{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T10:41:12Z","timestamp":1792838472793,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":102,"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>Subcutaneous emphysema (SE) after minimally invasive surgery is common, but its clinical significance in robot\u2010assisted gastrectomy remains unclear. We evaluated postoperative SE and explored the effect of a lower\u2010pressure insufflation strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 97 patients who underwent curative\u2010intent robot\u2010assisted gastrectomy for gastric cancer. SE on immediate postoperative abdominal radiographs was classified as negative or positive. Outcomes were compared between SE groups and between a standard\u2010pressure period (10\u2009mmHg) and a lower\u2010pressure period (6\u20138\u2009mmHg). Operative time was dichotomized using a 480\u2010min cutoff based on ROC analysis for CD grade\u2009\u2265\u2009II complications. AUCs were compared using the DeLong method. A supplementary analysis included the case number.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      SE occurred in 37 of 97 patients (38.1%). CD grade\u2009\u2265\u2009II complications were more frequent in the SE\u2010positive than in the SE\u2010negative group (29.7% vs. 8.3%). In the primary parsimonious multivariable model, SE positivity and prolonged operative time were associated with CD grade\u2009\u2265\u2009II complications. Adding SE to operative time increased the AUC numerically, but not significantly (DeLong\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.52). Compared with the standard\u2010pressure period, the lower\u2010pressure period showed a lower SE incidence, fewer CD grade\u2009\u2265\u2009II complications, and a shorter operative time. In a supplementary analysis, prolonged operative time remained significant, whereas case number was not, and the association with SE was attenuated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Postoperative SE was common and may represent a marker of intraoperative physiologic or technical stress. A lower\u2010pressure insufflation strategy coincided with lower SE incidence and fewer clinically relevant complications. These findings are hypothesis\u2010generating.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.70288","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T02:43:22Z","timestamp":1776134602000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Subcutaneous Emphysema and Postoperative Complications in Robot\u2010Assisted Gastrectomy: Impact of a Lower\u2010Pressure Insufflation Strategy"],"prefix":"10.1111","volume":"19","author":[{"given":"Takeshi","family":"Matsubara","sequence":"first","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Takao","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Kaji","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Okamura","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayana","family":"Kishimoto","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunari","family":"Ishitobi","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahito","family":"Taniura","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8624-1395","authenticated-orcid":false,"given":"Tetsu","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8191-6405","authenticated-orcid":false,"given":"Masaaki","family":"Hidaka","sequence":"additional","affiliation":[{"name":"Department of Digestive and General Surgery Shimane University  Izumo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.4293\/108680813X13693422520882"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1003800622"},{"issue":"1","key":"e_1_2_10_4_1","first-page":"126","article-title":"Retroperitoneoscopic Surgery is not Associated with Increased Carbon Dioxide Absorption","volume":"162","author":"Ng C. 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