To explore the feasibility of using indocyanine green(ICG) visualizing the deep infiltrating endometriosis (DIE) during robotic surgery.

A patient with DIE in Department of Genecology and Obstetrics, Chinese PLA General Hospital was selected and underwent total hysterectomy with bilateral adnexectomy and endometriosis lesion excision with perfect preoperative examination and no surgical contraindication. Near-infrared fluorescence imaging with indocyanine green was used in the operation to visualize the endometriosis lesions.

The location of the lesions were accurate and the patient discharged from hospital successfully.

Near-infrared fluorescence imaging system with indocyanine green may clearly visualize the deep infiltrating endometriosis during robotic surgery. It is characterized by brief operation, accuracy and real time. With this technique, we can comprehensively evaluate the scope of our surgery.

Varicocele is the most common cause of male infertility, while varicocele with thrombosis is extremely rare. This article reports two cases of varicocele with thrombosis, one with thrombosis secondary to varicocele and the other with an uncertain temporal sequence, and explores the underlying mechanism based on these cases. For treatment, there is no evidence that conservative anticoagulation or surgical treatment is preferable, but surgical treatment is preferentially recommend.

This article reports the diagnosis and treatment process of a patient with bladder diverticulum carcinoma. The patient presented to a local hospital in May 2023 with recurrent gross hematuria. Imaging studies suggested a mass in the diverticulum of the right bladder wall, and cystoscopic biopsy pathology revealed high-grade non-invasive papillary urothelial carcinoma. The patient underwent open partial cystectomy. Postoperative pathology indicated muscle-invasive urothelial carcinoma, but no further treatment was received initially. Subsequently, the patient visited our hospital, repeated contrast-enhanced CT, MRI, and cystoscopy showed no definite evidence of residual tumor. However, based on literature review, perioperative data, and the possibility of extravesical extension not being ruled out, radical cystectomy was recommended. But the patient strongly desired bladder preservation and therefore received three cycles of immunotherapy with toripalimab. Follow-up examination in September of the same year revealed thickening and enhancement of the right bladder wall on routine imaging. A multidisciplinary consultation on difficult cases in Guangdong Urological Association was conducted, the experts suggested that based on the comprehensive examination results, residual tumor and lymph node metastasis could not be excluded. The diagnosis was high-grade bladder diverticulum carcinoma, which is highly malignant and may involve early invasion of the bladder wall layers. The case did not meet the recommended criteria for bladder-preserving therapy, and there were signs of progression even after immunotherapy. Therefore, it was recommended to perform a PET-CT scan and proceed with radical cystectomy as soon as possible. Subsequent treatment (including radiotherapy, chemotherapy, or immunotherapy) would depend on the postoperative pathology, and close follow-up was necessary. After careful consideration, the patient returned to the hospital and underwent robot-assisted laparoscopic radical cystectomy. Intraoperatively, a frozen pelvis was found on the right side, and frozen section pathology confirmed metastasis to the right pelvic lymph nodes and invasion of the pelvic wall. An ileal conduit urinary diversion was subsequently performed. Postoperative immunohistochemical pathology confirmed regional urothelial carcinoma in situ of the bladder, with metastasis to the pelvic lymph nodes and pelvic wall. This case suggests that postoperative recurrence in bladder diverticulum carcinoma may not be local and could involve distant metastasis. Bladder-preserving therapy should be reserved for selected, suitable patients with favorable profiles, and should not be pursued blindly.

To analyze the current clinical application status of natural orifice specimen extraction surgery (NOSES) in China, providing important reference for its standardized and scientific promotion.

A WeChat-based questionnaire survey was conducted among physicians specializing in general surgery, oncological surgery, gynecology, and urology across China. The survey covered physician demographics, NOSES implementation status, challenges encountered, and the current state of NOSES technical training and research.

