This retrospective analysis aimed to assess and compare the short-term perioperative outcomes and morbidity of hybrid and full-Robotic-Assisted Minimally Invasive Esophagectomy (RAMIE) surgical techniques. A total of 168 robotic-assisted Ivor Lewis esophagectomy procedures performed at Muenster University Hospital were included in the study, with 63 cases in the hybrid group and 105 cases in the full-robotic group. Demographic factors, comorbidities, and tumor stages showed no significant differences between the two groups. However, the full-RAMIE technique demonstrated superiority in terms of overall operative time, postoperative pain levels, and patient morphine consumption. Additionally, the full-RAMIE group exhibited better perioperative outcomes, with significantly shorter ICU stays and fewer occurrences of pneumonias and severe complications. While there was a trend favoring the full-RAMIE technique in terms of severe postoperative complications and anastomotic insufficiencies, further research is required to establish it as the gold standard surgical technique for Ivor Lewis esophagectomy.

Background: Complications arising following minimally invasive Ivor Lewis esophagectomy often result from inadequate enteral nutrition, highlighting the need for proactive measures to prevent such issues. One approach involves identifying high-risk cases prone to complications and implementing percutaneous endoscopic jejunostomy (PEJ) tube placement during esophageal resection to ensure timely enteral nutrition. Methods: In this single-center, retrospective cohort study, we examined patients who underwent minimally invasive esophagectomy for esophageal cancer at a high-volume center. The dataset encompassed demographic information, comorbidities, laboratory parameters, and intraoperative details. Our center utilized the EndoVac system pre-emptively to safeguard the anastomosis from harmful secretions and to enhance local oxygen partial pressure. All patients received pre-emptive EndoVac therapy and underwent esophagogastroduodenoscopy in the early postoperative days. The need for multiple postoperative EndoVac cycles indicated complications, including anastomotic insufficiency and subsequent requirement for a PEJ. The primary objectives were identifying predictive factors for anastomotic insufficiency and the need for multi-cycle EndoVac therapy, quantifying their effects, and assessing the likelihood of postoperative complications. Results: 149 patients who underwent minimally invasive or hybrid Ivor Lewis esophagectomy were analyzed and 21 perioperative and demographic features were evaluated. Postoperative complications were associated with the body mass index (BMI) category, the use of blood pressure medication, and surgery duration. Anastomotic insufficiency as a specific complication was correlated with BMI and the Charlson comorbidity index. The odds ratio of being in the high-risk group significantly increased with higher BMI (OR = 1.074, p = 0.048) and longer surgery duration (OR = 1.005, p = 0.004). Conclusions: Based on our findings, high BMI and longer surgery duration are potential risk factors for postoperative complications following minimally invasive esophagectomy. Identifying such factors can aid in pre-emptively addressing nutritional challenges and reducing the incidence of complications in high-risk patients.

Esophageal surgery is deemed one of the most complex visceral operations. There is a well-documented correlation between higher caseload and better outcomes, with hospitals that perform more surgeries experiencing significantly lower mortality rates. The approach to caseload per year varies across different countries within Europe. Germany increased the minimum annual required caseload of complex esophageal surgeries from 10 to 26 starting in 2023. Furthermore, the new regulations present challenges for surgical training and staff recruitment, risking the further fragmentation of training programs. Enhanced regional cooperation is proposed as a solution to ensure comprehensive training. This review explores the benefits of robotic-assisted minimally invasive esophagectomy (RAMIE) in improving surgical precision and patient outcomes and aims to evaluate how the caseload per year influences the quality of patient care and the efficacy of surgical training, especially with the integration of advanced robotic techniques.

The purpose of this study is to demonstrate that repetitive minor surgical procedures allow for a high rate of permanent closure of perianal fistulas in patients with Crohn’s disease (CD). Patients with perianal fistulizing CD (PFCD) who underwent perianal surgery at the University Hospital of Muenster between 2003 and 2018 were assessed for fistula characteristics and surgical procedures. We included 45 patients (m:f = 28:17) with a mean age of 27 years at first fistula appearance. Of these, 49% suffered from a complex fistula. An average of 4.2 (1–14) procedures were performed, abscess incisions and fistula seton drainages included. Draining setons were left in place for 5 (1–54) months, until fistula closure. Final surgical techniques were fistulotomy (31.1%), seton removal with sustained biological therapy (26.7%), Anal Fistula Plug (AFP) (17.8%), Over-The Scope-Clip proctology (OTSC) (11.1%), and mucosa advancement flap (4.4%). In 8.9% of cases, the seton was kept as permanent therapy. The time from first to last surgery was 18 (0–182) months and the median follow-up time after the last surgery was 90 (15–200) months. The recurrence rate was 15.5% after 45 (17–111) months. Recurrent fistulas healed after another 1.86 (1–2) surgical re-interventions. The final success rate was 80%. Despite biological treatment, PFCD management remains challenging. However, by repeating minor surgical interventions over a prolonged period of time, high permanent healing rates can be achieved.

Introduction Females remain underrepresented in advanced endoscopy (AE). Factors such as ergonomics, concerns over radiation exposure and traditional family roles have been identified as barriers in prior studies. No published study to date has surveyed potential reasons for this at an international level. Aim To assess factors which may contribute to poor uptake of AE training among females on a global scale. Methods A cross-sectional survey was designed by the mentees of the inaugural Women in Endoscopy Mentorship Programme, including questions on demographics, endoscopy, family, wellbeing, mentorship and leadership. This was shared via social media and professional networks. Results There were 553 responses to the survey (n=282 Male). 24% of respondents reported that less than 10% of endoscopists at their centre were female. Females were significantly less likely to have a partner; if they had a partner, they were more likely to be in full-time employment than male respondents’ partners. (67% vs 43% p <0.001). They were more likely to feel they delayed having a family to in favour of career progression, and that they had sacrificed career progression to have a family. They were also more likely to feel their gender held them back(61.3% vs 19.9% p <0.001). More male respondents felt that they got the same opportunities as colleagues of opposite gender at the same time (75.2% vs 50.9% p <0.001). Conclusion Family responsibilities and perception of gender bias remain significant barriers to a career in advanced endoscopy for women worldwide.

Deep infiltrating endometriosis (DIE) often affects the bowel and may necessitate colorectal resection. While protective ileostomy can reduce complications, it carries relevant morbidity. This study evaluates endoscopic complication management and long-term outcome of patients treated at a certified surgical endoscopy and endometriosis center. All patients undergoing interdisciplinary surgery for DIE (2015–2024) were retrospectively included. Preoperative sigmoidoscopy and postoperative endoscopic evaluation of anastomoses were performed routinely. Surgical approaches included shaving, excision or resection with/without ileostomy. Surgical complications, such as anastomotic leakages and stenoses, were primarily managed endoscopically. 118 women (median age: 33 years) underwent surgery: rectal shaving (25%), sigmoid (6%) and rectal resection (69%). Median anastomotic height was 10 cm, 44% received a protective ileostomy. Anastomotic leakage (8%) and stenosis (9%) were successfully managed endoscopically. Recurrence requiring reoperation occurred in 41% after shaving vs. 27% after resection. Ileostomy reversal was achieved in all cases. Postoperative continence was acceptable (LARS median: 13). General health (EQ-5D-5 L: median 70) was good at a median follow-up of 75 months. 84% would choose surgical treatment again. Colorectal resection for DIE can achieve favorable long-term outcomes in a structured interdisciplinary setting. Proactive endoscopic management supports bowel continuity despite complications. Prospective studies are needed to validate outcomes and refine patient selection.