{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T22:53:05Z","timestamp":1781736785751,"version":"3.54.5"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":50,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/100019084","name":"Kobe University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100019084","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"DOI":"10.1007\/s00423-026-04056-9","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T17:55:47Z","timestamp":1777485347000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating surgeons\u2019 stress using heart rate variability during minimally invasive surgery for gastric cancer: a single-center prospective cohort study"],"prefix":"10.1007","volume":"411","author":[{"given":"Atsushi","family":"Shimada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Kanaji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Sugita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taro","family":"Ikeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasufumi","family":"Koterazawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Aoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Harada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunori","family":"Otowa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Urakawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironobu","family":"Goto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimihiro","family":"Yamashita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeru","family":"Matsuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Kakeji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"4056_CR1","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.surg.2009.10.007","volume":"147","author":"S Arora","year":"2010","unstructured":"Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R (2010) The impact of stress on surgical performance: a systematic review of the literature. Surgery 147:318\u2013330.e1\u2013e6 https:\/\/doi.org\/10.1016\/j.surg.2009.10.007","journal-title":"Surgery"},{"key":"4056_CR2","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1002\/bjs5.104","volume":"3","author":"PD Grantcharov","year":"2019","unstructured":"Grantcharov PD, Boillat T, Elkabany S, Wac K, Rivas H (2019) Acute mental stress and surgical performance. BJS Open 3:119\u2013125. https:\/\/doi.org\/10.1002\/bjs5.104","journal-title":"BJS Open"},{"key":"4056_CR3","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s00464-024-11389-3","volume":"39","author":"A Tam","year":"2025","unstructured":"Tam A, Bateman S, Buckingham G, Wilson M, Melendez-Torres GJ, Vine S, Clark J (2025) The effects of stress on surgical performance: a systematic review. Surg Endosc 39:77\u201398. https:\/\/doi.org\/10.1007\/s00464-024-11389-3","journal-title":"Surg Endosc"},{"key":"4056_CR4","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1016\/j.jamcollsurg.2016.03.022","volume":"222","author":"FM Dimou","year":"2016","unstructured":"Dimou FM, Eckelbarger D, Riall TS (2016) Surgeon burnout: a systematic review. J Am Coll Surg 222:1230\u20131239. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2016.03.022","journal-title":"J Am Coll Surg"},{"key":"4056_CR5","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1001\/jamasurg.2024.6072","volume":"160","author":"J Awtry","year":"2025","unstructured":"Awtry J, Skinner S, Polazzi S, Lifante JC, Dey T, Duclos A (2025) Top surgeons study group association between surgeon stress and major surgical complications. JAMA Surg 160:332\u2013340. https:\/\/doi.org\/10.1001\/jamasurg.2024.6072","journal-title":"JAMA Surg"},{"key":"4056_CR6","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1097\/SLA.0b013e3181ac4dfd","volume":"250","author":"TD Shanafelt","year":"2009","unstructured":"Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J, Freischlag JA (2009) Burnout and career satisfaction among American surgeons. Ann Surg 250:463\u2013471. https:\/\/doi.org\/10.1097\/SLA.0b013e3181ac4dfd","journal-title":"Ann Surg"},{"key":"4056_CR7","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.jss.2024.07.110","volume":"302","author":"JP Bereuter","year":"2024","unstructured":"Bereuter JP, Geissler ME, Geissler R, Schmidt S, Buck N, Wei\u00df J, Fries A, Krause-J\u00fcttler G, Weitz J, Distler M, Presslein K, Oehme F, von Bechtolsheim F (2024) Impact of operative room noise on laparoscopic performance: a prospective, randomized crossover trial. J Surg Res 302:648\u2013655. https:\/\/doi.org\/10.1016\/j.jss.2024.07.110","journal-title":"J Surg