A Japanese single-center retrospective study evaluated 169 patients with pathological T1 gastric cancer (pT1 GC) undergoing minimally invasive distal gastrectomy. Of these, 43 patients had previously undergone non-curative endoscopic submucosal dissection (ESD) and subsequently required definitive surgical resection.

After propensity-score matching, previous ESD was not associated with significantly longer operative time, increased blood loss, higher postoperative morbidity, or prolonged hospitalization. Importantly, R0 resection was achieved in all patients, and no recurrence was observed during the relatively short follow-up period.

A modest reduction in lymph-node yield was observed among patients undergoing gastrectomy after ESD. Although this did not translate into an adverse short-term oncological outcome, it deserves attention because adequate lymphadenectomy remains fundamental when additional gastrectomy is performed for non-curative endoscopic resection.

Within the post-ESD population, robotic distal gastrectomy was also feasible. Robotic procedures required longer operating time than conventional laparoscopy, largely attributed to docking and intracorporeal reconstruction, while blood loss, lymph-node retrieval, postoperative morbidity, and hospital stay were broadly similar.

Surgical Relevance

The study supports an increasingly important laparoendoscopic treatment pathway for early gastric cancer. ESD can provide organ-preserving treatment for appropriate lesions, while patients found to have non-curative pathological features can subsequently undergo minimally invasive gastrectomy without an obvious penalty in early surgical outcomes.

However, previous ESD should not lead surgeons to compromise the quality of subsequent oncological surgery. Particular attention should remain directed toward lymph-node dissection, resection margins, pathological risk factors, and appropriate multidisciplinary selection for additional gastrectomy.

Clinical Takeaway: Non-curative ESD does not appear to make subsequent minimally invasive distal gastrectomy substantially more hazardous, but oncological completeness—particularly lymphadenectomy quality—must remain the priority.

Source: PubMed – Minimally Invasive Distal Gastrectomy After Non-Curative ESD

Videofluoroscopy Identifies Measurable Swallowing Impairment After Minimally Invasive Esophagectomy

A prospective observational study examined swallowing physiology in 20 patients undergoing minimally invasive esophagectomy with cervical esophagogastric anastomosis. Swallowing was evaluated before surgery and again prior to hospital discharge.

Among 18 patients with complete paired data, postoperative videofluoroscopy demonstrated significant deterioration in several objective parameters, including hyoid movement, pharyngeal transit time, and Penetration-Aspiration Scale scores.

Interestingly, citric-acid cough latency remained relatively preserved, suggesting that postoperative swallowing impairment may occur even when protective cough mechanisms are not profoundly altered.

The measured abnormalities did not clearly discriminate patients who subsequently developed aspiration pneumonia from those who did not. Nevertheless, the study demonstrates that physiological dysphagia can be objectively documented early after minimally invasive esophagectomy.

Surgical Relevance

Post-esophagectomy respiratory complications are usually considered in relation to recurrent laryngeal nerve dysfunction, pulmonary physiology, aspiration, anastomotic complications, and deconditioning. This study emphasizes that swallowing biomechanics themselves may be altered following reconstruction.

Objective assessment may help multidisciplinary teams identify patients requiring modified oral intake, swallowing rehabilitation, or additional surveillance before discharge.

Clinical Takeaway: Recovery after minimally invasive esophagectomy should include attention to functional swallowing as well as anastomotic and pulmonary outcomes. Structured swallow assessment and early rehabilitation may strengthen aspiration-prevention pathways.

Source: PubMed – Swallowing Function After Minimally Invasive Esophagectomy

Ligamentum Teres Cardiopexy During Sleeve Gastrectomy Shows Potential for Reducing Postoperative Reflux

A prospective cohort of 40 patients compared conventional laparoscopic sleeve gastrectomy with sleeve gastrectomy combined with ligamentum teres cardiopexy, an anatomical adjunct intended to improve gastroesophageal junction stability and reduce postoperative reflux.

At one year, patients undergoing cardiopexy demonstrated lower GERD-HRQL symptom scores, less deterioration in Hill grade, and a greater probability of achieving a low reflux-symptom score.

CT assessment demonstrated numerically smaller hiatal defect areas and hernial sac volumes following cardiopexy, although these differences were not statistically significant.

The additional maneuver increased operative time by approximately 11 minutes and did not increase postoperative complications in this small cohort.

Surgical Relevance

Gastroesophageal reflux remains one of the major long-term concerns following sleeve gastrectomy. Potential mechanisms include alteration of the angle of His, reduced gastric compliance, increased intragastric pressure, hiatal dysfunction, and migration of the proximal sleeve.

Ligamentum teres cardiopexy offers an interesting anatomical concept for stabilizing the gastroesophageal junction without converting the primary procedure to a bypass operation.

However, a 40-patient cohort is insufficient to establish long-term effectiveness.

Clinical Takeaway: Ligamentum teres cardiopexy may reduce reflux symptoms after sleeve gastrectomy without substantial additional morbidity, but larger controlled studies with objective reflux testing and long-term follow-up are needed before routine adoption.

