INTRODUCTION: In order for the surgeon to perform a laparoscopic gastrostomy, he/she must have outstanding skills, therefore, laparoscopic simulators are an essential tool. They are also based on ex vivo, inanimate and virtual reality models. Objetive: To compare simulation models (ex vivo and 3D) to reproduce the laparoscopic gastrostomy technique in the training of novice surgeons at the University Hospital of Caracas.
METHODS: A prospective study was conducted, which included the participation of 8 surgeons, who reproduced the proposed technique through 10 practical sessions in both models. The time of each practice was timed and expert surgeons evaluated the exercises using the GOALS scale. Descriptive calculations of the variables were performed and compared using the Student T test. A value was considered significant if p<0.05.
RESULTS: The proposed technique was reproduced in both models. In addition, as the practices progressed, the performance time decreased and the score on the GOALS scale increased, with a slightly higher score in the ex vivo model. On the other hand, the execution time was longer in the 3D model practices.
DISCUSSION AND CONCLUSION: In both simulation models, the steps were recreated authentically, and they also allowed the acquisition of skills in advanced laparoscopic surgery. The ex vivo model provided greater comfort to the surgeons, but tissue quality is an essential factor and the 3D model was technically more difficult, but proved to be more accessible and cost-effective compared to the ex vivo model.

INTRODUCTION: To evaluate the quality and educational value of information generated by large language models (LLMs) for use in preoperative counselling with patients undergoing sleeve gastrectomy.
METHODS: Two LLMs were used to generate responses to common patient questions. Bariatric surgeons then evaluated the responses using a Likert scale to assess their accuracy, clarity and usefulness.
RESULTS: Both models mostly produced accurate and clear information on procedure details, though individual risk communication was sometimes limited.
DISCUSSION AND CONCLUSION: LLMs can provide supplementary information for preoperative education, but should not replace discussions with physicians. During preoperative counselling, clinicians should guide patients in interpreting AI-generated content.

INTRODUCTION: Protective loop ileostomy is commonly performed following laparoscopic low anterior resection for rectal cancer to reduce the clinical consequences of anastomotic leakage. Traditionally, the stoma is created through a separate abdominal incision; however, enlarging an existing trocar site may represent a less invasive alternative. This study aimed to compare the surgical and postoperative outcomes of ileostomy creation by enlarging a laparoscopic trocar site with those created through a conventional incision.
METHODS: This retrospective study included 92 patients who underwent laparoscopic low anterior resection with a protective loop ileostomy for rectal cancer between 2016 and 2024. Patients were divided into two equal groups according to the stoma creation technique. In Group T (n=46), the ileostomy was constructed by enlarging a 12-mm trocar site, whereas in Group C (n=46) a conventional abdominal incision was used. Operative time, postoperative complications (ileus, wound infection, and incisional hernia), length of hospital stay, and patient-reported aesthetic satisfaction were evaluated and compared between the groups.
RESULTS: Baseline demographic and clinical characteristics were comparable between the two groups. Operative time was significantly shorter in Group T than in Group C. Postoperative wound infection occurred less frequently in the trocarsite group, whereas the rates of ileus and incisional hernia were similar between the groups. Patients in Group T also reported significantly higher aesthetic satisfaction. No significant difference was observed in the length of hospital stay.
DISCUSSION AND CONCLUSION: Creating a protective loop ileostomy by enlarging a trocar site appears to be a safe and feasible alternative to the conventional incision technique. This approach may reduce operative time, decrease wound-related complications, and provide superior cosmetic outcomes in patients undergoing laparoscopic low anterior resection for rectal cancer.

INTRODUCTION: This study aimed to evaluate the impact of preoperative neutrophil-to-lymphocyte ratio (NLR) levels on early postoperative clinical outcomes in patients undergoing laparoscopic inguinal hernia repair using the Transabdominal Preperitoneal (TAPP) technique.
METHODS: In this single-center retrospective study, data from 93 patients who underwent surgery using the TAPP technique between June 2022 and December 2024 were analyzed. The patients were divided into two groups based on their preoperative NLR: ≤2 (Low NLR, n=51) and >2 (High NLR, n=42). The primary endpoint of the study was to compare the postoperative 6th-hour Visual Analog Scale (VAS) scores between the groups. Secondary endpoints included postoperative VAS scores at 24 h, 10 days, and 3 months, rescue analgesic consumption, the time to return to daily life/work.
RESULTS: The mean postoperative 6th-hour VAS score was significantly lower in the Low NLR group than in the High NLR group (p=0.006). Similarly, the mean 24th-hour VAS scores were significantly lower in the Low NLR group (p=0.022). However, the mean VAS scores on the 10th postoperative day and at 3 months were comparable between the groups (p=0.274 and p=0.104, respectively). Mean rescue analgesic consumption was significantly lower in the Low NLR group than in the High NLR group (p=0.005). The median time to return to daily life/work was shorter in the Low NLR group (p<0.001).
DISCUSSION AND CONCLUSION: A higher preoperative NLR is associated with greater early postoperative pain, higher analgesic consumption and delayed return to daily life/work after laparoscopic inguinal hernia repair. NLR may serve as a biomarker for predicting postoperative pain and recovery, although larger prospective studies are needed for validation.

