{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T07:52:07Z","timestamp":1792050727219,"version":"4.4.0"},"reference-count":8,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Laparoscopically assisted anorectoplasty (LAARP) for recto\u2010bulbar urethral fistula (RBUF) has not become standard practice because of the risk of urethral injury and incomplete fistula removal in the deep pelvic space. We herein report an effective technique for treating recto\u2010bulbar fistula, called \u201cReverse needle driving via umbilical trocar\u201d in LAARP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient and Surgical Technique<\/jats:title>\n                    <jats:p>The patient was diagnosed with RUBF by distal colostogram, and LAARP was planned to be performed. A 5\u2010mm trocar was inserted at the umbilicus and three additional trocars were inserted. The surgeon stands on the right side of the patient and performs anorectoplasty. The RUBF was ligated with a trans\u2010fixing suture of 4\u20130 absorbable monofilament that passed through the fistula tract using reverse needle driving with the surgeon's left hand. Since the surgeon's left\u2010hand forceps are inserted through the umbilical trocar, which is located in the midline, the suture could be reliably placed just below the urethra by performing reverse left needle driving in a straight line through the umbilical trocar, confirmed with a urethroscope. After transection of the fistula, the rectum was pulled through and the stump was sutured to the perineal skin to construct the neo\u2010anus. Postoperative imaging revealed complete fistula closure, without complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This technique addresses the traditional challenges of urethral injury risk and incomplete fistula removal by utilizing strategic umbilical trocar positioning combined with flexible urethroscope confirmation. This robust RUBF technique represents an effective and safe approach for treating RUBF in LAARP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.70231","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T07:29:37Z","timestamp":1767943777000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reverse Needle Driving via Umbilical Trocar: An Effective Technique for Treating Recto\u2010Bulbar Urethral Fistula in Laparoscopically Assisted Anorectoplasty"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0056-6843","authenticated-orcid":false,"given":"Toshio","family":"Harumatsu","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly Kagoshima University  Kagoshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4083-8206","authenticated-orcid":false,"given":"Koshiro","family":"Sugita","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly Kagoshima University  Kagoshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9247-4216","authenticated-orcid":false,"given":"Masakazu","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly Kagoshima University  Kagoshima Japan"},{"name":"Department of Pediatric Surgery Hokkaido Medical Center for Child Health and Rehabilitation  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayaka","family":"Nagano","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly Kagoshima University  Kagoshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumiko","family":"Tabata","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly Kagoshima University  Kagoshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumiko","family":"Iwamoto","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly Kagoshima University  Kagoshima 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