The survey covered 31 provinces, autonomous regions, and municipalities in China, yielding 1 710 valid responses. Among respondents, 1 166 (68.2%) performed NOSES procedures, while 544 (31.8%) did not. A total of 854 hospitals performed NOSES procedures, conducting 120 835 cases. By specialty: colorectal tumors (86 430 cases, 71%); gastric tumors (11 574 cases, 10%); gynecological tumors (5 612 cases, 5%); other benign conditions (17 219 cases, 14%). By specimen retrieval route: 95 553 cases (79.1%) via the anus, 23 383 cases (19.4%) via the vagina, and 1 375 cases (1.1%) via anterior rectal wall incision. By proportion of NOSES procedures among similar surgeries, 478 hospitals performed NOSES procedures accounting for less than 10% of similar surgeries, 317 hospitals performed them between 10% and 20%, and 59 hospitals performed them at over 20%. The survey revealed that most physicians primarily encountered NOSES techniques through large academic conferences (53%). Training methods predominantly involved attending workshops (42%) and watching live surgical demonstrations by experts (38%). 88% of surgeons who have performed NOSES believed that their assistants should receive training in NOSES techniques at experienced centers, while 92% of those who have not performed NOSES agreed that they themselves need to undergo such training. 50.3% of surgeons who have performed NOSES held the view that their assistants can be authorized to independently perform the procedure after completing 10~20 cases of hands-on training, and 55.3% of those who have not performed NOSES believed that they can independently carry out the procedure after such training. 290 individuals conducted NOSES-related research projects, with 212 publishing Chinese papers and 125 publishing English papers. Database data uploads (67 individuals) increased by 42.86%, 26.19%, 50.60%, and 131.03% respectively compared to previous periods. 83.2% and 82.7% of hospitals support their institutions and physicians in performing NOSES procedures, with 99.5% of treated patients expressing high satisfaction with NOSES outcomes.

NOSES surgery has gained widespread attention and experienced rapid growth in China, with over 120 000 procedures performed across disciplines including colorectal, gastric, gynecological, hepatobiliary, and urological surgery. It has generated positive impacts at the hospital, physician, and patient levels. In recent years, young and middle-aged physicians have become the main force performing NOSES procedures; primary-care physicians outside tertiary hospitals have acquired the capability to routinely perform NOSES surgery; major academic conferences have increased awareness of NOSES procedures, with surgical demonstrations and training workshops driving its dissemination. Training at accredited centers remains the most efficient pathway for young physicians to master the technique. Currently, NOSES-related research articles and projects continue to increase, with clinical studies gradually emerging to provide higher-level evidence-based support for the technique.

To investigate the application value of transanal assistance in laparoscopic transabdominal intersphincteric resection (ISR) sphincter-preserving surgery for low rectal cancer.

A retrospective analysis of clinical data from 37 patients with cT1~T2 low rectal cancer who underwent transanal assistance in laparoscopic transabdominal ISR at He’nan Provincial People’s Hospital between February 2023 and February 2025. During surgery, the assistant used the self-made anal lifter and anal pusher to assist the primary surgeon in dissecting the distal rectum to achieve subtotal or total ISR, reconstructing the digestive tract, or reinforcing the anastomosis. Baseline characteristics, postoperative pathology, postoperative complications, and tumor recurrence or metastasis during follow-up were collected and analyzed.

All 37 patients successfully underwent ISR sphincter-preserving surgery without prophylactic stoma creation, conversion to open surgery, or change in surgical approach. The mean operative time was (198.38±30.48) min, with a median intraoperative blood loss of 100 (50~250) mL. All patients achieved R0 resection, with a mean number of lymph nodes removed of (19.51±3.62). The mean postoperative hospital stay was (10.32±2.31) days. No tumor cells were detected in the cytological examination of the peritoneal lavage fluid. No anastomotic leaks or perioperative deaths occurred. All patients underwent postoperative follow-up with a median duration of 10 (6~18) months. No tumor recurrence or metastasis was observed during follow-up.

