.810 in the validation set) and satisfactory calibration. Decision curve analysis further confirmed its prominent clinical application value.

A prognostic prediction model based on MDSC-related genes was constructed and validated. This model can effectively stratify survival risks among breast cancer patients. As a visual assessment tool, the established nomogram enables clinicians to deliver individualized prognostic evaluation and facilitate clinical treatment decision-making.

To construct a high-accuracy, interpretable prognostic prediction model for breast cancer by integrating whole slide images (WSIs) and corresponding pathology report text from patients in the TCGA-BRCA public dataset, thereby providing a reliable auxiliary decision-making tool for clinical practice.

This study utilized The Cancer Genome Atlas Breast Cancer dataset (TCGA-BRCA). A total of 702 samples with complete WSIs, matched pathology reports, and survival data were obtained through stringent filtering. To handle the high resolution of WSIs, morphological methods were employed to segment tissue regions and partition them into image patches, constructing multi-instance feature bags. Pathology reports were parsed and structured using a large language model (LLM) to extract key semantic features. For model construction, a Transformer-based multimodal survival analysis framework was proposed: the image branch aggregated global and local features via improved multi-instance learning with an attention mechanism; the text branch encoded pathology reports into semantic embeddings. Deep fusion of textual and imaging features was achieved through a cross-attention mechanism. Finally, the output from the fully connected layer is a patient-level survival risk score, and the model is trained end-to-end using negative log-likelihood loss based on discrete-time survival analysis.

This study first developed a unimodal survival prediction model based solely on digital pathology whole-slide images (WSIs), employing a multiple instance learning framework to generate patients' recurrence risk scores and survival probabilities. Through 5-fold cross-validation, the model achieved a C-index of 0.687, significantly outperforming previously reported results in the literature. Further integration of clinical and pathological text information further improved the performance of the multimodal model: the C-index increased to 0.698, and the standard deviation decreased from ±0.046 to ±0.022—a reduction of approximately 50%—indicating a significant enhancement in model stability and reliability.

By developing and validating a novel multimodal fusion model, this study provides a more accurate and reliable solution for survival prediction in breast cancer patients.

To explore the clinical efficacy of single-port laparoscopic appendectomy without robotic arms (SSLA) for recurrent appendicitis, and analyze the factors affecting operative duration.

A total of 120 patients diagnosed with recurrent appendicitis who underwent surgical treatment in our hospital from January 2023 to December 2025 were enrolled. They were divided into the conventional single-incision laparoscopic surgery (SILS) group (n=65) and the SSLA group (n=55) according to different surgical approaches. SPSS 26.0 software was used for statistical analysis. The intraoperative and postoperative efficacy indicators between the two groups were compared using the t test or χ² test. Multivariate Logistic regression analysis was performed to identify the factors influencing the operative duration of SSLA.

The operative duration in the SSLA group was significantly longer than that in the conventional SILS group (P<0.05). There were no statistically significant differences between the two groups in intraoperative blood loss, time to first postoperative flatus, white blood cell count and C-reactive protein (CRP) level at 48 hours after operation (P>0.05). No significant difference was found in the overall incidence of postoperative complications between the two groups (P>0.05).In the SSLA group, 28 patients with operative duration over 60 minutes were assigned to the >60 min subgroup, and the remaining 27 patients were assigned to the ≤60 min subgroup. The proportions of patients with maximum appendiceal diameter >10 mm and disease course >3 days in the current episode were higher in the >60 min subgroup (P<0.05), and the preoperative CRP level was also significantly elevated in this subgroup (P<0.05). Multivariate Logistic regression analysis indicated that disease course >3 days in the current episode and elevated preoperative CRP level were independent risk factors for prolonged operative duration of SSLA (P<0.05).

SSLA is safe and feasible for the treatment of recurrent appendicitis, though it requires longer operative time than conventional SILS. A disease course longer than 3 days and high preoperative CRP level are independent risk factors for prolonged operative duration.

To explore the effects of preserving the integrity of gastric antrum and His angle during laparoscopic sleeve gastrectomy (LSG) on postoperative gastroesophageal reflux disease (GERD) and clinical outcomes.

A total of 156 patients with GERD after LSG admitted from January 2024 to April 2025 were enrolled and randomly divided into observation group and control group by random number table, with 78 cases in each group. Patients in the observation group underwent modified LSG with intact gastric antrum and His angle preserved, while the control group received conventional LSG. T test and chi-square test were adopted to compare major clinical outcome indicators, weight loss efficacy and nutritional parameters between the two groups before operation and 6 months postoperatively. A P value less than 0.05 was considered statistically significant.

