Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 95 appraisals
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy
Ventral hernia repair in emergency settings. A machine learning model to predict post-operative complications.
BACKGROUND: Emergency ventral hernia repair remains a challenging procedure due to patient instability, contaminated surgical fields, and heterogeneity in hernia types and operative techniques. Predicting postoperative complications in this setting is difficult using traditional statistical methods. Machine learning (ML) may offer improved predictive accuracy by recognizing nonlinear patterns among multiple perioperative factors. METHODS: A retrospective multicenter analysis was performed using data from the ACTIVE (Acute Treatment for Incisional Ventral Hernias) study, including 557 adult patients undergoing emergent ventral hernia repair between 2018 and 2021 in 31 Italian surgical centers. Demographic, preoperative, intraoperative, and postoperative variables were analyzed. Three ML algorithms-Decision Tree, Random Forest, and Deep Learning Neural Network-were trained and validated using five-fold cross-validation after class balancing with SMOTE. Model performance was compared with traditional logistic regression using accuracy, area under the ROC curve (AUC), and F1 score. RESULTS: Postoperative complications occurred in 181 patients (32.5%), while major complications (Clavien-Dindo ≥ II) occurred in 10%. Random Forest achieved the best performance (AUC 0.95, accuracy 0.88, F1 score 0.86), outperforming logistic regression (AUC 0.82, accuracy 0.78). The most influential predictors were operative duration, ASA score, and sepsis for overall complications, while bowel obstruction and BMI were key factors for major complications. Surgical approach (open vs. laparoscopic) did not independently correlate with adverse outcomes, highlighting the complexity of patient- and case-specific interactions. CONCLUSIONS: Machine learning models can accurately predict postoperative complications following emergent ventral hernia repair, surpassing traditional regression methods. These findings suggest that ML-based decision tools could support risk stratification and optimize surgical planning in high-risk emergency settings. Prospective validation is warranted to integrate AI-assisted prediction into perioperative clinical workflows.
3 Aug 2026
Read appraisal →Journal of pediatric surgery
Interpretable deep learning model for pediatric strangulated small bowel obstruction on CT: A multicenter study
OBJECTIVE: To develop and validate a deep learning-based multi-instance learning (MIL) model that integrates CT imaging and clinical data to improve the accuracy of discriminating between strangulated small bowel obstruction (StSBO) from simple small bowel obstruction (SiSBO) in pediatric patients. MATERIALS AND METHODS: This multicenter retrospective study, conducted between January 2018 and June 2024, enrolled hospitalized pediatric patients aged 1-14 years with a diagnosis of small bowel obstruction. We developed the clinical, multi-instance learning, and combined models based on CT and clinical features. Model performance was evaluated using receiver operating characteristic (ROC) analysis, while SHapley Additive exPlanations (SHAP) interpreted feature contributions. We further assessed whether MIL-assisted diagnosis could enhance physician accuracy in diagnosing StSBO. RESULTS: The study sample comprised 168 patients (mean age, 6.36 ± 3.97, 118 men). Ascites and closed-loop sign were identified as independent predictors of StSBO on multivariate analysis (both p< 0.05). The MIL model achieved the area under the curve (AUC) of 0.86 (95%CI 0.70-1.00), p= 0.01 in the external test cohort. The combined model showed the highest diagnostic performance (AUC 0.87, 95%CI 0.72-1.00, p= 0.01) in the external test cohort, with MIL-derived features showing predominant importance in SHAP analysis. Both junior and experienced radiologists and surgeon demonstrated improved diagnostic performance with MIL assistance, showing AUC increases of 16%, 2%, and 20%, respectively. CONCLUSIONS: The MIL model performed well in diagnosing StSBO, and clinical data integration improved its performance. As a decision support tool, the model may aid risk stratification and facilitate timely escalation of care in pediatric StSBO management.
3 Aug 2026
Read appraisal →European journal of radiology
A CT-based deep learning model to differentiate between benign and malignant adrenal lesions
OBJECTIVE: To develop a deep learning model to differentiate benign from malignant adrenal lesions. MATERIALS AND METHODS: A total of 380 patients with 385 pathologically confirmed adrenal lesions (101 malignant, 284 benign) were retrospectively included. Adrenal lesions were manually segmented on CT images and analyzed in a deep learning pipeline aimed at differentiating benign from malignant lesions. Four predictive models were developed that incorporated combinations of radiological data (tumor size, and spontaneous attenuation) and non-radiological data (i.e., medical history and laboratory results). Data of 267 patients were used as a training set and those of 113 patients for the test set. The diagnostic capabilities of the four models were estimated using sensitivity, specificity, accuracy, and areas under the receiver operating characteristic curves (AUC) using histopathological findings as the gold standard. The reproducibility of manual segmentation was estimated using the Dice similarity coefficient after blinded resegmentation of 40 adrenal lesions by an independent radiologist. RESULTS: Segmentation reproducibility achieved a mean Dice similarity coefficient of 0.92 ± 0.03 (range: 0.72-0.97). The most accurate model, which combined clinical, biological, and radiological data, achieved 84.2% accuracy (95% confidence interval: 79.9, 88.6) and an AUC of 0.93 (95% confidence interval: 89.9, 97.9) in the test set for diagnosis of malignant adrenal lesion. CONCLUSION: A deep learning model integrating preoperative clinical, biological, and radiological features demonstrates high capabilities in differentiating benign from malignant adrenal lesions on initial CT examination.
3 Aug 2026
Read appraisal →Surgery
Artificial intelligence to revolutionize surgical decision-making is still just around the corner.
Medical artificial intelligence, especially large language models, has engendered both excitement and unease across the medical community, promising improved surgical diagnostic accuracy, perioperative decision-making, and patient safety amidst concerns of considerable bias and its implications on the future of human expertise. The evolution of artificial intelligence clinical decision support originated in the surgical field through early systems like AAPHelp, which leveraged Bayesian reasoning to diagnose acute abdominal pain. Despite the initial promise of artificial intelligence clinical decision support, attempts to develop more robust diagnostic tools largely fell short in the 1980s, with instruments unable to adequately diagnose and manage complex presentations, a lack of transparency in their decision-making processes, and limitations in scope. It was not until the 2010s that clinical decision support began to show renewed potential as a meaningful adjunct in surgical practice, largely driven by advancements in machine learning techniques and wider access to large clinical data sets. New artificial intelligence models, particularly those utilizing large language models, now demonstrate impressive capabilities, from predicting the risk of postoperative complications for individual patients to streamlining clinical documentation and beyond. However, challenges persist regarding transparency, bias, reliability, and integration into clinical workflows. Despite these hurdles, artificial intelligence-based tools like large language models represent an exciting new chapter in surgical decision-making. Built on a long history of clinical decision support systems in surgery, these technologies hold great promise to meaningfully augment surgical practice and improve care for patients.
