{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:52:04Z","timestamp":1792176724651,"version":"4.4.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"vor","delay-in-days":94,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"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>Minimally invasive distal pancreatectomy (MIDP), although demanding, offers clinical advantages. Male sex has been associated with increased operative difficulty; however, the anatomical basis for this disparity remains unclear. This study investigated sex\u2010related differences in MIDP outcomes using propensity score matching and evaluated physique\u2010related computed tomography (CT) indices potentially affecting MIDP complexity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Among 187 patients who underwent distal pancreatectomy between 2010 and 2024, 77 who received MIDP were analyzed. Propensity score matching incorporated body mass index (BMI), pancreatic cancer, buried splenic artery, transection line, spleen preservation, and surgical approach. Surgical outcomes were compared between sexes before and after matching. Preoperative CT was used to measure anatomical distances and calculate physique\u2010related indices, including the umbilical\u2010pancreatic ratio: pancreas\u2010umbilicus distance divided by xiphoid\u2010umbilicus distance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After matching, 28 males and 28 females were included in the MIDP cohort. Males had longer operative times and a higher incidence of clinically relevant postoperative pancreatic fistula. CT analysis showed a greater pancreas\u2010to\u2010umbilicus distance and a higher umbilical\u2010pancreatic ratio in males. This ratio was correlated with BMI in males but not in females. Surgical difficulty, defined as operative time or intraoperative blood loss exceeding the 75th percentile, was independently associated with the umbilical\u2010pancreatic ratio, BMI, and pancreatic transection line on multivariable analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The increased surgical difficulty observed in male patients undergoing MIDP may be explained by the positional relationship between the umbilicus and the pancreas, particularly in patients with high BMI, rather than by sex alone. Cephalad camera port positioning may therefore be beneficial, especially in high\u2010BMI male patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.70284","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T01:50:53Z","timestamp":1775440253000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Male Sex and Umbilical\u2010Pancreatic Anatomy on Surgical Difficulty in Minimally Invasive Distal Pancreatectomy: A Propensity\u2010Matched Analysis"],"prefix":"10.1111","volume":"19","author":[{"given":"Masahiro","family":"Fukada","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery Gifu University Hospital  Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriki","family":"Mitsui","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Gifu University Hospital  Gifu 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