Background: s/Aims: In recent years, many minimally invasive techniques have been introduced to reduce the number of ports in laparoscopic cholecystectomy (LC), offering benefits such as reduced postoperative pain and improved cosmetic outcomes. ArtiSential®is a new multi-degree-of-freedom articulating laparoscopic instrument that incorporates the ergonomic features of robotic surgery, potentially overcoming the spatial limitations of laparoscopic surgery. ArtiSential® LC can be performed using only two ports. This study aims to compare the surgical outcomes of ArtiSential® LC with those of single-fulcrum LC. Methods: This retrospective study compared ArtiSential® LC and single-fulcrum LC among LCs performed for gallbladder (GB) stones at the same center, analyzing the basic characteristics of patients; intraoperative outcomes, such as operative time, estimated blood loss, and intraoperative GB rupture; and postoperative outcomes, such as length of hospital stay, incidence of postoperative complications, and postoperative pain. Results: A total of 88 and 63 patients underwent ArtiSential® LC and single-fulcrum LC for GB stones, respectively. Analysis showed that ArtiSential® LC resulted in significantly fewer cases of surgeries longer than 60 minutes (30 vs. 35 min, p = 0.009) and intraoperative GB ruptures (2 vs. 10, p = 0.007). In terms of postoperative outcomes, ArtiSential® LC showed better results in the respective visual analog scale (VAS) scores immediately after surgery (2.59 vs. 3.73, p < 0.001), and before discharge (1.44 vs. 2.02, p = 0.01). Conclusions ArtiSential® LC showed better results in terms of surgical outcomes, especially postoperative pain. Thus, ArtiSential®LC is considered the better option for patients, compared to single-fulcrum LC.

Background: s/Aims: In recent years, many minimally invasive techniques have been introduced to reduce the number of ports in laparoscopic cholecystectomy (LC), offering benefits such as reduced postoperative pain and improved cosmetic outcomes. ArtiSential®is a new multi-degree-of-freedom articulating laparoscopic instrument that incorporates the ergonomic features of robotic surgery, potentially overcoming the spatial limitations of laparoscopic surgery. ArtiSential® LC can be performed using only two ports. This study aims to compare the surgical outcomes of ArtiSential® LC with those of single-fulcrum LC. Methods: This retrospective study compared ArtiSential® LC and single-fulcrum LC among LCs performed for gallbladder (GB) stones at the same center, analyzing the basic characteristics of patients; intraoperative outcomes, such as operative time, estimated blood loss, and intraoperative GB rupture; and postoperative outcomes, such as length of hospital stay, incidence of postoperative complications, and postoperative pain. Results: A total of 88 and 63 patients underwent ArtiSential® LC and single-fulcrum LC for GB stones, respectively. Analysis showed that ArtiSential® LC resulted in significantly fewer cases of surgeries longer than 60 minutes (30 vs. 35 min, p = 0.009) and intraoperative GB ruptures (2 vs. 10, p = 0.007). In terms of postoperative outcomes, ArtiSential® LC showed better results in the respective visual analog scale (VAS) scores immediately after surgery (2.59 vs. 3.73, p < 0.001), and before discharge (1.44 vs. 2.02, p = 0.01). Conclusions ArtiSential® LC showed better results in terms of surgical outcomes, especially postoperative pain. Thus, ArtiSential®LC is considered the better option for patients, compared to single-fulcrum LC.