1 Aug 2026
Read appraisal →Journal of robotic surgery
Robot-assisted versus open kidney transplantation: an umbrella review of systematic reviews and meta-analyses
Robot-assisted kidney transplantation (RAKT) has emerged as a minimally invasive alternative to open kidney transplantation (OKT). However, the comparative benefits and limitations of both approaches remain unclear. To compare the outcomes of RAKT and OKT through an umbrella review of published systematic reviews and meta-analyses. This umbrella review was written following PRISMA guidelines. Only meta-analysis and systematic review were included. Many outcomes were studied such as warm (WIT) and cold ischemia times (CIT), rewarming time, total ischemia time, blood loss, blood transfusion, delayed graft function, surgical site infections (SSI), hospital stay, graft rejection, graft failure, all-cause mortality, operation time, incision length, hospital readmission, vascular and ureteral anastomosis time, and other complications. We assessed methodological quality via the AMSTAR-2 tool. Consistency and strength of evidence were also evaluated. 6 studies were included: four meta-analyses and two systematic reviews. Studies were of low to moderate quality. Robotic kidney transplant surgery yields better outcomes in terms of blood loss (MDs ranging from - 16 to - 55 mL across studies), post-operative pain, incision length, SSI and ureteral leak. On the other hand, CIT, rewarming time, total ischemia time, operative time and ileus rate were favored in open surgery. Same rejection rates, graft failure, mortality and hospital readmission rate were found between both techniques. RAKT appears to improve several perioperative outcomes while maintaining comparable graft and patient survival outcomes to OKT. However, the available evidence remains limited by the low-to-moderate quality of existing reviews, highlighting the need for high-quality prospective studies.
27 July 2026
Read appraisal →Medicine
Comparative safety and effectiveness of stents in drainage of pancreatic fluid collections guided by endoscopic ultrasonography: A systematic review and network meta-analysis
BACKGROUND: Endoscopic ultrasonography-guided drainage is an effective treatment for pancreatic fluid collections (PFCs). However, the optimal stent strategy for endoscopic ultrasonography-guided drainage of PFCs is still unclear. This study aims to compare the clinical outcomes of different stent types to identify the best option. METHODS: Databases including PubMed, EMBASE, and Cochrane were searched up to August 2024. The analysis focused on comparisons between bi-flanged metal stents (BFMS), double-pigtail plastic stents (DPPS), fully covered self-expanding metal stents (FCSEMS), lumen-apposing metal stents (LAMS), and the combination of LAMS and DPPS (LAMS + DPPS). RESULTS: A total of 38 studies, involving 4265 patients with PFCs, were analyzed. In all of these patients, LAMS (risk ratio [RR]: 1.07, 95% confidence interval [CI]: 1.02-1.13) and BFMS (RR: 1.08, 95% CI: 1.01-1.15) showed higher clinical success rates compared with DPPS. LAMS + DPPS reduced infection rates compared with BFMS (RR: 0.32, 95% CI: 0.10-0.99), DPPS (RR: 0.19, 95% CI: 0.06-0.62), and FCSEMS (RR: 0.23, 95% CI: 0.07-0.76). Within the pancreatic pseudocysts subgroup, LAMS (RR: 1.08, 95% CI: 1.01-1.16) and LAMS + DPPS (RR: 1.24, 95% CI: 1.03-1.48) demonstrated higher clinical success rates compared with DPPS. Similarly, in the walled-off necrosis subgroup, LAMS (RR: 1.10, 95% CI: 1.02-1.17), LAMS + DPPS (RR: 1.19, 95% CI: 1.01-1.41), FCSEMS (RR: 1.14, 95% CI: 1.03-1.26), and BFMS (RR: 1.11, 95% CI: 1.03-1.20) all showed higher success rates compared with DPPS, with BFMS exhibiting a lower bleeding rate than DPPS (RR: 0.32, 95% CI: 0.18-0.99). CONCLUSION: Newer metal stents, including BFMS, LAMS, and LAMS + DPPS, offer advantages over plastic stents like DPPS alone. BFMS is preferable when bleeding risk is a concern, while LAMS + DPPS is more effective in reducing infection rates in PFCs.
26 July 2026
Read appraisal →European journal of trauma and emergency surgery : official publication of the European Trauma Society
The association between pancreatic enzyme serum concentrations and blunt pancreatic trauma: a systematic review.
PURPOSE: Blunt pancreatic trauma is uncommon. When suspected, serum amylase and lipase are measured, but their diagnostic value remains uncertain. This systematic review evaluated the diagnostic performance of serum amylase and serum lipase in detecting blunt pancreatic trauma in adults. METHODS: MEDLINE, Embase, Scopus and Cochrane Central were searched for studies evaluating serum amylase and/or lipase in adults with blunt pancreatic trauma. Observational studies reporting diagnostic accuracy or clinical outcomes were included. Two reviewers independently screened studies and assessed risk of bias using the Newcastle-Ottawa Scale. RESULTS: Four observational studies met inclusion criteria. A total of 4937 patients with blunt abdominal trauma, including 150 with pancreatic injury were investigated. Two studies evaluated serum lipase alone and two compared amylase and lipase. Pancreatic injuries were graded according to the American or Japanese Association for the Surgery of Trauma. Early serum amylase measurement (< 90 min post-injury) demonstrated low sensitivity. In contrast, testing performed more than 3 h after injury has shown improved diagnostic accuracy with one study suggesting combined serum amylase and lipase testing can achieve a sensitivity of 85% and specificity of 100%. CONCLUSION: Early serum pancreatic enzymes measurement does not appear to aid initial management decisions following blunt abdominal trauma. Delayed testing (> 3-6 h), particularly using lipase or combined lipase and amylase showed improved diagnostic performance. Prospective multicentre validation is needed to define their role in guiding further imaging after equivocal or negative initial CT.
22 July 2026
Read appraisal →Journal of robotic surgery
Transfer of technical skills from virtual reality robotic simulation to non-virtual surgical performance: a systematic review and meta-analysis
Virtual Reality Robotic Surgery Simulators (VR-RSS) are widely used, but their educational value depends on whether skills acquired in virtual reality (VR) training transfer to non-virtual performance. This review evaluated whether VR training improves transferable robotic surgical skills. We searched PubMed, Scopus, Web of Science, and Cochrane from inception to March 3, 2026, for randomized trials evaluating VR robotic simulator training with transfer to non-virtual settings. Screening was performed in Rayyan. Data were extracted systematically, risk of bias was assessed with RoB 2, and random-effects meta-analyses using Hedges' g were conducted in R. Eight trials were included in the review, and seven were included in meta-analysis. Sample sizes ranged from 12 to 35 participants. Although the pooled standardized mean difference (SMD) for global technical skill scores favored the VR training group, it did not reach statistical significance (g = 0.77, 95% CI -0.64-2.18; p = 0.205). Task completion time was also shorter in the VR training group, but this difference was not statistically significant (g = 0.47, 95% CI -0.35-1.29; p = 0.164). This review suggests a potential benefit of VR-based robotic simulation for transferring trained skills to non-VR environments. Future studies should include larger sample sizes and longitudinal assessments using validated metrics to better characterize these trends.