INTRODUCTION: Metabolic and inflammatory processes have been increasingly implicated in colorectal carcinogenesis. Fasting blood glucose and leukocyte count are routinely available laboratory parameters that may reflect these mechanisms. This study aimed to investigate the association between fasting glucose levels, glucose-to-leukocyte ratio, and colorectal polyp size as a surrogate marker of polyp-related risk.
METHODS: A total of 422 patients who underwent colonoscopic polypectomy were retrospectively analyzed. Fasting glucose, leukocyte count, and glucose-to-leukocyte ratio were evaluated using individual patient-level data. Correlation analyses, multivariate linear regression, and receiver operating characteristic (ROC) curve analyses were performed.
RESULTS: A significant positive correlation was observed between fasting glucose and polyp size (r=0.41, p<0.001), while leukocyte count alone was not significantly associated (p=0.28). The glucose-to-leukocyte ratio also demonstrated a significant correlation with polyp size (r=0.36, p<0.001). In multivariate analysis, fasting glucose (β=0.39, p<0.001) and glucose-to-leukocyte ratio (β=0.27, p=0.006) remained independently associated with polyp size. ROC analysis showed moderate discriminative ability for fasting glucose (AUC=0.71) and glucose-to-leukocyte ratio (AUC=0.75) in identifying larger polyps (≥10 mm).
DISCUSSION AND CONCLUSION: Fasting glucose and the glucose-to-leukocyte ratio were associated with colorectal polyp size, with the combined parameter demonstrating slightly improved discriminative performance. These findings suggest that simple, routinely available laboratory markers may provide additional information regarding polyp-related risk; however, further prospective studies incorporating histopathological parameters are required.

INTRODUCTION: Robotic surgery has become a cornerstone of minimally invasive colorectal surgery, offering enhanced visualization, greater dexterity, and improved ergonomics. However, variability in clinical practice and limited guideline coverage for niche areas highlight the need for expert-driven consensus, especially in countries like Türkiye where adoption is expanding but inconsistent.
METHODS: A Modified Delphi process was used to generate expert consensus on key aspects of robotic colorectal surgery. A Scientific Committee of three experienced colorectal surgeons identified four main themes: Indications, education, operating room layout and positioning, and surgical technique and perioperative outcomes. Twenty-one evidence-based statements were developed employing the GRADE framework. These statements were presented and anonymously voted on by participants, predominantly colorectal and general surgeons, during a consensus session at the 17th National Endoscopic Laparoscopic Robotic Surgery Congress in Türkiye (October 2024). A consensus threshold was defined as ≥70% agreement for each statement.
RESULTS: Of the total 21 statements, 15 reached consensuses, including 10 with strong agreement (>90%). Statements related to ergonomic superiority and long-term functional outcomes of robotic surgery received strong support. Topics such as the use of robotic surgery in high BMI patients, prior abdominal surgery, and vessel sealing for IMA showed lower agreement, reflecting a variety in practices and familiarity with robotic techniques. ERAS protocols, although integral to the future of robotic colorectal surgery, received limited support.
DISCUSSION AND CONCLUSION: This study presents a national expert consensus on robotic colorectal surgery in Türkiye. The findings integrate current evidence with expert insight, offering guidance for clinical decision-making and education.

INTRODUCTION: Gastric polyps are frequently detected during upper gastrointestinal endoscopy, most of which are benign; however, a subset carries a risk of malignant transformation. Identifying factors associated with high-risk gastric pathology remains clinically important, particularly in regions with distinct epidemiological characteristics. This study aimed to evaluate the clinicopathological features of gastric polyps and to identify predictors of high-risk pathology in patients undergoing gastric polypectomy in the Van region of eastern Türkiye.
METHODS: This retrospective, single-center study included 210 consecutive patients who underwent endoscopic gastric polypectomy. Demographic data, endoscopic findings, and histopathological results were analyzed. High-risk pathology was defined as adenomatous polyps, high-grade dysplasia, or neuroendocrine tumors. Group comparisons, receiver operating characteristic (ROC) analysis, and penalized multivariable logistic regression were performed.
RESULTS: High-risk gastric pathology was identified in 9 patients (4.3%). Patients with high-risk lesions had a significantly higher polyp count and were more likely to have multiple polyps and underlying atrophic gastritis. Polyp size demonstrated limited discriminative ability for high-risk pathology (AUC=0.603). In exploratory penalized multivariable analysis, male sex, polyp multiplicity, and atrophic gastritis were associated with increased odds of high-risk pathology.
DISCUSSION AND CONCLUSION: High-risk gastric polyps were uncommon in this regional cohort. Polyp multiplicity and atrophic gastritis, rather than polyp size alone, were the main factors associated with high-risk pathology. Comprehensive assessment of both endoscopic features and background gastric mucosa may improve risk stratification in patients with gastric polyps.