Background: s/Aims: In recent years, many minimally invasive techniques have been introduced to reduce the number of ports in laparoscopic cholecystectomy (LC), offering benefits such as reduced postoperative pain and improved cosmetic outcomes. ArtiSential®is a new multi-degree-of-freedom articulating laparoscopic instrument that incorporates the ergonomic features of robotic surgery, potentially overcoming the spatial limitations of laparoscopic surgery. ArtiSential® LC can be performed using only two ports. This study aims to compare the surgical outcomes of ArtiSential® LC with those of single-fulcrum LC. Methods: This retrospective study compared ArtiSential® LC and single-fulcrum LC among LCs performed for gallbladder (GB) stones at the same center, analyzing the basic characteristics of patients; intraoperative outcomes, such as operative time, estimated blood loss, and intraoperative GB rupture; and postoperative outcomes, such as length of hospital stay, incidence of postoperative complications, and postoperative pain. Results: A total of 88 and 63 patients underwent ArtiSential® LC and single-fulcrum LC for GB stones, respectively. Analysis showed that ArtiSential® LC resulted in significantly fewer cases of surgeries longer than 60 minutes (30 vs. 35 min, p = 0.009) and intraoperative GB ruptures (2 vs. 10, p = 0.007). In terms of postoperative outcomes, ArtiSential® LC showed better results in the respective visual analog scale (VAS) scores immediately after surgery (2.59 vs. 3.73, p < 0.001), and before discharge (1.44 vs. 2.02, p = 0.01). Conclusions ArtiSential® LC showed better results in terms of surgical outcomes, especially postoperative pain. Thus, ArtiSential®LC is considered the better option for patients, compared to single-fulcrum LC.

Background: s/Aims: This study aimed to compare the minimally invasive pancreatoduodenectomy with venous vascular resection (MI-PDVR) and open pancreatoduodenectomy with venous vascular resection (O-PDVR) for periampullary cancer. Methods: Data of 124 patients who underwent PDVR (45 MI-PDVR, 79 O-PDVR) between January 1, 2016, and December 31, 2023, was retrospectively reviewed. Results: MI-PDVR is significantly better than O-PDVR in terms of perioperative outcomes (median operation time [452.69 minutes vs. 543.91 minutes; p = 0.004], estimated blood loss [410.44 mL vs. 747.59 mL; p < 0.01], intraoperative transfusion rate [2 cases vs. 18 cases; p = 0.01], and hospital stay [18.16 days vs. 23.91 days; p = 0.008]). The complications until the discharge day showed no significant difference between the two groups (Clavien–Dindo < 3, 84.4% vs. 82.3%; Clavien–Dindo ≥ 3, 15.6% vs. 17.7%; p = 0.809). In terms of long-term oncological outcomes, there was no statistical difference in overall survival (OS, 51.55 months [95% CI: 35.95–67.14] vs.median 49.92 months [95% CI: 40.97–58.87]; p = 0.340) and disease-free survival (DFS, median 35.06 months [95% CI: 21.47–48.65] vs.median 38.77 months [95% CI: 29.80–47.75]; p = 0.585), between the two groups. Long-term oncological outcomes for subgroup analysis focusing on pancreatic ductal adenocarcinoma also showed no statistical differences in OS (40.86 months [95% CI: 34.45–47.27] vs.48.48 months [95% CI: 38.16–58.59]; p = 0.270) and DFS (24.42 months [95% CI: 17.03–31.85] vs. 34.35 months, [95% CI: 25.44–43.27]; p = 0.740). Conclusions MI-PDVR can provide better perioperative outcomes than O-PDVR, and has similar oncological impact.

Purpose: Laparoscopic cholecystectomy is the gold standard procedure for benign gallbladder disease. However, reducing ports still causes frustration when using various instruments. We investigated early perioperative outcomes of laparoscopic single site + 1 cholecystectomy using ArtiSential instruments (ArtiSential laparoscopic cholecystectomy [ALC], LIVSMED). Methods: From July 2022 to December 2022, 116 patients underwent ALC in Severance Hospital and Yongin Severance Hospital. From May 2019 to December 2022, 210 patients underwent robotic single-port cholecystectomy (RSPC). We compared clinical characteristics, perioperative outcomes, and postoperative pain scores between the ALC and RSPC groups. Results: Patients in the ALC group were significantly older than those in the RSPC group (51.9 years vs. 43.9 years, P < 0.001), and the ALC group had a larger proportion of male patients (50.9% vs. 24.8%, P < 0.001) and cases of acute cholecystitis with stones (21.6% vs. 0.5%, P < 0.001) than the RSPC group. The groups did not differ in their estimated blood loss, postoperative complications, or hospital stays. The mean operation time of the ALC group was shorter than that of the RSPC group (56.5 minutes vs. 94.8 minutes, P < 0.001). Although the pain scores reported on discharge day did not differ, the ALC group reported significantly lower immediate postoperative pain scores than the RSPC group (2.7 vs. 5.4, P < 0.001). Conclusions ALC is a safe and feasible procedure. ALC patients reported markedly lower immediate postoperative pain scores than RSPC patients, with comparable operative outcomes for estimated blood loss, hospital stay, and postoperative complication rates.