21 July 2026
Read appraisal →Pediatric surgery international
Pediatric colonic diverticulitis: clinical presentation, management, and review of the literature
Colonic diverticulitis is rare in the pediatric population and often presents with nonspecific symptoms that may be misdiagnosed as other causes of acute abdominal pain, such as appendicitis, leading to diagnostic uncertainty and variability in management. We report a case of pediatric colonic diverticulitis and present a systematic review to characterize its clinical presentation, diagnostic challenges and management. Clinical data for the index patient were retrospectively reviewed, and parental consent was obtained. A structured literature search was performed using PubMed, Scopus, and Embase. Studies reporting patients younger than 18 years were included. A 16-year-old male presented with right lower quadrant pain. CT suggested cecal diverticulitis. Worsening symptoms prompted diagnostic laparoscopy, revealing an inflamed diverticulum adjacent to a normal appendix. The postoperative course was uneventful. The review identified 27 studies including 101 patients. Median age was 14 years (IQR 12-16; range 3-17), with 57% male preponderance. Most cases involved a solitary right-sided diverticulum. CT correctly identified diverticulitis in 85%. Complicated disease occurred in 17%. In conclusion, in the pediatric age diverticulitis often arises from a solitary cecal diverticulum and can closely mimic appendicitis. Awareness may improve diagnosis, and uncomplicated cases can be treated conservatively with careful follow-up and appropriate clinical monitoring.
21 July 2026
Read appraisal →Journal of robotic surgery
Mapping the evolution of deep learning and computer vision in robotic surgery: a bibliometric analysis of surgical video intelligence, instrument perception, and clinical translation.
Deep learning and computer vision are increasingly embedded in robotic surgery, yet the development and translational direction of this research domain remain incompletely characterized. We conducted a bibliometric and visualization analysis of publications retrieved from the Web of Science Core Collection using Bibliometrix/Biblioshiny, VOSviewer, and CiteSpace. A total of 1,186 documents published between 2010 and 2026 across 356 sources were included. Scientific output increased rapidly, with an annual growth rate of 16.09% and a peak of 216 publications in 2025. The field involved 5,296 authors, and international collaboration accounted for 30.69% of publications. IEEE Robotics and Automation Letters was the most productive and locally influential source. China and the United States were the leading contributors, with China showing the most rapid recent expansion and the United States retaining the highest citation impact. Citation-burst and keyword analyses identified U-Net, residual learning, transformer architectures, and foundation-model-enabled segmentation as major methodological drivers. The conceptual structure evolved from image guidance, registration, and navigation toward surgical video intelligence, instrument perception, workflow understanding, autonomous assistance, and clinical translation. Instrument perception emerged as a central link between algorithmic development and operative application. Future progress will require diverse multi-institutional datasets, external and prospective validation, integrated scene understanding, and rigorous evaluation of intelligent assistance within real robotic surgical workflows.
21 July 2026
Read appraisal →Journal of robotic surgery
Technology-enhanced training in basic robotic surgical skills: a systematic review
Robotic surgery has seen substantial growth, however training access remains limited by resources and time-intensive credentialling pathways. Technology enhanced learning may address these barriers whilst improving training efficiency and assessment objectivity. We aimed to systematically evaluate technology-enhanced approaches to basic robotic surgical skills training. This systematic review followed PRISMA guidelines with prospective registration (OSF: V93MZ). MEDLINE (via OVID), Embase, and the Cochrane Library (CENTRAL and CDSR) were searched on 23 May 2025 without date restrictions. Technologies included virtual reality, augmented reality, sensor-based systems, video review, and performance feedback. Risk of bias was assessed using the RoB-2 and ROBINS-I tools, and certainty of evidence using GRADE. Narrative synthesis was utilised given methodological heterogeneity, with reported outcomes mapped to the Kirkpatrick model of training evaluation. Seventeen studies involving 484 participants were included (10 randomised trials, 7 prospective cohort studies; 16 single-centre). Technologies comprised virtual reality (7), sensor-based systems (5), performance feedback (3), video review (1), and augmented reality (1); no eligible artificial intelligence studies were identified. Virtual reality, utilised within bespoke robotic simulators, demonstrated accelerated learning curves, although some systems required more repetitions than traditional robotic simulator-based training. The single augmented reality study improved instrument velocity. Sensor-based force measurement devices improved force application and ergonomics. Video review improved accuracy but temporarily increased completion time. Multimodal feedback systems outperformed conventional feedback. Evidence was concentrated at Kirkpatrick level 2 (learning); one study reported only level 1 (reaction) data, with no studies reporting level 3 or 4 outcomes. Risk of bias was low in randomised studies and low-moderate in non-randomised studies. Technology-enhanced basic robotic skills training has evidence supporting improved performance outcomes, accelerated learning curves, and enhanced objective assessment capabilities. Gaps persist for basic skills training in augmented reality, artificial intelligence, and docking and setup. Standardised competency assessment frameworks are required to evaluate these rapidly progressing tools.
21 July 2026
Read appraisal →Journal of the American College of Surgeons
Defining Quality Metrics for Telemedicine in Surgery: A Critical Examination
The rapid adoption of telemedicine has transformed healthcare delivery in the US, enhancing access and communication for surgical patients across wide geographic areas. However, a critical challenge persists: the need to define and standardize quality metrics specifically for telemedicine in surgery. Existing studies suggest that telemedicine can yield equivalent or improved outcomes compared with in-person visits. Nevertheless, literature remains limited in evaluating patient satisfaction, cost-effectiveness, and diagnostic accuracy. Through expert consensus within the American College of Surgeons Board of Governors Telehealth Pillar, we propose a structured framework for defining and implementing quality metrics for surgical telemedicine. This is based on the Donabedian model, addressing structure, process, and outcome, while also considering the distinct phases of surgical care: preoperative, intraoperative, and postoperative. This framework identifies unique domains of telemedicine in surgical care, emphasizing hospital and organizational structure, patient and provider readiness, and policy alignment. A comparative analysis with existing AHRQ and WHO frameworks highlights gaps in surgical applicability. Finally, we propose an implementation roadmap prioritizing immediate, feasible metrics while identifying areas for future validation. Collaboration among researchers, clinicians, and policymakers will be essential to establish these metrics and ensure that telemedicine delivers on its potential to improve surgical care delivery while addressing disparities in access and outcomes.
18 July 2026
Read appraisal →Pediatric surgery international
Single-stage versus staged reconstruction for high and intermediate anorectal malformations in neonates: a systematic review and meta-analysis
The surgical approach to high and intermediate anorectal malformations remains controversial. This systematic review compared continence and infection outcomes between the two approaches. MEDLINE, Embase, and Cochrane CENTRAL were searched per a registered protocol (PROSPERO CRD420261291319). Comparative studies of single-stage versus staged repair in neonates with high or intermediate anorectal malformations were included. Risk of bias was assessed using ROBINS-I. Random-effects meta-analysis with prediction intervals was performed. Four comparative studies (746 patients: 399 single-stage, 347 staged) were included. Pooled analysis showed no significant difference in incontinence outcomes (RR 0.93, 95% CI: 0.52-1.66, p = 0.80; 95% prediction interval: 0.28-3.08) with substantial heterogeneity (I²=83%). Infection data could not be pooled due to methodological concerns in outcome reporting. All included studies demonstrated moderate to serious risk of bias. GRADE certainty was LOW for incontinence and VERY LOW for infection. Current evidence does not demonstrate superiority of either approach for bowel continence (LOW certainty). Infection evidence was insufficient for synthesis (VERY LOW). Wide prediction intervals indicate substantial uncertainty; available data cannot confirm or refute inferior outcomes after single-stage repair. Prospective studies with standardized outcomes are needed. Protocol registration: PROSPERO CRD420261291319.
