A retrospective study published in the World Journal of Gastrointestinal Surgery developed an internally validated prediction model to estimate the risk of clinically significant biliary events within 30 days after laparoscopic cholecystectomy (LC). The study included 287 adult patients, among whom 10.1% experienced postoperative biliary complications.

The composite endpoint included retained common bile duct (CBD) stones, bile leakage, cholangitis, biliary pancreatitis, postoperative ERCP, image-guided drainage, or hospital readmission.

Key Findings

Using LASSO regression and multivariable analysis, the investigators identified only two independent predictors of postoperative biliary events:

• Preoperative serum total bilirubin.
• Common bile duct-to-height (CBD/Height) index measured on preoperative imaging.

The prediction model demonstrated excellent diagnostic performance, with an area under the ROC curve (AUC) of approximately 0.88–0.90 in both training and validation cohorts. The model also remained robust after excluding patients who had undergone ERCP within 30 days before surgery.

Clinical Significance

Both predictive variables are inexpensive, objective, and routinely available during preoperative assessment. Although prospective external validation is still required, the nomogram may help surgeons identify patients at higher risk for retained ductal pathology and postoperative biliary complications.

Clinical Relevance

For laparoscopic surgeons, this model may improve individualized patient counselling, optimize preoperative MRCP or ERCP selection, and support closer postoperative surveillance in patients demonstrating biochemical or ultrasonographic evidence of biliary obstruction.

Source: https://www.wjgnet.com/1948-9366/full/v18/i7/121443.htm

Primary Closure Offers Faster Recovery Than T-Tube Drainage After Laparoscopic Choledocholithotomy

A single-centre retrospective study compared primary bile duct closure with traditional T-tube drainage following laparoscopic choledocholithotomy in 102 patients with gallbladder stones and common bile duct stones.

Key Findings

Following adjustment for baseline differences in bile duct diameter:

Primary closure resulted in:

• Shorter operative time.
• Reduced drainage from the Winslow foramen.
• Earlier drain removal.
• Shorter hospital stay.
• Lower overall treatment cost.
• Lower incidence of postoperative electrolyte imbalance.

Importantly:

• Complete stone clearance rates were similar.
• Bile leak rates were not significantly different.
• Outcomes remained highly dependent on patient selection and surgeon experience.

Clinical Significance

Avoiding prolonged external biliary drainage may reduce metabolic disturbances while accelerating postoperative recovery. However, primary closure should only be considered when complete duct clearance is confidently achieved and the bile duct is healthy without significant inflammation or edema.

Clinical Relevance

The study supports primary closure as an excellent recovery-focused strategy for carefully selected patients undergoing laparoscopic CBD exploration, while emphasizing that T-tube drainage remains appropriate when ductal conditions or operative findings increase postoperative risk.

Source: https://www.wjgnet.com/1948-9366/full/v18/i7/120916.htm

Erector Spinae Plane Block Improves Early Visceral Pain Control After Laparoscopic Appendectomy

A retrospective comparison involving 183 patients undergoing laparoscopic appendectomy evaluated two ultrasound-guided regional anaesthesia techniques:

• Erector Spinae Plane Block (ESPB)
• Transversus Abdominis Plane Block (TAPB)

Key Findings

Compared with TAPB, ESPB provided:

• Lower visceral pain scores at 2, 6 and 12 hours.
• Reduced pain during movement.
• Lower postoperative tramadol consumption.
• Less need for rescue analgesia.
• Greater patient satisfaction.

However:

• Somatic pain scores were similar.
• Time to ambulation was unchanged.
• First bowel movement, hospital stay and postoperative nausea were comparable.
• No significant block-related complications occurred.

Clinical Significance

Unlike many analgesia studies that combine all postoperative pain into a single score, this study separately evaluated visceral and somatic pain, demonstrating that ESPB appears particularly effective in controlling visceral discomfort.

Clinical Relevance

For laparoscopic surgeons implementing Enhanced Recovery After Surgery (ERAS) pathways, ESPB may become an attractive option for improving early postoperative comfort and facilitating recovery, particularly in patients whose discharge is delayed by visceral pain rather than wound discomfort.

Source: https://www.wjgnet.com/1948-9366/full/v18/i7/120890.htm

Remimazolam Provides More Stable Hemodynamics Than Propofol During Elderly Laparoscopic Cholecystectomy

A randomized clinical trial compared remimazolam benzenesulfonate with propofol for total intravenous anaesthesia in elderly patients undergoing laparoscopic cholecystectomy.

Among 120 randomized patients, 118 completed the study.

Key Findings

Compared with propofol, remimazolam demonstrated:

• More stable mean arterial pressure.
• Better heart rate control.
• Reduced requirement for vasoactive medications.
• Lower incidence of adverse cardiovascular events.
• Less agitation immediately after extubation.
• Better early Mini-Mental State Examination (MMSE) scores.
• Improved early postoperative pain scores.

The trade-off was:

• Slightly slower induction.
• Longer time to achieve BIS values below 60.

By later postoperative follow-up, cognitive and pain differences between both groups had disappeared.

Clinical Significance

Maintaining cardiovascular stability is particularly important in elderly patients because pneumoperitoneum and reverse Trendelenburg positioning can significantly increase cardiovascular stress during laparoscopic surgery.

Clinical Relevance

For surgeons managing elderly or high-risk patients, remimazolam may offer important perioperative haemodynamic advantages while maintaining effective anaesthesia and early postoperative recovery.

Source: https://www.wjgnet.com/1948-9366/full/v18/i7/121776.htm

Systematic Review Demonstrates Early Success of the Toumai Robotic Surgical Platform

A systematic review published in the Journal of Robotic Surgery evaluated the current clinical evidence regarding the Toumai robotic surgical system, including its emerging role in robotic general surgery and telesurgery.

The review analysed eight studies involving 416 patients, including 329 confirmed Toumai robotic procedures.

Procedures Included

The Toumai platform was used for:

• Hepatopancreatobiliary surgery.
• Radical gastrectomy.
• Cholecystectomy.
• Inguinal hernia repair.
• Colorectal surgery.
• Vascular resection.

Major Findings

Across the included studies:

• Conversion rates remained low.
• Blood loss was minimal.
• Most complications were minor (Clavien-Dindo Grade I–II).
• No procedure-related mortality was reported.

One comparative study found no significant short-term differences between Toumai and the da Vinci Xi system during robotic radical gastrectomy.

The review also highlighted successful 5G telesurgery, including:

• Remote radical gastrectomy over 15 km.
• Remote robotic cholecystectomy over 70 km.

Limitations

Despite encouraging feasibility, all available studies originated from China, and most carried moderate risk of bias. Long-term comparative outcomes, cost-effectiveness, learning curves, and international generalizability remain uncertain.

Clinical Relevance

For robotic surgeons and healthcare institutions considering next-generation robotic platforms, the review highlights the promise of Toumai technology while emphasizing that wider adoption should continue to rely on structured credentialing, rigorous clinical evaluation, cost analysis, and governance before routine implementation.

Source: https://link.springer.com/10.1007/s11701-026-03714-w

Key Takeaway

Today's evidence highlights continued advances in laparoscopic and robotic surgery through improved risk prediction, enhanced bile duct management, optimized postoperative analgesia, safer anaesthetic techniques, and emerging robotic technologies. Individualized patient selection, multidisciplinary perioperative planning, structured ERAS protocols, and evidence-based adoption of new surgical platforms remain essential for improving outcomes and maintaining patient safety in minimally invasive surgery.