The application of transanal assistance in laparoscopic transabdominal ISR sphincter-preserving surgery for low rectal cancer is safe and feasible.

To explore the surgical methods and experiences and lessons in perioperative management of radiation-induced enteropathy.

A retrospective review of data from 12 patients with chronic radiation-induced intestinal injury who underwent surgical treatment at the First Hospital of Shanxi Medical University from January 2024 to April 2025. Four patients underwent simple ileostom. Eight patients had resection of the responsible lesion, including 4 modified Bacon procedures, one Parks procedure, one Dixon procedure, and 2 total pelvic reconstructions due to concurrent bladder fistula.

Among the 8 patients who underwent resection, one died due to empty pelvis syndrome; one had intestinal retraction leading to a stoma that could not be reduced; three had their stomas reduced, with anal function pending observation; two stomas awaited reduction; additionally, four patients currently had ileostomies with the lesion pending resection.

Resection of the responsible lesion can cure radiation-induced rectal injury, significantly alleviating clinical symptoms and improving the quality of life for patients. However, perioperative management is challenging and complications are numerous, making the compilation of clinical experiences and lessons regarding this condition necessary.

Natural orifice specimen extraction surgery(NOSES) for colorectal cancer has now been widely recognized and applied by colorectal surgeons. One key technique in digestive tract reconstruction during this procedure is the methods that place and fix the anvil of the circular stapler into the proximal colon segment. This article reports and analyzes two cases report of NOSES for colorectal tumors in which anvils were placed with magnetic traction, and discusses the feasibility, advantages and precautions of this method based on the author’s experience, with the aim of providing a new method for the placement of anvil in NOSES for colorectal tumors and promoting its application.

To analyze the relationship between blood loss volume and the etiologies as well as risk factors of severe postpartum hemorrhage (sPPH), providing a basis for developing and optimizing targeted preventive measures.

A retrospective study was conducted on clinical data from 683 patients with sPPH admitted to Shenzhen Maternity and Child Healthcare Hospital between January 2018 and December 2022. Patients were stratified into three groups based on blood loss volume: Group A (1 000~1 499 ml, n=385), Group B (1 500~2 499 ml, n=183), and Group C (≥2 500 ml, n=115). The causes of sPPH, relevant prenatal and intrapartum factors, multivariate analysis, and adverse pregnancy outcomes were analyzed.

Among the 683 sPPH cases, the etiologies were uterine atony (7.91%, 54/683), placental factors (38.51%, 263/683), birth canal laceration (5.42%, 37/683), and coagulopathy (4.25%, 29/683). Group A: 255 cases (66.23%) of uterine atony and 99 cases (25.71%) of placental factors; Group B: 81 cases (44.26%) of uterine atony and 81 cases (44.26%) of placental factors; Group C: 18 cases (15.65%) of uterine atony and 83 cases (72.17%) of placental factors. The differences in the distribution of both uterine atony and placental factors among the groups were statistically significant ( χ²=96.478 and 84.216, respectively; both P<0.001). Univariate analysis identified 15 factors associated with the severity of sPPH: maternal age ≥40 years, gestational age, primigravida, multiparity, history of intrauterine procedures, previous cesarean delivery(≥1), conception via assisted reproductive technology(ART), placenta accreta, placenta previa, pregnancy with uterine scar, cesarean delivery, and pre-delivery levels of hemoglobin, fibrinogen, serum calcium, and creatinine. Logistic regression revealed four independent factors for sPPH: placenta accreta (OR=4.386, 95%CI: 2.765~6.956, P<0.001), number of previous cesarean deliveries (OR=1.441, 95%CI: 1.016-2.043, P<0.05), ART conception (OR=1.512, 95%CI: 1.047~2.183, P<0.05), and pre-delivery fibrinogen level (OR=0.811, 95%CI: 0.659~0.998, P<0.05). As blood loss increased, the rates of blood transfusion (52.47%, 90.71%, 100.00%; χ²=144.865), ICU admission (18.44%, 54.64%, 93.04%; χ²=387.123), hemorrhagic shock (0.52%, 4.37%, 10.43%; χ²=28.988), and hysterectomy (0.26%, 0, 13.91%; χ²=74.392) showed a significant upward trend (all P<0.001).