17 July 2026
Read appraisal →Breast cancer research and treatment
Extended applications of chest wall perforator flaps in breast surgery: case series and systematic literature review
PURPOSE: Chest wall perforator flaps (CWPFs) are integral to modern oncoplastic breast surgery, offering volume replacement without muscle sacrifice. While their role in partial breast reconstruction is established, data on extended and non-conventional applications remain limited. This study aims to synthesize current clinical experience and delineate the extended applications of chest wall perforator flaps beyond conventional oncoplastic contexts. METHODS: This study combined a prospective institutional case series from two tertiary centers (Singapore and UK) with a systematic literature review of PubMed, Embase, Web of Science, and Cochrane databases. Eligible studies described CWPF use for extended oncologic, reconstructive, or aesthetic indications. Data were synthesized descriptively according to PRISMA guidelines. RESULTS: Six women underwent LICAP-based reconstruction for complex indications including skin-replacing excisions, implant salvage, chronic sinus closure, and total autologous reconstruction with adjunct lipofilling. All flaps were fully viable with good contour restoration and symmetry, and adjuvant therapy proceeded without delay. The systematic review identified 38 studies (≈ 324 patients, 349 flaps). CWPFs, most commonly LICAP, LTAP, and TDAP, were used for defects following oncologic resection, radiotherapy injury, implant failure, or post-bariatric contour correction. Overall flap success exceeded 95%, with major complications under 5%. Donor-site morbidity was minimal, with high aesthetic satisfaction (> 90%). CONCLUSIONS: CWPFs represent muscle-sparing reconstructive options whose utility may extend beyond conventional oncoplastic indications; this descriptive series supports their feasibility and short-term outcomes across a range of selected clinical settings, suggesting that CWPFs warrant further consideration in the management of complex breast and chest wall defects.
17 July 2026
Read appraisal →International ophthalmology
Safety and efficacy of silicone intubation compared to standard techniques in endoscopic dacryocystorhinostomy: a systematic review and meta-analysis
BACKGROUND: Primary Acquired nasolacrimal duct obstruction (PANDO) is a lacrimal drainage disorder, commonly seen in adults. Endoscopic Dacryocystorhinostomy (EN-DCR) is a widely adopted surgical procedure for treatment of nasolacrimal duct obstruction. Silicon intubation is a technique, which involves inserting a soft silicone stent to keep the ostium patent post operatively. METHODS: This meta-analysis followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, with searches across 4 databases. Primary outcomes were overall success rate, and overall failure rate. Secondary outcomes included granulations/intracanalicular obstruction (ICO) threats, hemorrhage, anatomical failure, functional failure, recurrent symptoms/epiphora, and cicatricial stenosis/post-procedural restenosis. Data were analyzed using R software version 4.3. Heterogeneity was assessed using the I2 statistic. RESULTS: From 3,974 studies initially, 20 studies were selected in the final review, in which 17 were RCTs and 3 observational studies. A statistically significant improvement in surgical success rates, while reducing failure rates were observed in the silicone intubation (stented) group compared to the unstented group. No significant difference was observed in the incidence of restenosis, hemorrhage, functional failure, epiphora or recurrent symptoms. Reduction of anatomical failure was observed. Increase in adverse effects of granulation tissue formation and internal canalicular obstruction were observed. Heterogeneity was low and no publication bias was detected in outcomes. CONCLUSIONS: Silicone intubation during mechanical endoscopic dacryocystorhinostomy (EN-DCR) was associated with improved success and patency rates, as well as lower failure rate. While more resource-intensive, it provides a slightly higher advantage, particularly in recurrent or revision instances, recommending its implementation in routine EN-DCR where possible.
16 July 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Fasciotens® for abdominal wall closure: current evidence and clinical perspectives.
PURPOSE: Management of open abdomen (OA) and complex ventral hernias remains associated with high morbidity, prolonged hospitalization, and substantial healthcare costs. Vertical fascial traction has emerged as a novel approach aimed at facilitating early primary fascial closure. This study provides a narrative review and multidimensional overview of the available evidence regarding the Fasciotens® device, focusing on clinical outcomes, safety, economic considerations, and organizational aspects. METHODS: A narrative systematic literature review was performed to identify studies evaluating the use of Fasciotens® in adult patients with open abdomen or complex ventral hernias. Clinical, economic, organizational, and ethical domains were assessed. RESULTS: Available evidence, primarily derived from observational studies and case series, suggests that the use of Fasciotens® is associated with high rates of primary fascial closure, shorter time to closure, and reductions in intra‑abdominal pressure. Device‑related adverse events appear to be infrequent and mainly limited to minor skin‑related complications. Preliminary economic considerations indicate that earlier closure and avoidance of complex reconstructive procedures may reduce operative time, intensive care unit stay, and overall hospital resource utilization. CONCLUSION: Current evidence supports the clinical feasibility and potential value of Fasciotens® as an adjunctive technology for the management of open abdomen and complex ventral hernias. However, the available data are limited by small sample sizes and non‑comparative study designs. Further prospective and comparative studies are needed to better define its role within standardized treatment pathways.
16 July 2026
Read appraisal →Nutricion hospitalaria
Immunonutrition in surgical patients with colorectal cancer: a systematic review
Introduction: surgery in patients with colorectal cancer often leads to complications, affecting recovery, prolonging hospital stay, and impacting quality of life. Immunonutrition plays an important role by modulating the immune system and may contribute to the reduction of these complications. Objective: to assess the effect of immunonutrient supplementation on complications in surgical patients with colorectal cancer. Materials and methods: a literature search was conducted in PubMed, Web of Science, Embase, and Cochrane, following the PRISMA model. A total of 20 clinical trials and two observational studies published between 2000 and 2025 were selected, analyzing postoperative complications, physical or nutritional status, immune response, and length of hospital stay. Results: a reduction in postoperative complications was observed with combined immunonutrient supplementation (arginine, omega-3 fatty acids, nucleotides, L-alanine, and L-glutamine), particularly in wound infections. No benefits were found with isolated supplementation. Conclusion: combined immunonutrient administration may improve postoperative complications, especially wound infections, although results regarding hospital stay are inconsistent. Isolated supplementation with omega-3 fatty acids shows no benefit. Introducción: la cirugía en pacientes con cáncer colorrectal conlleva complicaciones, alterando la recuperación, alargando la estancia hospitalaria y afectando a la calidad de vida. La inmunonutrición ejerce una acción importante al modular el sistema inmunológico y podría mejorar estas complicaciones. Objetivo: evaluar el efecto de la suplementación con inmunonutrientes en las complicaciones en pacientes quirúrgicos por cáncer colorrectal. Material y métodos: se realizó una búsqueda bibliográfica en PubMed, Web of Science, Embase y Cochrane, siguiendo el modelo PRISMA. Se seleccionaron 20 ensayos clínicos y dos observaciones, publicados entre 2000 y 2025, que analizaron complicaciones posoperatorias, el estado físico o nutricional, la respuesta inmune y la duración de estancia hospitalaria. Resultados: se halló una reducción de las complicaciones posoperatorias con una suplementación combinada de inmunonutrientes como arginina, ácidos grasos omega-3, nucleótidos, L-alanina y L-glutamina, especialmente en infecciones de herida, sin beneficios en la administración aislada. Conclusión: la administración combinada podría mejorar las complicaciones posquirúrgicas, especialmente de la infección de la herida, con resultados contradictorios para estancia hospitalaria. La suplementación aislada de ácidos grasos n-3 no aporta beneficios.