Res"},{"issue":"6","key":"4056_CR8","doi-asserted-by":"publisher","first-page":"4452","DOI":"10.1007\/s00464-021-08797-0","volume":"36","author":"A Koch","year":"2022","unstructured":"Koch A, Kullmann A, Stefan P, Weinmann T, Baumbach SF, Lazarovici M, Weigl M (2022) Intraoperative dynamics of workflow disruptions and surgeons\u2019 technical performance failures: insights from a simulated operating room. Surg Endosc 36(6):4452\u20134461. https:\/\/doi.org\/10.1007\/s00464-021-08797-0","journal-title":"Surg Endosc"},{"key":"4056_CR9","doi-asserted-by":"publisher","first-page":"4569","DOI":"10.1007\/s00464-020-07878-w","volume":"35","author":"S Ayas","year":"2021","unstructured":"Ayas S, Gordon L, Donmez B, Grantcharov T (2021) The effect of intraoperative distractions on severe technical events in laparoscopic bariatric surgery. Surg Endosc 35:4569\u20134580. https:\/\/doi.org\/10.1007\/s00464-020-07878-w","journal-title":"Surg Endosc"},{"key":"4056_CR10","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1007\/s00464-013-3213-z","volume":"28","author":"GI Lee","year":"2014","unstructured":"Lee GI, Lee MR, Clanton T, Sutton E, Park AE, Marohn MR (2014) Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc 28:456\u2013465. https:\/\/doi.org\/10.1007\/s00464-013-3213-z","journal-title":"Surg Endosc"},{"key":"4056_CR11","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1007\/s11701-024-01834-9","volume":"18","author":"J Sujka","year":"2024","unstructured":"Sujka J, Ahmed A, Kang R, Grimsley EA, Weche M, Janjua H, Mi Z, English D, Martinez C, Velanovich V, Bennett RD, Docimo S, Saad AR, DuCoin C, Kuo PC (2024) Examining surgeon stress in robotic and laparoscopic surgery. J Robot Surg 18:82. https:\/\/doi.org\/10.1007\/s11701-024-01834-9","journal-title":"J Robot Surg"},{"issue":"4","key":"4056_CR12","doi-asserted-by":"publisher","first-page":"e2113","DOI":"10.1002\/rcs.2113","volume":"16","author":"IJY Wee","year":"2020","unstructured":"Wee IJY, Kuo LJ, Ngu JCY (2020) A systematic review of the true benefit of robotic surgery: Ergonomics. Int J Med Robot 16(4):e2113. https:\/\/doi.org\/10.1002\/rcs.2113","journal-title":"Int J Med Robot"},{"issue":"1","key":"4056_CR13","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1007\/s11701-025-02401-6","volume":"19","author":"H Cooper","year":"2025","unstructured":"Cooper H, Lau HM, Mohan H (2025) A systematic review of ergonomic and muscular strain in surgeons comparing robotic to laparoscopic approaches. J Robot Surg 19(1):252. https:\/\/doi.org\/10.1007\/s11701-025-02401-6","journal-title":"J Robot Surg"},{"key":"4056_CR14","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.amjsurg.2005.08.034","volume":"191","author":"CM Wetzel","year":"2006","unstructured":"Wetzel CM, Kneebone RL, Woloshynowych M, Nestel D, Moorthy K, Kidd J, Darzi A (2006) The effects of stress on surgical performance. Am J Surg 191:5\u201310. https:\/\/doi.org\/10.1016\/j.amjsurg.2005.08.034","journal-title":"Am J Surg"},{"key":"4056_CR15","doi-asserted-by":"publisher","first-page":"e43","DOI":"10.1016\/j.jss.2012.11.011","volume":"182","author":"EW Kuhn","year":"2013","unstructured":"Kuhn EW, Choi YH, Sch\u00f6nherr M et al (2013) Intraoperative stress in cardiac surgery: attendings versus residents. J Surg Res 182:e43\u2013e49. https:\/\/doi.org\/10.1016\/j.jss.2012.11.011","journal-title":"J Surg Res"},{"key":"4056_CR16","doi-asserted-by":"publisher","first-page":"11953","DOI":"10.3390\/ijerph182211953","volume":"18","author":"G Awad","year":"2021","unstructured":"Awad G, Pohl R, Darius S, Thielmann V, Kuzmin B, Slottosch I, Wippermann J, Schmidt H, Scherner MP, B\u00f6ckelmann I (2021) Evaluation of stress levels of trainee cardiac surgery residents during training interventions using physiological stress parameters. Int J Environ Res Public Health 18:11953. https:\/\/doi.org\/10.3390\/ijerph182211953","journal-title":"Int J Environ Res Public Health"},{"key":"4056_CR17","doi-asserted-by":"publisher","first-page":"zrae097","DOI":"10.1093\/bjsopen\/zrae097","volume":"8","author":"CD De Louche","year":"2024","unstructured":"De Louche CD, Mandal M, Fernandes L, Lawson J, Bicknell CD, Pouncey AL (2024) Heart rate variability as a dynamic marker of surgeons\u2019 stress during vascular surgery. BJS Open 8:zrae097. https:\/\/doi.org\/10.1093\/bjsopen\/zrae097","journal-title":"BJS Open"},{"key":"4056_CR18","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1007\/s00420-020-01525-6","volume":"93","author":"AF The","year":"2020","unstructured":"The AF, Reijmerink I, van der Laan M, Cnossen F (2020) Heart rate