Uterine atony was the primary cause of sPPH, but the proportion of placental factors increased with greater blood loss. Placenta accreta, number of previous cesarean deliveries, and ART conception were independent risk factors for sPPH, while pre-delivery fibrinogen level served as a protective factor. Early recognition, diagnosis, intervention, and comprehensive management are essential to improve maternal outcomes.

探讨妊娠合并血管性Ehlers-Danlos综合征(vascular Ehlers-Danlos syndrome，vEDS)的家系遗传特征与基因检测建议、妊娠结局、麻醉方式、围手术期管理及母乳喂养管理。

回顾性分析1例COL3A1双杂合突变vEDS孕妇的孕产期资料；同时在PubMed数据库中，以"vascular Ehlers-Danlos syndrome"或"vEDS""pregnancy"为关键词检索1983年1月至2025年8月发表的英文文献，最终纳入9篇观察性研究及病例系列进行系统分析。

本例患者孕前已完成基因咨询及多学科管理，于孕37^＋6周在全身麻醉下行剖宫产术，母婴均未发生血管相关不良事件。文献分析结果显示，vEDS合并妊娠的流产率为19%~25%，早产率为19%~31%，阴道顺产率为38.2%~79.1%，剖宫产率20.9%~61.8%。1983—2019年期间孕产妇死亡率为5.3%~25%，2022年后死亡率呈现下降趋势。

妊娠合并vEDS的患者在孕前进行COL3A1基因筛查、妊娠期实施血管影像动态监测及多学科个体化管理，可显著降低母胎不良发病风险及死亡率。

探讨大动脉炎(Takayasu arteritis，TAK)肾动脉搭桥术后合并妊娠的围产期管理策略。

报道1例TAK肾动脉搭桥术后孕妇的诊疗，结合文献分析管理要点。

患者在孕前多学科评估指导下受孕。孕期规律使用糖皮质激素、免疫抑制剂、阿司匹林与降压药物控制原发病。考虑其重症分型(Ⅳ型，P^＋)及既往血管手术史，于孕37^＋4周经多学科讨论后行剖宫产终止妊娠，母婴结局良好。随访20个月病情稳定。

TAK肾动脉术后患者通过孕前评估、多学科协作及个体化围产期管理可获得良好结局。

To explore the clinical efficacy and treatment experience of laparoscopic placement of IPST-specific hernia patch and open ostomy reconstruction in the treatment of stoma-side hernia.

: The clinical data of 52 patients with stoma-side hernia who underwent laparoscopic placement of IPST-specific hernia patch and open ostomy reconstruction from 2016 to 2024 were retrospectively analyzed. The size of the hernia ring, operation time, recovery time of intestinal function, postoperative hospital stay, and occurrence of postoperative complications were analyzed.

All 52 patients successfully completed the surgery. The size of the hernia ring was 5.5 (4~10)cm × 4.2 (3~8)cm. The operation time was 110 (90~120) minutes. The recovery time of intestinal function was 2 (1~5) days. The postoperative hospital stay was 6 (4~8) days. Postoperative follow-up was conducted for 30 (3~54) months. The incidence of postoperative complications was 1 case of exposed stoma intestinal perforation (see surgical complications ①) and 1 case of poor healing of the abdominal wall incision at the stoma site (see surgical complications ②). After conservative treatment, they improved. There was no infection, recurrence, seroma, intestinal obstruction, or stoma stenosis.

Laparoscopic placement of IPST-specific hernia patch and open ostomy reconstruction is a safe and effective surgical method for treating stoma-side hernia. It is more recommended for patients with large defects and stoma prolapse at the stoma side.