15 July 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Clinical outcomes in abdominal wall autologous flap reconstruction: a systematic review
PURPOSE: Complex abdominal wall defects present major reconstructive challenges when restoration of fascial continuity must be combined with durable soft-tissuecoverage, visceral protection, and, in selected cases, functional repair. Although autologous flap reconstruction is well established for selected indications, its overall role across defect types has yet to be established. METHODS: A systematic review was performed in accordance with PRISMA guidelines (PROSPERO: CRD42023491916). PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched from inception to April 2026 for studies reporting adult autologous flap-based abdominal wall reconstruction. Given substantial clinical and methodological heterogeneity, data were analysed descriptively. RESULTS: 172 studies comprising 4,421 patients were included. Pedicled flaps predominated (n=4,095, 92.6%), with free flaps used in 146 patients (3.3%) and mixed approaches in 180 (4.1%). Hernia-related pathology was the commonest indication (n=3751, 84.8%), followed by malignancy (n=470, 10.6%). Frequently used flap categories included anterolateral thigh, tensor fascia lata, rectus-based, and latissimus dorsi-based flaps. Flap selection was primarily defect-driven: fascia-bearing regional and turnover techniques were used mainly for structurally focused hernia repair, whereas composite flaps were used more often for oncologic, fistulating, traumatic, contaminated, or full-thickness defects. Common short-term complications include seroma, surgical site infection, and wound dehiscence. Flap failure and reported long term hernia recurrence were low. Free flaps were used more often for larger defects weighted mean 401 cm² vs 250 cm² for pedicled flaps), although size ranges overlapped. CONCLUSIONS: Autologous flap reconstruction is a durable and versatile option for selected complex abdominal wall defects. Reconstructive strategy should be guided primarily by defect composition.
10 July 2026
Read appraisal →BMJ open
Impact of climatic variables on postoperative outcomes in various surgical disciplines: a systematic review.
OBJECTIVES: The impact of climate change on health is well recognised, yet its influence on postoperative complications remains underexplored. This systematic review examines how climatic factors-particularly temperature, humidity and seasonal variations-affect surgical outcomes. DESIGN: Systematic review with narrative synthesis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. DATA SOURCES: A comprehensive search of PubMed, Web of Science and the Cochrane Library from June 2015 to June 2025 was conducted. An additional supplementary PubMed search was performed to identify further relevant studies. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Included were studies published in English or German that examined associations between climatic factors, including temperature, humidity, precipitation or seasonality and postoperative outcomes in surgical patients. Studies without a surgical or climatic focus, animal studies, reviews and commentaries were excluded. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies and extracted data using predefined criteria. Risk of bias was assessed using the Newcastle-Ottawa Scale. Due to methodological heterogeneity, findings were synthesised narratively. RESULTS: Fifteen studies were included. High ambient temperatures were frequently associated with increased risks of surgical site infections (SSIs). Some large studies reported that even a one-degree rise significantly elevated infection rates. Humidity was also linked to higher infection rates, with evidence suggesting an independent effect in some cases. Seasonal changes influenced complication rates across regions and surgical disciplines, with infection and pneumonia peaks in summer or winter months. A few studies reported increased risks during heavy rainfall or institutional transitions such as the 'July effect'. CONCLUSION: Overall, elevated temperature and humidity appear to be associated with increased postoperative risks, especially SSIs. Seasonal patterns may further influence outcomes depending on geography and procedure type. While the available evidence supports a link between climate and surgical complications, methodological differences and limited adjustment for confounders highlight the need for more rigorous studies.
5 July 2026
Read appraisal →Langenbeck's archives of surgery
The role of large language models in the writing of surgical reviews: fact or fantasy?
BACKGROUND: Amidst the current enthusiasm concerning artificial intelligence and its possible application in the composition of different kinds of scientific and non-scientific written documents, we evaluated the usage of artificial intelligence for writing surgical short reviews. METHODS: In order to assess the formal and content quality of AI-generated texts compared to human written texts, ten AI-based text generators (five chatbots and five content creators) and four surgeons in training received the same prompt for a short scientific article on a liver surgery theme. All texts were anonymized and subsequently evaluated by three experienced liver surgeons based on a pre-defined scoring scheme, as well as for quality of references and readability according to readability indices. Furthermore, all texts were tested for plagiarism using PlagScan. RESULTS: Overall percentage of correct assessment for AI/non-AI generation by experienced surgeons lay at 78.57%. Human written text had a mean word count of 1054 versus 874 in AI-generated text, with a higher mean Flesh Reading Ease Score (FRE, 26.2 ± 5.1 versus 17.7 ± 6.1). References were PubMed-listed in 100% for human versus 46% for AI-generated text, with only one non-human text reaching 100% formally correct citation of references. PlagScan found 6.4%±1.3 mean resemblance to existing texts for human versus 7.6%±4.5 for AI-generated text. DISCUSSION: Overall, AI could already mislead experienced scientific surgeons in 26.7% of cases into believing it to be human. However, formal requirements, especially considering referencing, are still in great need of improvement with only one of AI-generated articles fulfilling our quality requirements.
4 July 2026
Read appraisal →Medicine
Clinical outcome of revisional gastrectomy postgastric banding failure: A systematic review.
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been widely used for obesity management; however, its long-term failure, due to complications such as band erosion, slippage, and inadequate weight loss, has necessitated revisional bariatric procedures. Revisional laparoscopic sleeve gastrectomy has emerged as a common alternative, yet its safety and efficacy remain debated. METHODS: A systematic review was conducted in accordance with PRISMA guidelines; this review was prospectively registered with Prospective Register of Systematic Reviews (CRD42024568094). A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane databases was performed up to July 19, 2024. Studies published in English that reported postoperative outcomes following revisional laparoscopic sleeve gastrectomy after failed LAGB were included. Data were extracted independently by 2 reviewers, focusing on patient demographics, complication rates (including leaks, bleeding, and infections), and nutritional outcomes. Quality assessment was performed using a standardized tool for observational studies, cohort and cross-sectional studies. RESULTS: Fifty studies involving a total of 16,192 patients were analyzed. Patients had a mean age between 30 and 50 years and a revision body mass index ranging from 33 to 52 kg/m2. Infection was reported in 9 studies, though incidence was low. Bleeding was examined in 30 studies, with mostly isolated cases; thrombosis was reported in only 1 study. Leak rates were reported in 39 studies, ranging from 0% to 8.1%, with stage-specific rates between 2.8% and 5.8%. Four studies noted nutritional deficiencies, including increased ferritin deficiency and some cases contributing to readmission. Overall complication rates were reported in 22 studies, averaging 9.95% and ranging from 0% to 37.5%. CONCLUSION: Revisional laparoscopic sleeve gastrectomy following failed LAGB appears to offer a safe and effective alternative, with acceptable complication rates and favorable weight loss outcomes. However, heterogeneity in study designs and patient characteristics underscores the need for standardized reporting and further research to optimize clinical protocols.