Source: PubMed – Ligamentum Teres Cardiopexy During Sleeve Gastrectomy

vNOTES Ovarian Cystectomy Shows Lower Early Pain and Greater Patient Satisfaction in Pilot Study

A prospective quasi-randomized pilot study compared vaginal natural orifice transluminal endoscopic surgery (vNOTES) ovarian cystectomy with conventional laparoscopic ovarian cystectomy in 20 premenopausal women with benign ovarian cysts.

vNOTES was successfully completed in 80% of cases, with one conversion attributed to adhesions, while conventional laparoscopy was completed in 90%. Operative duration was numerically shorter with vNOTES but did not differ significantly.

The most notable findings were patient-centered: pain scores at six and 24 hours were lower after vNOTES, and patient satisfaction was higher.

Surgical Relevance

Avoiding abdominal trocar incisions may contribute to reduced early pain and improved cosmetic satisfaction. However, vaginal access introduces different anatomical and technical limitations, particularly in patients with adhesions, distorted pelvic anatomy, previous surgery, restricted vaginal access, or uncertain pathology.

The reported conversion related to adhesions is particularly instructive: adoption of vNOTES should occur alongside preservation of conventional laparoscopic capability.

Clinical Takeaway: vNOTES ovarian cystectomy may provide early pain and satisfaction advantages in selected patients, but careful selection and immediate laparoscopic bailout capability remain essential.

Source: PubMed – vNOTES Versus Laparoscopic Ovarian Cystectomy

Nonopioid Analgesia Is Noninferior to Routine Oxycodone Prescribing After Minimally Invasive Hysterectomy

A randomized noninferiority trial published in Obstetrics & Gynecology evaluated postoperative analgesia in 64 patients undergoing benign laparoscopic or robotic hysterectomy.

Patients received either acetaminophen plus ibuprofen alone or the same multimodal regimen combined with a routine prescription for 12 oxycodone tablets.

Postoperative pain scores on days 1 and 7 met the predefined criteria for noninferiority, and satisfaction with pain management remained high in both groups.

By postoperative day 7, median oxycodone consumption was only one tablet in the routine-opioid group compared with zero in the nonopioid group. Importantly, patients assigned to nonopioid management retained access to rescue opioid medication when clinically necessary.

Surgical Relevance

Routine opioid prescribing after uncomplicated minimally invasive surgery can result in unnecessary medication exposure and unused tablets remaining in the community.

A default strategy based on scheduled acetaminophen and NSAID therapy with selective rescue opioids may provide adequate pain control for many patients while reducing opioid exposure.

This approach fits naturally within contemporary ERAS and day-care minimally invasive gynecology pathways.

Clinical Takeaway: Routine opioid prescriptions may not be necessary after many uncomplicated laparoscopic or robotic hysterectomies. Multimodal nonopioid analgesia with selective rescue medication can provide effective postoperative pain control while minimizing unnecessary opioid exposure.

Source: PubMed – Nonopioid Analgesia After Minimally Invasive Hysterectomy

OpenTrainer Provides a Reproducible Low-Cost Platform for Laparoscopic Simulation

A Journal of Surgical Education “How I Do It” article describes OpenTrainer, a low-cost, do-it-yourself laparoscopic box trainer designed using components accessible through university, hospital, or community makerspaces.

The system combines a smartphone display, smartphone-compatible industrial endoscope, laser-cut acrylic enclosure, 3D-printed trocar components, and interchangeable task modules.

Training modules can reproduce several tasks familiar from the Fundamentals of Laparoscopic Surgery curriculum, including:

• Peg transfer
• Precision cutting
• Ligature placement
• Intracorporeal suturing

The estimated material cost is below USD 150, substantially lower than commercial FLS-style training systems that may cost several thousand dollars.

Surgical Relevance

Access to deliberate laparoscopic practice remains inconsistent, particularly in resource-constrained institutions and among trainees who have limited access to formal simulation centers.

A reproducible low-cost trainer could allow departments to establish multiple practice stations, home-based skills practice, resident competitions, structured suturing curricula, and objective pre-OR psychomotor training without major capital expenditure.

The educational value will ultimately depend not simply on the box itself but on how it is incorporated into a curriculum with defined tasks, repetition, feedback, objective assessment, and competency targets.

Clinical Takeaway: Affordable open-source simulation platforms can help democratize laparoscopic skills training. Low equipment cost should be combined with structured deliberate practice and objective competency assessment to translate simulation into meaningful surgical skill development.

Source: PubMed – OpenTrainer Low-Cost Laparoscopic Simulator

Key Message

The 1 September 2026 evidence update demonstrates how minimally invasive surgery is progressing across the entire patient pathway. Non-curative ESD can transition safely to definitive minimally invasive gastric surgery; functional swallowing assessment may improve recovery after esophagectomy; anatomical modifications may help address reflux after sleeve gastrectomy; vNOTES continues to expand selected gynecologic access; opioid-sparing protocols can improve responsible postoperative prescribing; and affordable simulation technology can broaden access to structured laparoscopic training.

The future of minimally invasive surgery depends not only on performing operations through smaller access, but on integrating endoscopy and surgery, preserving function, reducing postoperative burden, selecting the right access for each patient, and making high-quality surgical training accessible to the next generation.