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Approaches to Prevention and Management of Postoperative Complications in Minimally Invasive Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 30 March 2027 | Viewed by 2707

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Dr. Shingo Tsujinaka

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Division of Gastroenterological Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Japan
Interests: colorectal cancer; minimally invasive surgery; colorectal surgery
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Special Issue Information

Dear Colleagues,

The aim of this Special Issue, “Approaches to Prevention and Management of Postoperative Complications in Minimally Invasive Surgery”, is to highlight recent advances in minimizing and managing early and late postoperative complications following minimally invasive surgical procedures. We invite submissions from diverse specialties, including thoracic, gastrointestinal, hepatobiliary–pancreatic surgery, gynecology, and urology, to foster a multidisciplinary discussion. Topics of interest include preoperative risk assessment, intraoperative techniques, and postoperative care strategies aimed at preventing and managing issues such as bleeding, organ injury, bowel obstruction, surgical site occurrence, incisional hernia, and anesthetic-related events. This Special Issue will also explore the role of technology, patient optimization, and multidisciplinary approaches in improving postoperative outcomes. Furthermore, it will emphasize how minimally invasive surgery affects patient care and patient satisfaction, with a focus on patient-reported outcomes and their impact on overall quality of care.

Dr. Shingo Tsujinaka
Guest Editor

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Keywords

minimally invasive surgery
postoperative complications
preventive measures
risk assessment
surgical techniques
patient optimization
complication management
surgical outcomes
patient satisfaction
patient-reported outcomes

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Published Papers (4 papers)

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Research

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13 pages, 1584 KB

Open AccessFeature PaperArticle

Suture Versus Non-Suture Closure of the Cystic Duct Orifice During Fenestrating Laparoscopic Subtotal Cholecystectomy: A Single-Center Retrospective Study

by Hiroto Sakurai, Kei Nakagawa, Shingo Tsujinaka, Kenichiro Yambe, Kazuhiro Takami, Noriko Kondo, Kuniharu Yamamoto, Chikashi Shibata and Yu Katayose

J. Clin. Med. 2026, 15(9), 3548; https://doi.org/10.3390/jcm15093548 - 6 May 2026

Viewed by 526

Abstract

Background/Objectives: Laparoscopic subtotal cholecystectomy (LSC) can be performed using either the fenestrating or reconstituting method. In the fenestrating method, some surgeons additionally perform suture closure of the cystic duct orifice, whereas others do not. However, evidence regarding the clinical significance of suture closure remains limited. Methods: Between April 2018 and December 2023, 934 patients underwent cholecystectomy at our institution. Among them, 37 underwent LSC because standard cystic duct control could not be achieved intraoperatively. Of these, 34 were treated with the fenestrating method. Among these 34 patients, 27 did not undergo suture closure of the cystic duct orifice (non-suture group), while 7 underwent suture closure (suture group). Perioperative outcomes were retrospectively compared between the groups. Results: No statistically significant differences were observed between the groups in operative time, drain retention period, postoperative hospital stay, postoperative bile leakage, or the need for postoperative endoscopic treatment. Similar findings were observed in exploratory subgroup analyses among patients with intraoperative bile flow from the cystic duct orifice (IBF) and within the non-suture group according to the presence or absence of IBF. No reoperations, readmissions, or deaths occurred in either group. However, postoperative bile leakage (11/27 [40.7%] vs. 1/7 [14.3%]) and endoscopic treatment (7/27 [25.9%] vs. 1/7 [14.3%]) were more frequent in the non-suture group, although not statistically significant. Conclusions: In this small retrospective single-institution cohort, no statistically significant differences in perioperative outcomes were observed between patients with or without suture closure of the cystic duct orifice during fenestrating LSC. However, the non-suture group showed a trend toward higher rates of postoperative bile leakage and endoscopic treatment. These hypothesis-generating findings should be interpreted cautiously. Full article

(This article belongs to the Special Issue Approaches to Prevention and Management of Postoperative Complications in Minimally Invasive Surgery)

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10 pages, 325 KB

Open AccessArticle

Mid-Term Oncological Outcomes of Vaginal Natural Orifice Transluminal Endoscopic Surgery Compared with Total Laparoscopic Hysterectomy for Early-Stage Endometrial Cancer: A Single-Center Retrospective Study

by Ken Imai, Junya Abe, Kenro Chikazawa, Mina Hasegawa, Nanami Suzuki, Miyuki Taniguchi and Tomoyuki Kuwata

J. Clin. Med. 2026, 15(9), 3350; https://doi.org/10.3390/jcm15093350 - 28 Apr 2026

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Abstract

Background/Objectives: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is increasingly being used to avoid abdominal incisions; however, its mid-term oncological safety in endometrial cancer remains unclear. Methods: This single-center retrospective cohort study included patients with International Federation of Gynecology and Obstetrics (FIGO) clinical stage IA endometrioid endometrial carcinoma undergoing simple hysterectomy between January 2014 and December 2023. Patients were treated with either total laparoscopic hysterectomy (TLH) or vNOTES. Patients who underwent lymph node assessment were excluded. Follow-up assessed mid-term oncological outcomes. Recurrence-free survival (RFS) was evaluated using the Kaplan–Meier method and compared between the groups, and Cox proportional hazards models were used to identify prognostic factors for RFS. Results: In total, 130 patients were included: 109 underwent TLH and 21 vNOTES. The median follow-up period was 48 and 33 months in the TLH and vNOTES groups, respectively. Postoperative adjuvant therapy was more frequent in the vNOTES group. The operative time was significantly shorter with vNOTES. Postoperative complications were low and similar between the groups. The 3-year RFS was 92.8% and 94.4% in the TLH and vNOTES groups, respectively, without a significant difference (p = 0.874). Lymphovascular space invasion was significantly associated with worse RFS, whereas surgical approach was not significantly associated with RFS. Conclusions: No statistically significant difference in mid-term RFS was observed between vNOTES hysterectomy and conventional TLH in this highly selected low-risk cohort. However, the study was underpowered and subject to residual confounding; therefore, these findings should be considered preliminary and hypothesis-generating. Full article