28 June 2026
Read appraisal →World journal of surgical oncology
Robotic-assisted versus conventional nipple-sparing mastectomy with immediate implant-based breast reconstruction: a GRADE-assessed systematic review and meta-analysis of prospective studies
BACKGROUND: Robotic nipple-sparing mastectomy with immediate implant-based reconstruction is increasingly adopted to improve cosmetic outcomes and patient experience; however, its comparative perioperative value against conventional or open nipple-sparing mastectomy remains uncertain when restricted to prospective evidence. METHODS: We performed a PRISMA-aligned systematic review and random-effects meta-analysis of prospective comparative studies and randomized trials comparing robotic versus conventional or open nipple-sparing mastectomy with immediate implant-based reconstruction. The primary outcome was the total operative time, and the secondary outcomes were major complications, nipple-areolar complex ischemia or necrosis, and length of hospital stay. The risk of bias was assessed using RoB 2 for randomized data and ROBINS-I for nonrandomized data. Leave-one-out sensitivity analyses were conducted for outcomes with substantial heterogeneity, and the certainty of the evidence was graded using GRADE. RESULTS: Three prospective studies were included. Robotic surgery was associated with a significantly longer total operative time (mean difference 64.01 min, 95% confidence interval 8.54-119.47). Major complications did not differ between the approaches (risk ratio 0.63, 95% confidence interval 0.27-1.47), nor did nipple areolar complex ischemia or necrosis (risk ratio 0.56, 95% confidence interval 0.28-1.11) or length of hospital stay (mean difference 0.22 days, 95% confidence interval - 0.26 to 0.70). Heterogeneity was high for operative time and moderate to substantial for length of stay. The certainty of the evidence was low overall, driven by imprecision, heterogeneity, and limitations of the non-randomized design. CONCLUSIONS: Robotic nipple-sparing mastectomy is associated with a longer operative time than conventional or open approaches. No statistically significant differences were observed in major complications or nipple-areolar complex viability; however, the current prospective evidence base is limited, heterogeneous, and imprecise, and clinically important differences cannot be excluded. In experienced centers, robotic nipple-sparing mastectomy may be considered for carefully selected patients who prioritize scar concealment and minimally invasive access; however, its broader role in routine practice remains uncertain pending stronger prospective data on safety, patient-reported outcomes, and resource use.
26 June 2026
Read appraisal →Journal of robotic surgery
Telesurgery and remote surgery research: a bibliometric analysis of scientific growth, collaboration, and thematic evolution
Telesurgery and remote surgery have gained relevance in surgical innovation due to advances in robotics, telepresence, artificial intelligence, and high-speed communication networks. Despite this progress, the global evolution, collaborative structure, and thematic development of this field remain insufficiently characterized. A bibliometric study was conducted using records retrieved from Web of Science. Publications on telesurgery and remote surgery published up to 2025 were included. Bibliographic data were processed and analyzed using the bibliometrix package in R. Bibliometric indicators, citation metrics, country productivity, journal output, author contributions, collaboration networks, and keyword-based thematic patterns were assessed. A total of 476 publications on telesurgery were included, distributed across 290 journals. Scientific production showed sustained growth, with an annual growth rate of 20.59%, a mean document age of 6.06 years, and peak output in 2024. The average citation count was 28.54 citations per document. The United States and China were the leading contributors, with 151 and 120 publications, respectively, and also acted as the main hubs in the international collaboration network. The most cited studies focused on telerobotic systems for minimally invasive surgery, telerobotic neurovascular interventions, and ultra-reliable low-latency communications. Keyword analysis showed a progressive shift from early clinical feasibility and surgical applications toward connectivity, latency, robotic systems, extended reality, blockchain, and artificial intelligence. These trends indicate the transition of telesurgery from a clinically exploratory field to a technology-driven research domain. Telesurgery and remote surgery constitute a rapidly expanding and technologically driven research field. Future progress will require stronger international collaboration, real-world clinical validation, standardized outcome assessment, and strategies to reduce technological inequities across regions.
23 June 2026
Read appraisal →Journal of robotic surgery
Mapping the scientific landscape of robotic hernia repair: a bibliometric and topic modeling analysis of thematic transitions
Robotic hernia repair (RHR) has profoundly transformed modern surgery, yet it remains intensely debated. To understand this dynamic field, bibliometric analysis offers a powerful tool to evaluate its evolving research trends. Our study presents a comprehensive bibliometric and machine learning analysis of 1,503 publications from 2003 to 2025. The literature demonstrates a growth trend (R2 = 0.96), characterized by initial latency (2003-2015), steady adoption (2016-2020) and a recent exponential explosion (2020-2025) peaking at 262 publications in 2025. The United States is the leading contributing nation (n = 892), followed by Italy (n = 98), Germany (n = 71), and China (n = 68). Key contributors include Kudsi OY, Malcher F, and Muysoms F, with Surgical Endoscopy serving as the predominant publication venue (n = 203). Spatial and relational networks were mapped using VOSviewer and CiteSpace. Critically, Latent Dirichlet Allocation (LDA) topic modeling combined with principal component analysis (PCA) stratified the corpus into four major research domains comprising the anatomical spectrum, the balance between resource and risk management, hardware evolution and surgical education, and technical complexity coupled with high-level evidence. Longitudinal regression of thematic probabilities revealed a significant thematic transition in research emphasis from early hardware feasibility and technical exploration toward value-based evaluation. Current research priorities are increasingly focused on rigorous cost-effectiveness evaluation in high-risk populations together with the generation of high-quality randomized evidence. In conclusion, this multidimensional analysis illustrates how this field is increasingly guided by the interconnected domains of Evidence, Education and Economics, which align with established frameworks for sustainable surgical progress.