Background: s/Aims: This study aimed to compare the minimally invasive pancreatoduodenectomy with venous vascular resection (MI-PDVR) and open pancreatoduodenectomy with venous vascular resection (O-PDVR) for periampullary cancer. Methods: Data of 124 patients who underwent PDVR (45 MI-PDVR, 79 O-PDVR) between January 1, 2016, and December 31, 2023, was retrospectively reviewed. Results: MI-PDVR is significantly better than O-PDVR in terms of perioperative outcomes (median operation time [452.69 minutes vs. 543.91 minutes; p = 0.004], estimated blood loss [410.44 mL vs. 747.59 mL; p < 0.01], intraoperative transfusion rate [2 cases vs. 18 cases; p = 0.01], and hospital stay [18.16 days vs. 23.91 days; p = 0.008]). The complications until the discharge day showed no significant difference between the two groups (Clavien–Dindo < 3, 84.4% vs. 82.3%; Clavien–Dindo ≥ 3, 15.6% vs. 17.7%; p = 0.809). In terms of long-term oncological outcomes, there was no statistical difference in overall survival (OS, 51.55 months [95% CI: 35.95–67.14] vs.median 49.92 months [95% CI: 40.97–58.87]; p = 0.340) and disease-free survival (DFS, median 35.06 months [95% CI: 21.47–48.65] vs.median 38.77 months [95% CI: 29.80–47.75]; p = 0.585), between the two groups. Long-term oncological outcomes for subgroup analysis focusing on pancreatic ductal adenocarcinoma also showed no statistical differences in OS (40.86 months [95% CI: 34.45–47.27] vs.48.48 months [95% CI: 38.16–58.59]; p = 0.270) and DFS (24.42 months [95% CI: 17.03–31.85] vs. 34.35 months, [95% CI: 25.44–43.27]; p = 0.740). Conclusions MI-PDVR can provide better perioperative outcomes than O-PDVR, and has similar oncological impact.

Purpose: Laparoscopic cholecystectomy is the gold standard procedure for benign gallbladder disease. However, reducing ports still causes frustration when using various instruments. We investigated early perioperative outcomes of laparoscopic single site + 1 cholecystectomy using ArtiSential instruments (ArtiSential laparoscopic cholecystectomy [ALC], LIVSMED). Methods: From July 2022 to December 2022, 116 patients underwent ALC in Severance Hospital and Yongin Severance Hospital. From May 2019 to December 2022, 210 patients underwent robotic single-port cholecystectomy (RSPC). We compared clinical characteristics, perioperative outcomes, and postoperative pain scores between the ALC and RSPC groups. Results: Patients in the ALC group were significantly older than those in the RSPC group (51.9 years vs. 43.9 years, P < 0.001), and the ALC group had a larger proportion of male patients (50.9% vs. 24.8%, P < 0.001) and cases of acute cholecystitis with stones (21.6% vs. 0.5%, P < 0.001) than the RSPC group. The groups did not differ in their estimated blood loss, postoperative complications, or hospital stays. The mean operation time of the ALC group was shorter than that of the RSPC group (56.5 minutes vs. 94.8 minutes, P < 0.001). Although the pain scores reported on discharge day did not differ, the ALC group reported significantly lower immediate postoperative pain scores than the RSPC group (2.7 vs. 5.4, P < 0.001). Conclusions ALC is a safe and feasible procedure. ALC patients reported markedly lower immediate postoperative pain scores than RSPC patients, with comparable operative outcomes for estimated blood loss, hospital stay, and postoperative complication rates.

