In this JSHBPS project study from 63 high-volume surgical centers, Nakamura and colleagues demonstrated that a history of antithrombotic use was a significant risk factor for postpancreatectomy hemorrhage and mortality. As delayed postpancreatectomy hemorrhage was associated with the resumption of antithrombotic therapy, early postoperative resumption should be done with caution.

Ishii and colleagues found that a smaller diameter of the common bile duct, gallbladder stones, and tumor involvement in the cystic duct were significant independent risk factors for early cholecystitis after covered self-expandable metallic stent placement for distal biliary obstruction, but no significant risk factors were identified for late cholecystitis.

Toyonaga and colleagues demonstrate, with accompanying video, the use of low echo reduction, which is a novel endoscopic ultrasound function provided by a new endoscopic ultrasound processor that increases contrast without white-out. Low echo reduction might be useful in improving lesion boundaries and needle visibility during endoscopic ultrasound-guided tissue acquisition.

Shibuya and colleagues describe their innovative technique using the femoral vein as a graft for portal vein/superior mesenteric vein reconstruction during pancreatectomy. The femoral vein has an appropriate diameter and is particularly useful when long resection of the superior mesenteric vein is required in surgery for locally advanced pancreatic ductal adenocarcinoma.

Lee and colleagues describe a groundbreaking total robot-assisted explant hepatectomy followed by robotic engraftment for a patient requiring a living donor liver transplant. This report represents a crucial step towards implementing robot-assisted liver transplantation, a cutting-edge surgical technique that could change the surgical trend in recipient surgery for liver transplantation.

Tanisaka and colleagues report the usefulness of texture and color enhancement imaging provided by a new-generation image-enhanced endoscopy system in a patient with intraductal papillary mucinous neoplasm who had undergone peroral pancreatoscopy. Texture and color enhancement imaging clearly showed structural changes of the lesion and improved the diagnostic quality of peroral pancreatoscopy.