At 6 months after surgery, the GERD questionnaire score, Los Angeles classification of esophagitis and DeMeester score in the observation group were markedly lower, whereas the quality of life score was obviously higher than those in the control group (P<0.05). No significant differences were observed in percentage total weight loss (%TWL), percentage excess weight loss (%EWL), body mass index (BMI), ferritin, vitamin B12, 25-hydroxyvitamin D, glycated hemoglobin, fasting blood glucose and triglyceride between the two groups (P>0.05). The operative duration was significantly longer in the observation group (P<0.05), while estimated intraoperative blood loss and conversion rate to open surgery showed no statistical differences (P>0.05). The incidence of postoperative complications was comparable between the two groups (P>0.05).

The modified LSG preserving intact gastric antrum and His angle can effectively reduce the risk of postoperative GERD and improve patients' quality of life, without affecting the core curative effects on weight loss, nutrition and metabolism.

Obstructive jaundice induced by hilar cholangiocarcinoma (HCCA) often requires preoperative or palliative biliary decompression. Percutaneous transhepatic biliary drainage (PTBD) with external drainage is one of the most widely adopted modalities at present. Nevertheless, long-term massive extrahepatic bile loss may trigger water-electrolyte disorders, steatorrhea and impairment of the intestinal barrier. The bile reinfusion (BR) technique forms a closed loop of "extracorporeal drainage and intracorporeal reinfusion", which can theoretically restore the enterohepatic circulation, preserve intestinal microecology and improve nutritional status. This paper systematically reviews published clinical trials, experimental studies and meta-analyses in recent years, and summarizes the indications, technical protocols, efficacy evidence and potential risks of BR after PTBD in patients with HCCA, so as to provide references for clinical practice and future research.

Laparoscopic radical gastrectomy is a minimally invasive surgical technique. With laparoscope and surgical instruments inserted through small abdominal wall incisions, surgeons can resect gastric tumors and perform regional lymph node dissection. This procedure features rapid postoperative recovery and a low incidence of complications. In recent years, the diagnostic rate of gastric cancer has increased year by year, leading to wider application of laparoscopic radical gastrectomy. Nevertheless, considerable challenges remain regarding postoperative digestive tract reconstruction and the prevention and management of anastomotic leakage. This article reviews the latest research advances in digestive tract reconstruction techniques and strategies for preventing anastomotic leakage after laparoscopic radical gastrectomy, aiming to provide references for the surgical treatment of gastric cancer.

Improving postoperative enterostomy function is an important measure to elevate patients' quality of life. Multiple interventions including preoperative stoma localization, postoperative nursing care, prevention and management of complications, selection of the optimal timing for stoma closure, nutritional support and dietary adjustment regimens, pharmacotherapy (anti-infection, anti-inflammatory and analgesic, and antioxidant medications), physical therapy (infrared therapy, ultrasound therapy and laser therapy), psychological nursing and social support can effectively reduce the incidence of postoperative enterostomy complications and enhance patients' self-management capacity. With the continuous advancement of medical technology and the development of new nursing supplies, postoperative enterostomy function will be further optimized. This paper reviews recent research advances in improving postoperative enterostomy function, aiming to provide references for clinical practice.

Laparoscopic technique has become an important minimally invasive platform for sphincter-preserving surgery of locally advanced low rectal cancer. This paper systematically reviews the advances in the application of laparoscopic techniques in total mesorectal excision, pelvic nerve preservation, distal resection margin management, and transanal combined approaches. Available high-quality randomized controlled trials have demonstrated that laparoscopic surgery is non-inferior to open surgery with regard to 5-year overall survival rate, disease-free survival rate and local recurrence rate. Its positive circumferential resection margin rate is controlled within 5% to 10%, and no significant difference is observed in the number of harvested lymph nodes.In terms of perioperative outcomes, the laparoscopic group achieves markedly reduced intraoperative blood loss (an average reduction of 50~100 ml), shortened postoperative hospital stay, and approximately 30%~50% lower wound infection rates. Nevertheless, its application remains challenging for special cases such as patients with a difficult pelvis (male gender, obesity, narrow pelvic cavity) and those with tissue fibrosis following neoadjuvant chemoradiotherapy. The conversion-to-laparotomy rate ranges from 5% to 15%. Moreover, the incidence of low anterior resection syndrome reaches as high as 60%~80%, and further prospective studies are required to verify its long-term functional preservation effects.

Mesh infection is a postoperative complication following laparoscopic hernia repair, which is generally associated with mesh materials, surgical techniques and other factors. Such infections are often complicated by enteric fistulas and cutaneous fistulas, whereas concurrent bladder fistulas are extremely rare. This article reports the treatment course of one patient who developed mesh infection combined with enteric fistula and bladder fistula after laparoscopic hernia repair. The patient had a previous history of laparoscopic hernia repair, and presented with gross hematuria and dull hypogastric pain as chief complaints. After admission, comprehensive examinations including abdominal computed tomography (CT) and colonoscopy were completed. The patient underwent transurethral pneumatic lithotripsy for bladder calculi, transurethral electroresection of bladder lesions, and cecectomy to remove bladder stones and the infected mesh. By reporting this rare case, this paper discusses its potential pathogenesis, so as to avoid misdiagnosis and missed diagnosis of similar conditions.