21 June 2026
Read appraisal →Journal of robotic surgery
Outcomes in laparoscopic versus robotic-assisted surgery for median arcuate ligament syndrome: a systematic review and meta-analysis
Median Arcuate Ligament Syndrome (MALS) is a rare condition caused by external compression of the coeliac artery by the median arcuate ligament (MAL), leading to postprandial abdominal pain, nausea, vomiting, and weight loss. This study aims to compare outcomes of robotic (RMALR) and laparoscopic (LMALR) MAL release. A systematic search of PubMed/MEDLINE, Scopus, and Embase databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to compare perioperative and postoperative outcomes of LMALR versus RMALR. Comparative studies including adult patients undergoing either approach were included. Outcomes assessed were conversion to open surgery, resolution of pain, length of admission, postoperative complications, symptom recurrence and time to recurrence. Five retrospective comparative studies comprising 158 patients were included. No differences were found between laparoscopic and robotic approaches in conversion to open, resolution of pain, postoperative complications, length of admission, or overall time to recurrence. However, RMALR showed a significantly longer time to symptom recurrence (9.04 months, 95% CI 4.18-13.89; p = 0.0003). Both LMALR and RMALR are safe and effective for MALS, with comparable perioperative and postoperative outcomes. The longer symptom-free interval after robotic surgery may reflect greater precision in dissection around the coeliac axis. However, further prospective studies with standardised follow-up are needed to validate these findings.
20 June 2026
Read appraisal →Journal of robotic surgery
Rethinking health technology assessment in robotic surgery: an EFISDS-TROGSS position paper. Official position paper of the European Federation - International Society for Digestive Surgery (EFISDS) and The Robotic Global Surgical Society (TROGSS).
Robotic-assisted surgery (RAS) has evolved from a procedural innovation into an increasingly integrated component of contemporary digital surgical ecosystems. Nevertheless, most current Health Technology Assessment (HTA) frameworks continue to evaluate robotic systems primarily through comparator-based models focused on isolated perioperative and oncological outcomes. In this EFISDS-TROGSS position paper, we critically examine the methodological limitations of conventional HTA paradigms when applied to robotic surgical platforms, using the recent Italian AGENAS appraisal as a representative case study. While the AGENAS document represents one of the most comprehensive national evaluations of RAS performed to date, its heterogeneous recommendations across procedures highlight unresolved tensions regarding perioperative benefit, real-world implementation, learning curves, organizational impact, and long-term healthcare value. We argue that RAS should increasingly be interpreted not simply as a surgical device, but as a platform technology interacting with simulation-based training, digital infrastructure, surgical data science, artificial intelligence, telecommunication systems, and institutional organization. Rather than a surgical device alone, RAS should be interpreted and regarded as a combination of technological advances and approaches that integrate various degrees of artificial intelligence autonomy, image navigation, telesurgery, and other benefits to empower the surgical team. Conventional HTA models, originally developed for relatively discrete therapeutic interventions, may incompletely capture the multidimensional interaction between robotic technologies and modern healthcare systems. Particular attention is dedicated to real-world evidence, implementation maturity, reimbursement limitations, and the growing mismatch between current Diagnosis-Related Group (DRG) structures and technologically integrated surgical care. Finally, we propose more flexible and multidimensional assessment frameworks integrating procedural outcomes with organizational sustainability, digital interoperability, workforce implications, and longitudinal healthcare value.
20 June 2026
Read appraisal →Journal of robotic surgery
The need for a dedicated surgical consent framework for robotic telesurgery: a global call to action
Robotic telesurgery has progressed from experimental demonstrations to real-world clinical implementation across multiple continents. Landmark interconnected procedures, including intercontinental robotic prostatectomies, humanitarian implementations in underserved regions, and expansion of teleproctoring/tele-mentoring networks, showcase a rapidly maturing field. Despite this proliferation, no standardized, procedure-specific surgical consent for telesurgery exists in the medical literature. Current consent processes for robotic surgery, telemedicine, and surgical research fail to address critical elements unique to telesurgery, including latency thresholds, technical redundancies, network architecture, cybersecurity risks, remote surgeon responsibilities, and contingency planning. Our article aims to define the essential elements that should compose a dedicated telesurgery-specific informed consent and to highlight why current consent frameworks are insufficient for this rapidly expanding global practice. This expert-opinion paper synthesizes high-impact literature on consent ethics, digital surgery, telehealth governance, and robotic surgery; evaluates current consents used in pioneering telesurgery programs across North America, South America, Africa, Europe, and Asia; and incorporates multidisciplinary insights from surgery, anesthesiology, biomedical engineering, cybersecurity, telecommunications, ethics, and global health. We identify major gaps in contemporary consent frameworks, including (1) inadequate disclosure of connectivity-related risks; (2) insufficient explanation of data transmission, cybersecurity, and encryption; (3) absence of latency thresholds and safety-based interruption criteria; (4) lack of transparency regarding remote surgeon responsibility and handover protocols; and (5) limited patient education regarding contingency conversion and chain-of-care accountability. We thus propose a 9-component International Telesurgery Consent Framework, providing standardized language and structure for global implementation. The rapid expansion of telesurgery demands an equally rapid evolution in patient-centered informed consent. A dedicated telesurgery consent should become the ethical, medicolegal, and operational standard for any remote robotic clinical procedure. This paper serves as the basis for an international consensus effort involving global leaders in robotic surgery, telehealth, AI-enabled surgery, and digital health regulation.
14 June 2026
Read appraisal →Scientific data
Appendix300: Surgical video and patient metadata of 330 laparoscopic appendectomy cases from five institutions
The limited availability of diverse and representative training data poses a critical barrier to the development of clinically relevant computational tools for intraoperative surgical decision support. Surgical procedures are not routinely recorded, and data annotation requires domain expertise, resulting in a scarcity of open-access surgical video datasets with high-quality annotations. Existing datasets are typically limited to single institutions and specific procedures, such as cholecystectomy, and rarely comprise patient-level metadata like demographic characteristics, disease history, or laboratory parameters. The Appendix300 dataset comprises 330 laparoscopic surgery recordings, including 325 full-length laparoscopic appendectomies and 5 control recordings from non-appendectomy procedures in pediatric and adult patients treated at five German centers. The dataset includes patient-level clinical metadata (demographics, medical history, clinical symptoms, preoperative laboratory parameters, and histopathologic findings, as well as standardized expert annotations of the laparoscopic grade of appendicitis). This dataset enables novel validation tasks for computer vision in laparoscopic surgery and facilitates simulation of decentralized learning approaches, overall enhancing the breadth and translational relevance of AI-based surgical video analysis.
14 June 2026
Read appraisal →Journal of the American College of Surgeons
Governance Framework for Safe and Ethical Implementation of Artificial Intelligence in Surgery: A Modified Delphi Consensus
BACKGROUND: Artificial intelligence (AI)-enabled clinical decision support systems (CDSS) demonstrate performance comparable or superior to human experts in certain tasks. However, their integration into surgical practice faces a significant implementation gap, alongside ethical, privacy, and legal concerns. Clear governance frameworks are needed to guide their responsible adoption in surgery, to prevent inconsistent application, care quality variation, and exacerbation of algorithmic bias. Here, we establish a systematic, evidence-based, and consensus-driven framework to guide the ethical, effective, and sustainable adoption of AI-enabled CDSS in surgery. STUDY DESIGN: A systematic literature review was conducted of PubMed, Cochrane Library, Medline, and Embase databases until 2024 to identify key governance themes. The themes informed the generation of candidate items, which were then refined through a multiround expert panel consensus process using a modified Delphi approach to produce the final framework. RESULTS: Thematic analysis of 80 full-text articles meeting inclusion criteria identified 4 overarching themes for AI governance: (1) technical prerequisites and model design; (2) clinical implementation and human factors; (3) ethics, safety, and trustworthiness; and (4) bias, fairness, and equity. Panel consensus evaluation resulted in the development of a 19-item framework. CONCLUSIONS: The consensus-driven framework presented here provides foundational guidance essential for navigating the complexities of implementing AI-enabled CDSS safely and ethically in surgery. Addressing the considerations outlined across these 4 core themes can facilitate the responsible adoption of AI, accelerating the transition toward an advanced, data-driven surgical practice while mitigating potential risks.
