Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Neurosurgical review
Safety profile and surgical outcomes of the endoscopic transorbital approach as a skull base surgical corridor: a systematic review and meta-analysis
Endoscopic techniques have enabled minimally invasive approaches in neurosurgery, providing shorter recovery times and favorable outcomes. Among these, the endoscopic transorbital approach (ETOA) has emerged as a versatile surgical modality. Despite the growing body of evidence, complication rates associated with ETOA have not yet been systematically evaluated. We systematically searched PubMed, Embase, Scopus, and Web of Science up to March 2026. We included studies enrolling ≥ 5 patients who underwent ETOA as the sole surgical modality to treat both skull base and orbital lesions, providing data on early or long-term complications. A single-group meta-analysis was performed using a random-effects model with 95% confidence intervals. Heterogeneity was assessed with the I² statistic and further explored through Baujat plots and sensitivity analyses. A total of 11 observational studies, comprising 269 patients, were included. Overall, 21 different pathologies were reported. Meningioma represented the most frequent lesion (60.6% of cases), followed by schwannoma (12.0%), cavernous hemangioma (4.6%), and glioma (2.7%). Mean follow-up was 27.6 ± 15.1 months. CSF leak was observed in 1% (95% CI: 0.00 to 0.04, I² = 46.5%), and wound infection was observed in 3% (95% CI: 0.01 to 0.07, I²=0%). Ptosis occurred in 4% (95% CI: 0.00 to 0.14, I²=79.4%) and diplopia occurred in 6% (95% CI: 0.01 to 0.14, I²=68.9%). Medial gaze palsy occurred in 9% (95% CI: 0.04 to 0.18, I²=8.8%). Improvement in visual function was seen in 47% (95% CI: 0.22 to 0.73, I²=88.7%). Visual dysfunction occurred in 1% (95% CI: 0.00 to 0.04, I²=48.6%). Transient facial numbness occurred in 16% (95% CI: 0.09 to 0.25, I²=35.0%). Mortality was 0% (95% CI: 0.00 to 0.02, I²=28.7%). ETOA is a safe and promising technique for managing a wide range of skull base and orbital lesions. Future prospective and comparative studies are needed to refine indications and validate its long-term efficacy.
14 May 2026
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Vaginal natural orifice transluminal endoscopic surgery versus laparoscopy for ovarian cystectomy: a prospective, open-label, randomized, non-inferiority pilot trial
PURPOSE: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an innovative minimally invasive procedure. The study aimed to evaluate whether vNOTES achieves non-inferior results compared to conventional laparoscopy in patients undergoing ovarian cystectomy. METHODS: Participants with benign ovarian tumors were randomly assigned (1:1) to undergo laparoscopy or vNOTES. Randomization was stratified based on the size of the ovarian tumor. Patients and surgeons were aware of the allocated procedures. The primary outcome was the proportion of patients successfully treated by the allocated procedure (non-inferiority hypothesis, margin of 15%). The secondary outcomes included operative time, estimated blood loss, time for specimen retrieval, postoperative pain score, use of analgesics, time to first flatus, and perioperative complications. RESULTS: Sixty-four patients were randomly assigned to laparoscopy (n = 32) and vNOTES (n = 32) and were included in the intention-to-treat analysis. The success rates were 100% and 96.9%, respectively. Non-inferiority of vNOTES was demonstrated, as the lower limit of the one-sided 95% confidence interval for the stratified risk difference was -12.7%, which lies above the pre-specified non-inferiority margin of -15%. The vNOTES group exhibited lower pain scores, with a median difference of -1 (95% CI -1 - -1, p < 0.001). CONCLUSION: vNOTES demonstrates non-inferiority to laparoscopy for ovarian cystectomy in selected patients, with notable advantages in cosmetic outcomes and reduced postoperative pain. CLINICAL TRIAL IDENTIFICATION NUMBER: ChiCTR2300070890.
4 Apr 2026
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