INTRODUCTION: The simultaneous performance of laparoscopic cholecystectomy (LC) and totally extraperitoneal (TEP) inguinal hernia repair remains controversial due to concerns about mesh infection when combining a clean-contaminated procedure with prosthetic mesh implantation. This study aimed to evaluate the safety, clinical outcomes, and cost-effectiveness of this combined approach.
METHODS: We retrospectively analyzed 37 consecutive patients who underwent simultaneous LC and TEP inguinal hernia repair between January 2019 and January 2024. TEP was performed first in all cases, with the umbilical port used for both procedures. Postoperative complications were graded according to the Clavien-Dindo classification. Patient satisfaction was assessed via a questionnaire. Costs were calculated using standardized governmental reimbursement rates.
RESULTS: The median operative time was 85 minutes (IQR: 78-89). No conversions to open surgery or TAPP were recorded. Intraoperative complications occurred in 3 patients (8.1%). Postoperative complications were observed in 6 patients (16.2%), including seroma (n=3), wound infection at the epigastric port site (n=2), and urinary retention (n=1). No mesh infections were recorded. Most patients (97.3%) were discharged on postoperative day 1. Over a median follow-up of 32 months, one recurrence (2.7%) was observed. Patient satisfaction was high, with 91.9% willing to undergo the combined procedure again. The simultaneous approach yielded a 7.7% cost reduction for unilateral cases compared to staged surgery.
DISCUSSION AND CONCLUSION: Simultaneous LC and TEP inguinal hernia repair is a safe and feasible procedure with no in-crease in mesh-related complications. The hernia-first approach and anatomical separation of operative fields support the safety of this combined strategy.

INTRODUCTION: Esophageal cancer surgery represents one of the major surgical procedures associated with high morbidity and mortality. This study aimed to evaluate the clinical, pathological, and short-term outcomes of esophagectomy cases performed entirely using a minimally invasive approach by a single surgeon.
METHODS: In this retrospective study, 13 patients who underwent surgical resection for esophageal malignancy by a single surgeon at our center were included. Demographic characteristics, surgical techniques, histopathological findings, and neoadjuvant and adjuvant treatment status were analyzed. Perioperative and pathological parameters, including anastomotic leakage, mortality, pT/pN/pM staging, lymph node metastasis, lymphovascular invasion, perineural invasion, surgical margin status, and recurrence, were evaluated.
RESULTS: A total of 13 patients underwent minimally invasive esophagectomy, including minimally invasive abdominal (distal) esophagectomy in 6 patients (46.2%), minimally invasive transhiatal esophagectomy in 4 patients (30.8%), and minimally invasive Ivor Lewis esophagectomy in 3 patients (23.1%). Histopathological evaluation revealed adenocarcinoma in 11 patients (84.6%) and squamous cell carcinoma in 2 patients (15.4%). Neoadjuvant therapy was administered in 5 patients (38.5%), while 7 patients (53.8%) received adjuvant treatment. Anastomotic leakage occurred in 2 patients (15.4%), and the overall mortality rate was 15.4% (n=2). Lymph node metastasis was detected in 7 patients (53.8%), with pT3 being the most common tumor stage. The median number of retrieved lymph nodes was 19. Based on the available follow-up data, radiologically detected recurrence was observed in 1 patient (7.7%).
DISCUSSION AND CONCLUSION: In selected patients with esophageal cancer, minimally invasive esophagectomy performed by a single surgeon may provide acceptable short-term clinical and oncological outcomes when oncological principles are carefully followed. Despite the inherent morbidity and mortality associated with esophagectomy, our findings suggest that minimally invasive approaches can be safely implemented in appropriately selected patients. Larger multicenter studies with longer follow-up are needed to further validate these findings.

INTRODUCTION: Advanced histology in colorectal polyps is central to post-polypectomy risk stratification. This study aimed to identify clinical, endoscopic, and histopathological determinants of advanced histology among patients with colonoscopically detected colorectal polyps.
METHODS: Adult patients who underwent colonoscopy between 2 January 2024 and 30 January 2025 were retrospectively evaluated. The analysis included 402 patients with detected colorectal polyps. Advanced histology was defined as tubulovillous adenoma, villous adenoma, or adenocarcinoma. Demographic variables, polyp size, burden, location, morphology, resection technique, bowel preparation quality, and cecal intubation were analyzed. Independent determinants were assessed using multivariable logistic regression.
RESULTS: Advanced histology was detected in 70 patients (17.4%). Its rate increased with polyp size: 0% in polyps <5 mm, 9.4% in 6–9 mm polyps, and 67.8% in polyps ≥10 mm (p<0.001). Advanced histology also increased with polyp burden, from 14.1% in solitary polyps to 43.8% in patients with ≥5 polyps (p=0.003). Polyp location, morphology, resection technique, bowel preparation adequacy, and cecal intubation were not significantly associated with advanced histology. In multivariable analysis, polyp size ≥10 mm was the only independent determinant of advanced histology (adjusted OR: 58.64, 95% CI: 27.03–127.21, p<0.001).
DISCUSSION AND CONCLUSION: Polyp size was the dominant determinant of advanced histology. Careful size estimation, complete resection, and appropriate pathological evaluation of larger colorectal polyps remain essential for post-polypectomy risk stratification.