variability as a measure of mental stress in surgery: a systematic review. Int Arch Occup Environ Health 93:805\u2013821. https:\/\/doi.org\/10.1007\/s00420-020-01525-6","journal-title":"Int Arch Occup Environ Health"},{"key":"4056_CR19","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1159\/000365580","volume":"31","author":"J Heemskerk","year":"2014","unstructured":"Heemskerk J, Zandbergen HR, Keet SWM, Martijnse I, van Montfort G, Peters RJA, Svircevic V, Bouwman RA, Baeten CGMI, Bouvy ND (2014) Relax, it\u2019s just laparoscopy! A prospective randomized trial on heart rate variability of the surgeon in robot-assisted versus conventional laparoscopic cholecystectomy. Dig Surg 31:225\u2013232. https:\/\/doi.org\/10.1159\/000365580","journal-title":"Dig Surg"},{"key":"4056_CR20","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1001\/archsurg.136.3.305","volume":"136","author":"B B\u00f6hm","year":"2001","unstructured":"B\u00f6hm B, R\u00f6tting N, Schwenk W, Grebe S, Mansmann U (2001) A prospective randomized trial on heart rate variability of the surgical team during laparoscopic and conventional sigmoid resection. Arch Surg 136:305\u2013310. https:\/\/doi.org\/10.1001\/archsurg.136.3.305","journal-title":"Arch Surg"},{"key":"4056_CR21","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s00420-013-0847-z","volume":"87","author":"A Rieger","year":"2014","unstructured":"Rieger A, Stoll R, Kreuzfeld S, Behrens K, Weippert M (2014) Heart rate and heart rate variability as indirect markers of surgeons\u2019 intraoperative stress. Int Arch Occup Environ Health 87:165\u2013174. https:\/\/doi.org\/10.1007\/s00420-013-0847-z","journal-title":"Int Arch Occup Environ Health"},{"key":"4056_CR22","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/j.jsurg.2020.08.012","volume":"78","author":"LR Kennedy-Metz","year":"2021","unstructured":"Kennedy-Metz LR, Dias RD, Stevens RH, Yule SJ, Zenati MA (2021) Analysis of mirrored psychophysiological change of cardiac surgery team members during open surgery. J Surg Educ 78:622\u2013629. https:\/\/doi.org\/10.1016\/j.jsurg.2020.08.012","journal-title":"J Surg Educ"},{"key":"4056_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10120-022-01331-8","volume":"26","author":"Japanese Gastric Cancer Association","year":"2023","unstructured":"Japanese Gastric Cancer Association (2023) Japanese gastric cancer treatment guidelines 2021 (6th edition). Gastric Cancer 26:1\u201325. https:\/\/doi.org\/10.1007\/s10120-022-01331-8","journal-title":"Gastric Cancer"},{"key":"4056_CR24","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1126\/science.6166045","volume":"213","author":"S Akselrod","year":"1981","unstructured":"Akselrod S, Gordon D, Ubel FA, Shannon DC, Berger AC, Cohen RJ (1981) Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 213:220\u2013222. https:\/\/doi.org\/10.1126\/science.6166045","journal-title":"Science"},{"key":"4056_CR25","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","volume":"93","author":"Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology","year":"1996","unstructured":"Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 93:1043\u20131065","journal-title":"Circulation"},{"key":"4056_CR26","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jelectrocard.2004.04.004","volume":"37","author":"EB Schroeder","year":"2004","unstructured":"Schroeder EB, Whitsel EA, Evans GW, Prineas RJ, Chambless LE, Heiss G (2004) Repeatability of heart rate variability measures. J Electrocardiol 37:163\u2013172. https:\/\/doi.org\/10.1016\/j.jelectrocard.2004.04.004","journal-title":"J Electrocardiol"},{"key":"4056_CR27","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1097\/SLA.0000000000003058","volume":"271","author":"BR Lowndes","year":"2020","unstructured":"Lowndes BR, Forsyth KL, Blocker RC, Dean PG, Truty MJ, Heller SF, Blackmon S, Nelson H (2020) NASA-TLX assessment of surgeon workload variation across specialties. Ann Surg 271:686\u2013692. https:\/\/doi.org\/10.1097\/SLA.0000000000003058","journal-title":"Ann Surg"},{"key":"4056_CR28","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1007\/s00268-011-1352-8","volume":"36","author":"I Uyama","year":"2012","unstructured":"Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S (2012) Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg 36:331\u2013337. https:\/\/doi.org\/10.1007\/s00268-011-1352-8","journal-title":"World J Surg"},{"key":"4056_CR29","doi-asserted-by":"publisher","first-page":"e15091","DOI":"10.1097\/MD.0000000000015091","volume":"98","author":"T