(This article belongs to the Special Issue Approaches to Prevention and Management of Postoperative Complications in Minimally Invasive Surgery)

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14 pages, 262 KB

Open AccessArticle

Long-Term Safety and Efficacy of Alginate-Based Serosal Reinforcement (SEAL-G/SEAL-G MIST) Following Colorectal Anastomosis: A Multicenter, Comparative and Retrospective Cohort Study

by Fahim Kanani, Antonino Spinelli, Mordechai Shimonov, Husam Zbede, Nouha Hinnawi, Ron Lavy, Oded Zmora and Moshe Kamar

J. Clin. Med. 2026, 15(4), 1448; https://doi.org/10.3390/jcm15041448 - 12 Feb 2026

Viewed by 664

Abstract

Background: Anastomotic leakage (AL) remains a major complication following colorectal surgery (3–19% incidence, 6–39% mortality). SEAL-G/SEAL-G MIST are alginate-based sealants for anastomotic reinforcement. While short-term safety and efficacy feasibility have been established in a previous study, this study reports long-term results. Methods: A multicenter, retrospective and comparative study at three centers (Israel, Italy). Retrospective Treatment group: 79 patients from the original study treated with SEAL-G/SEAL-G MIST during elective colon cancer resection (2021–2023). Retrospective Control group: 86 comparative patients with standard technique. Primary endpoint: Incidence of long-term complications (adhesions, stenosis, stricture, obstruction) at 1 year. Secondary endpoints: Complications at 1–4 years and 30-day AL rate. Non-inferiority assessed via Farrington–Manning method (margin 0.10). Results: Mean follow-up: 3.3 ± 0.63 years (treatment) vs. 3.4 ± 1.10 years (control). Groups were comparable for demographics and surgical characteristics. Long-term complications at 1 year: 1.27% (1/79) vs. 2.33% (2/86); 90% CI for difference: −0.067 to 0.046, p = 0.0048 (non-inferiority confirmed). No stenosis or stricture occurred in either group. No additional complications emerged at 1–4 years in the treatment group. Thirty-day AL rate: 1.27% (1/79) vs. 5.68% (5/88); all subclinical leaks (Grade B, n = 4) occurred in controls. Conclusions: Serosal reinforcement with alginate-based sealants does not introduce device-related long-term complications following colorectal anastomosis. The favorable short-term safety profile extends to 2–4 years. These findings support the safety of alginate-based sealants as anastomotic adjuncts, consistent with the paradigm of leak containment and severity reduction. Full article

(This article belongs to the Special Issue Approaches to Prevention and Management of Postoperative Complications in Minimally Invasive Surgery)

Review

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18 pages, 925 KB

Open AccessReview

Prevention, Recognition, and Management of Anastomotic Leakage and Pelvic Sepsis After Rectal Cancer Surgery: A Structured Narrative Review

by Koji Morohara, Tsunekazu Hanai, Kenji Oshima, Yui Kitagawa, Shiho Okada, Kosuke Mochizuki, Kazuma Horiguchi, Hiroki Tani, Yoshiki Kunimura, Takashi Imanaka, Takahiro Tashiro, Yuka Kondo, Hidetoshi Nagata, Hiroyuki Kato, Zenichi Morise, Akihiko Horiguchi and Hidetoshi Katsuno

J. Clin. Med. 2026, 15(16), 6427; https://doi.org/10.3390/jcm15166427 - 20 Aug 2026

Viewed by 52

Abstract

Anastomotic leakage (AL) and pelvic sepsis remain important causes of morbidity after restorative rectal cancer surgery, affecting mortality, stoma-free survival, bowel function, and oncologic treatment. Reported rates after low anterior resection are approximately 5–20%. We conducted a structured narrative review of PubMed/MEDLINE and the Cochrane Library through 20 July 2026, focusing on prevention, recognition, source control, and long-term recovery after low pelvic reconstruction. Most biological requirements for healing and principles of source control are approach-agnostic, whereas open, laparoscopic, and robotic surgeries create different technical conditions for pelvic exposure, stapler trajectory, articulation, tactile feedback, conversion, and fluorescence imaging. This review therefore integrates approach-specific technical constraints with post-discharge recognition, anatomy-based source control, and patient-centered long-term outcomes rather than treating these domains separately. Among preventive measures, combined mechanical bowel preparation and oral antibiotics has the strongest support in elective, non-obstructed patients; indocyanine green fluorescence is a useful adjunct when perfusion is uncertain but does not replace assessment of tension or mechanical integrity. C-reactive protein is mainly useful for ruling out major complications, whereas contrast-enhanced computed tomography remains first-line imaging and pelvic magnetic resonance imaging is best reserved for selected small defects, chronic sinuses, or complex pelvic sepsis. Management should be driven first by physiology and then by leak timing and location, defect size, conduit viability, diversion status, and cavity drainability. Durable success includes sepsis control, anatomical healing, stoma reversal when feasible, and acceptable long-term function. Full article

(This article belongs to the Special Issue Approaches to Prevention and Management of Postoperative Complications in Minimally Invasive Surgery)

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