Journal of Surgical Innovation and Education

Volume 3(1); June 2026

How I Do It

Single-Incision Robotic Splenectomy Using the da Vinci SP System with an Additional Trocar: Yeongsoo Jo, Seog Ki Min; J Surg Innov Educ. 2026;3(1):1-5. Published online June 19, 2026; DOI: https://doi.org/10.69474/jsie.2026.00017

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Abstract PDF: The da Vinci SP system has been increasingly used in several surgical fields, partly because it can reduce the number of abdominal incisions by enabling surgery through a single access port. However, single-incision laparoscopic splenectomy is technically demanding because of the spleen’s anatomical position and vascularity, and significant bleeding may occur without meticulous hilar and perisplenic dissection. This report describes a robotic splenectomy performed with the da Vinci SP system using a single-port-plus-one approach. A single umbilical access port was placed through an approximately 3-cm incision, and an additional trocar was inserted in the left abdomen for use by the assistant, including introduction of energy devices, a laparoscopic stapler, and a drain. We present a representative case treated using this approach. The patient was a 42-year-old woman with hemolytic anemia, hyperbilirubinemia, a body mass index of 24.2 kg/m2, and splenomegaly measuring 15.1 cm in maximal craniocaudal diameter. The console time was 100 minutes, and the estimated blood loss was 10 mL. The splenic hilum was divided using a laparoscopic stapler. No surgical complications occurred, and the patient was discharged on postoperative day 3. Robotic splenectomy using the da Vinci SP system with an additional assistant trocar was technically feasible in this carefully selected patient. Further studies are needed to determine its safety, indications, and comparative advantages over conventional laparoscopic or multiport robotic approaches.

Original Articles

Feasibility and Competency Outcomes of a Standardized Colonoscopy Curriculum in General Surgery Residency: Dae Kyung Sohn, Sang-Ho Jeong, Seung Jae Roh, Sa-Hong Min, In-Seob Lee; J Surg Innov Educ. 2026;3(1):6-13. Published online June 9, 2026; DOI: https://doi.org/10.69474/jsie.2026.00010

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Abstract PDF Supplementary Material: Background
Integrating structured colonoscopy training into general surgery residency programs remains both a logistical and educational challenge. This study evaluated the feasibility and educational outcomes of a standardized colonoscopy training curriculum for surgical residents using objective competency assessments and trainee perceptions.
Methods
A retrospective mixed-methods analysis was conducted among general surgery residents who participated in a standardized colonoscopy training program between 2022 and 2025. Faculty assessed objective procedural competency using the Direct Observation of Procedural Skills framework across three domains: basic manipulation, anatomical understanding, and insertion & advancement. Trainee perceptions regarding the training environment, procedural difficulty, and perceived educational value were evaluated using a post-training survey.
Results
Objective competency data from 369 residents were analyzed. Residents demonstrated high performance in the basic manipulation and anatomical understanding domains following completion of the training program. In contrast, scores in the insertion & advancement domain were comparatively lower, suggesting greater technical difficulty. Post-graduate year (PGY)-3 residents achieved significantly higher scores than PGY-2 residents in this domain (p=0.015), whereas performance in the other domains was comparable between the groups. Post-training survey responses indicated that most residents considered the training duration and group size appropriate, and more than 94% reported that the program would be beneficial for their future clinical practice.
Conclusions
A standardized colonoscopy training curriculum implemented during surgical residency was feasible and was associated with high levels of competency in fundamental endoscopic skills. However, insertion and advancement techniques remained more challenging for junior trainees, suggesting that additional practice opportunities targeting complex insertion skills may improve future training programs.