Ojima","year":"2019","unstructured":"Ojima T, Nakamura M, Nakamori M et al (2019) Robotic radical lymphadenectomy without touching the pancreas during gastrectomy for gastric cancer. Med (Baltim) 98:e15091. https:\/\/doi.org\/10.1097\/MD.0000000000015091","journal-title":"Med (Baltim)"},{"key":"4056_CR30","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1007\/s10120-019-00979-z","volume":"22","author":"GI van Boxel","year":"2019","unstructured":"van Boxel GI, Ruurda JP, van Hillegersberg R (2019) Robotic-assisted gastrectomy for gastric cancer: a European perspective. Gastric Cancer 22:909\u2013919. https:\/\/doi.org\/10.1007\/s10120-019-00979-z","journal-title":"Gastric Cancer"},{"key":"4056_CR31","doi-asserted-by":"publisher","first-page":"rjad007","DOI":"10.1093\/jscr\/rjad007","volume":"2023","author":"SW Wong","year":"2023","unstructured":"Wong SW, Ang ZH, Crowe P (2023) Improving ergonomics for the bedside assistant in robotic colorectal surgery. J Surg Case Rep 2023:rjad007. https:\/\/doi.org\/10.1093\/jscr\/rjad007","journal-title":"J Surg Case Rep"},{"key":"4056_CR32","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1007\/s00595-023-02672-2","volume":"54","author":"KS Chan","year":"2024","unstructured":"Chan KS, Oo AM (2024) Learning curve of laparoscopic and robotic total gastrectomy: a systematic review and meta-analysis. Surg Today 54:509\u2013522. https:\/\/doi.org\/10.1007\/s00595-023-02672-2","journal-title":"Surg Today"},{"key":"4056_CR33","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1007\/s10120-023-01389-y","volume":"26","author":"S Shibasaki","year":"2023","unstructured":"Shibasaki S, Suda K, Hisamori S, Obama K, Terashima M, Uyama I (2023) Robotic gastrectomy for gastric cancer: systematic review and future directions. Gastric Cancer 26:325\u2013338. https:\/\/doi.org\/10.1007\/s10120-023-01389-y","journal-title":"Gastric Cancer"},{"key":"4056_CR34","doi-asserted-by":"publisher","first-page":"12927","DOI":"10.1038\/s41598-020-69553-3","volume":"10","author":"Z Zakeri","year":"2020","unstructured":"Zakeri Z, Mansfield N, Sunderland C, Omurtag A (2020) Physiological correlates of cognitive load in laparoscopic surgery. Sci Rep 10:12927. https:\/\/doi.org\/10.1038\/s41598-020-69553-3","journal-title":"Sci Rep"},{"key":"4056_CR35","doi-asserted-by":"publisher","first-page":"6518","DOI":"10.1007\/s00464-024-11238-3","volume":"38","author":"AK Budden","year":"2024","unstructured":"Budden AK, Henry A, Wakefield CE, Abbott JA (2024) Surgeon stress, anxiety, and workload: a descriptive study of participant reported responses to fundamentals of laparoscopic surgery exercises. Surg Endosc 38:6518\u20136526. https:\/\/doi.org\/10.1007\/s00464-024-11238-3","journal-title":"Surg Endosc"},{"key":"4056_CR36","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1007\/s00268-016-3449-6","volume":"40","author":"D Yu","year":"2016","unstructured":"Yu D, Lowndes B, Thiels C, Bingener J, Abdelrahman A, Lyons R, Hallbeck S (2016) Quantifying intraoperative workloads across the surgical team roles: room for better balance? World J Surg 40:1565\u20131574. https:\/\/doi.org\/10.1007\/s00268-016-3449-6","journal-title":"World J Surg"},{"issue":"1","key":"4056_CR37","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1186\/s12913-024-10998-x","volume":"24","author":"CYL Yaow","year":"2024","unstructured":"Yaow CYL, Ng QX, Chong RIH, Ong C, Chong NZY, Yap NLX, Hong ASY, Tan BKT, Loh AHP, Wong ASY, Tan HK (2024) Intraoperative adverse events among surgeons in Singapore: a multicentre cross-sectional study on impact and support. BMC Health Serv Res 24(1):512. https:\/\/doi.org\/10.1186\/s12913-024-10998-x","journal-title":"BMC Health Serv Res"}],"container-title":["Langenbeck's Archives of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00423-026-04056-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-04056-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-04056-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T22:46:22Z","timestamp":1781736382000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00423-026-04056-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4056"],"URL":"https:\/\/doi.org\/10.1007\/s00423-026-04056-9","relation":{},"ISSN":["1435-2451"],"issn-type":[{"value":"1435-2451","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"assertion":[{"value":"6 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. This study was approved by the Institutional Review Board of Kobe University Hospital (Approval No. B230068, 2023\/09\/26). Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"167"}}