Background: s/Aims: This study aimed to compare the minimally invasive pancreatoduodenectomy with venous vascular resection (MI-PDVR) and open pancreatoduodenectomy with venous vascular resection (O-PDVR) for periampullary cancer. Methods: Data of 124 patients who underwent PDVR (45 MI-PDVR, 79 O-PDVR) between January 1, 2016, and December 31, 2023, was retrospectively reviewed. Results: MI-PDVR is significantly better than O-PDVR in terms of perioperative outcomes (median operation time [452.69 minutes vs. 543.91 minutes; p = 0.004], estimated blood loss [410.44 mL vs. 747.59 mL; p < 0.01], intraoperative transfusion rate [2 cases vs. 18 cases; p = 0.01], and hospital stay [18.16 days vs. 23.91 days; p = 0.008]). The complications until the discharge day showed no significant difference between the two groups (Clavien–Dindo < 3, 84.4% vs. 82.3%; Clavien–Dindo ≥ 3, 15.6% vs. 17.7%; p = 0.809). In terms of long-term oncological outcomes, there was no statistical difference in overall survival (OS, 51.55 months [95% CI: 35.95–67.14] vs.median 49.92 months [95% CI: 40.97–58.87]; p = 0.340) and disease-free survival (DFS, median 35.06 months [95% CI: 21.47–48.65] vs.median 38.77 months [95% CI: 29.80–47.75]; p = 0.585), between the two groups. Long-term oncological outcomes for subgroup analysis focusing on pancreatic ductal adenocarcinoma also showed no statistical differences in OS (40.86 months [95% CI: 34.45–47.27] vs.48.48 months [95% CI: 38.16–58.59]; p = 0.270) and DFS (24.42 months [95% CI: 17.03–31.85] vs. 34.35 months, [95% CI: 25.44–43.27]; p = 0.740). Conclusions MI-PDVR can provide better perioperative outcomes than O-PDVR, and has similar oncological impact.

Purpose: Laparoscopic cholecystectomy is the gold standard procedure for benign gallbladder disease. However, reducing ports still causes frustration when using various instruments. We investigated early perioperative outcomes of laparoscopic single site + 1 cholecystectomy using ArtiSential instruments (ArtiSential laparoscopic cholecystectomy [ALC], LIVSMED). Methods: From July 2022 to December 2022, 116 patients underwent ALC in Severance Hospital and Yongin Severance Hospital. From May 2019 to December 2022, 210 patients underwent robotic single-port cholecystectomy (RSPC). We compared clinical characteristics, perioperative outcomes, and postoperative pain scores between the ALC and RSPC groups. Results: Patients in the ALC group were significantly older than those in the RSPC group (51.9 years vs. 43.9 years, P < 0.001), and the ALC group had a larger proportion of male patients (50.9% vs. 24.8%, P < 0.001) and cases of acute cholecystitis with stones (21.6% vs. 0.5%, P < 0.001) than the RSPC group. The groups did not differ in their estimated blood loss, postoperative complications, or hospital stays. The mean operation time of the ALC group was shorter than that of the RSPC group (56.5 minutes vs. 94.8 minutes, P < 0.001). Although the pain scores reported on discharge day did not differ, the ALC group reported significantly lower immediate postoperative pain scores than the RSPC group (2.7 vs. 5.4, P < 0.001). Conclusions ALC is a safe and feasible procedure. ALC patients reported markedly lower immediate postoperative pain scores than RSPC patients, with comparable operative outcomes for estimated blood loss, hospital stay, and postoperative complication rates.

Purpose: To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. Conclusions Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.