Artificial Intelligence-Assisted Monitoring for Detecting Perioperative Safety Deviations in General Surgical Practice: Opeyemi Qozeem Asafa, Aishat Omowunmi Asafa, Ayodeji Olaolu Oyeniran, Olajide Emmanuel Babalola, Olumuyiwa Tope Ajayeoba, Roseline Olufunmilola Folami, Ganiyu Adebukola Oyeniyi, Kehinde Adesola Alatishe, Adegboyega Segun Afolabi, Ismail Idowu Uthman; J Surg Innov Educ. 2026;3(1):14-28. Published online June 15, 2026; DOI: https://doi.org/10.69474/jsie.2026.00080

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Abstract PDF: Background
Perioperative safety deviations remain an important challenge in surgical care despite implementation of safety measures such as the surgical safety checklist. Emerging digital technologies, particularly artificial intelligence (AI), may provide additional support for identifying potential safety threats during surgical care. This study evaluated the usefulness of AI-assisted monitoring for identifying and helping prevent common perioperative safety deviations in routine general surgical practice.
Methods
This prospective observational study included 136 patients who underwent general surgical procedures at a tertiary hospital. Procedures included inguinal hernia repair, exploratory laparotomy, appendectomy, ventral or incisional hernia repair, excisional biopsy, and other minor surgical operations. AI-supported monitoring tools were integrated into perioperative workflows to identify potential safety deviations during operative care. Demographic characteristics, procedure types, and intraoperative safety events were recorded. The primary outcome was the frequency of safety deviations and their detection using AI support. Secondary outcomes included the proportion of identified deviations corrected before completion of surgery.
Results
Among the 136 procedures, 26 perioperative safety deviations (19.1%) were identified. The most common deviations involved incomplete checklist steps, delayed administration of prophylactic antibiotics, and discrepancies in instrument or sponge counts. AI-assisted monitoring detected 20 of the 26 deviations (76.9%), and 17 of the 20 detected deviations (85.0%) were corrected before completion of the procedure. The overall detection rate increased from 53.8% with routine observation alone to 76.9% with AI-assisted monitoring (p=0.02). No cases of retained surgical items or wrong-site surgery occurred during the study period.
Conclusions
AI-assisted monitoring demonstrated the potential to improve early recognition and correction of perioperative safety deviations during general surgical procedures. Integration of such systems into perioperative workflows may strengthen existing safety practices and improve detection of workflow-related safety irregularities.

Dynamic Educational Manuscript

Reduced-Port Robotic Distal Gastrectomy for Gastric Cancer: The Marionette Technique and Soft Coagulation Lymphadenectomy: Dongwon Lim, Si-Hak Lee, Sun-Hwi Hwang, Jae Hun Chung; J Surg Innov Educ. 2026;3(1):29-30. Published online June 11, 2026; DOI: https://doi.org/10.69474/jsie.2026.00073

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Abstract PDF: Radical gastrectomy with meticulous lymph node dissection remains the definitive treatment for gastric cancer, and ongoing technical advances continue to focus on minimizing surgical trauma while preserving oncological safety. Robotic gastrectomy provides enhanced surgical precision through three-dimensional visualization and articulated instrumentation. Because a 3–4 cm umbilical incision is required for specimen extraction, maximizing the utility of this incision to reduce the need for additional ports represents a practical surgical strategy. Reduced-port and single-port approaches have therefore been introduced to decrease postoperative pain, improve cosmetic outcomes, and reduce port-related complications. Building on this concept, reduced- port robotic distal gastrectomy (rpRDG) utilizes a “4-arms in 3-ports” configuration that maximizes the utility of the umbilical incision while reducing surgical access trauma. A major technical consideration in rpRDG is the efficient use of robotic arms. In this video article, we demonstrate the marionette technique using endoclips to avoid dedicating a robotic arm exclusively to static traction. Briefly, the target tissue is grasped using an endoclip with a pre-tied suture, after which the free end of the suture is exteriorized through the abdominal wall and secured externally with a mosquito or Kelly clamp to provide stable, hands-free gastric retraction. Alternatively, the exteriorized suture can be weighted with heavy surgical instruments, such as long Kelly clamps, rather than fixed in place with a clamp. Additional instruments may then be added incrementally as dissection proceeds, allowing gravity-assisted traction with finely adjustable tension. This approach permits all robotic arms to remain available for active dissection, thereby improving operative ergonomics. We further present a strategic operative workflow in which bipolar dissection with soft coagulation using Maryland forceps is performed for precise lymphadenectomy around major vessels, whereas a vessel sealer is used along the greater curvature to reduce operative time. Through a representative case, we illustrate the fundamental procedural steps and technical principles of rpRDG.

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