13 June 2026
Read appraisal →PloS one
The application of large language models in bariatric surgery: A scoping review
BACKGROUND: Exploratory applications of large language models within the specialized field of metabolic and bariatric surgery have begun to emerge. Nevertheless, existing research remains fragmented, lacking comprehensive integration. OBJECTIVE: To conduct a scoping review of studies on the application of large language models in the field of metabolic and bariatric surgery, aiming to provide a reference for clinical practice and future research. METHODS: This scoping review adhered to the Joanna Briggs Institute methodological framework and followed the preferred reporting items for systematic reviews and meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.PubMed, Web of Science, The Cochrane Library, Embase, CINAHL, CNKI, Wanfang, and VIP databases were searched for relevant studies, with the search timeframe from database inception to November 2025. The included literature was summarized and analyzed. RESULTS: A total of 21 English-language studies were included. LLMs were primarily applied in scenarios such as patient education and information consultation, clinical decision support, and professional knowledge assessment. While LLMs performed well in information-provision tasks, they showed low consistency with expert opinions in complex clinical tasks such as individualized surgical recommendations. Performance varied across different models, with GPT-4 generally demonstrating superior performance, and domain-specific models showing professional potential. Current research still faces challenges regarding information accuracy, readability, and clinical applicability. CONCLUSION: Large language models hold auxiliary potential in the field of metabolic and bariatric surgery, particularly for knowledge dissemination and patient education. However, their reliability in complex clinical decision-making remains limited. Future efforts should focus on conducting high-quality studies, advancing model specialization and standardized evaluation, and exploring safe and effective human-AI collaboration models.
7 June 2026
Read appraisal →BMC surgery
Improvement of mobility and motivation in patients with elective colorectal resection using tracking devices and utilizing self-awareness (IMPETUS): a randomized controlled trial in a traditional non-ERAS clinical setting
BACKGROUND: Early postoperative mobilization is a cornerstone of modern perioperative care, including in elective colorectal surgery. Here we evaluated the effectiveness of smart wearables for improving patients' mobility and motivation during the recovery period after elective colorectal resection. METHODS: This prospective randomized two-armed clinical trial enrolled 62 patients undergoing elective colorectal resection. These patients were randomized into an intervention group that received hourly active reminders to mobilize via a smartwatch, and a control group that received only passive monitoring. All patients were given a wearable device that tracked their daily step counts. The primary end-point was the total number of steps taken within five postoperative days. Secondary end-points included complication rates, length of hospital stay, and subjective motivation, assessed using a structured questionnaire. RESULTS: Compared to the control group, the intervention group achieved significantly higher step counts (p = 0.039), and reported increased motivation for mobilization (p = 0.016). The groups did not significantly differ in overall complication rates or duration of hospital stay. CONCLUSION: Smart wearable devices with hourly active reminder functionalities effectively promoted postoperative mobility and motivation. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00039731. Registered 24.03.2026. Retrospectively registered.
29 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Two-dimensional vs. three-dimensional laparoscopic transabdominal preperitoneal (TAPP) hernia repair: a systematic review and meta-analysis
BACKGROUND: Two-dimensional (2D) laparoscopy provides limited depth perception, which may limit performance during technically demanding operations. Three-dimensional (3D) systems offer stereoscopic vision, improving visualization. We compared 3D versus 2D systems in adults for operative time, visualization, and postoperative complications. METHODS: PubMed, Scopus, Web of Science, and Cochrane were searched through December 2025. We included randomized controlled trials and observational studies of patients undergoing TAPP repair, comparing 3D with 2D laparoscopy. Total operative time was the primary outcome; visualization and postoperative complications were secondary outcomes. Risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale, and certainty of evidence using GRADE. RESULTS: Six studies met the inclusion criteria; five were included in the primary meta-analysis (n = 521 patients). Total operative time favored 3D (MD-18.48 min; 95% CI-29.27,-7.69; p = 0.0008), with substantial heterogeneity (I²=94%). Subgroup analysis also favored 3D in RCTs (MD-11.70; 95% CI-17.74,-5.66) and observational studies (MD-26.85; 95% CI-30.55,-23.15). Contrast favored 3D (MD 2.11; 95% CI 0.56, 3.67; p = 0.008), while sharpness was not statistically different (MD 1.49; 95% CI-0.25 to 3.24; p = 0.09). No difference in postoperative complications (MD 1.11; 95% CI 0.75, 1.65; p = 0.59). CONCLUSION: 3D laparoscopy has been proposed to improve visualization and shorten operative time; however this should be interpreted with caution due to very low certainty of evidence and variability in surgeon experience. REGISTRATION/FUNDING: PROSPERO CRD420251272842.
28 May 2026
Read appraisal →BMC urology
Comparison of suction and standard ureteral access sheath versus sheathless flexible ureteroscopy in management of upper ureteral and renal calculi
PURPOSE: Comparative effectiveness of suction versus traditional ureteral access sheath (UAS) remains an area of ongoing research. We aim to compare the outcomes of retrograde intrarenal surgery (RIRS) with suction and standard UAS versus without UAS in the management of renal and upper ureteric stones, with a specific focus on operative efficiency, stone-free rates, and postoperative complications. METHODS: This study was conducted between October 2023 and January 2025, including 90 patients with renal stones ≤ 3 cm and upper ureteric stones ≤ 1.5 cm. Patients were divided into three groups by random Allocation Software (version 2): Group A1 (standard UAS, n = 30), Group A2 (suction UAS, n = 30), and Group B (no UAS, n = 30). Operative time, vision quality, stone clearance, complications, and hospital stay were assessed. RESULTS: Group A2 had the shortest mean operative time (70.1 ± 10.3 min) with significantly better vision compared to Group A1 (114.3 ± 27.0 min) and Group B (125.0 ± 28.01 min) (p < 0.001). Residual stone rates were lowest in Group A2 (3.3%) compared to Group A1 (10.0%) and Group B (26.7%) (p = 0.035). The need for a second procedure was significantly higher in Group B (26.7%) compared to Group A1 (10.0%) and absent in Group A2 (p = 0.002). Hospital stay was significantly shorter in Group A2 compared to Group A1 and Group B (p = 0.005). Fever incidence (Clavien Grade II) was significantly higher in Group B (23.3%) compared to Group A1 (16.7%) and absent in Group A2 (p = 0.005). CONCLUSION: Suction ureteral access sheaths in flexible ureteroscopic lithotripsy for renal stones ≤ 3 cm and upper ureteric stones ≤ 1.5 cm was associated with improved stone clearance, reduced operative time and hospital stay, provide better endoscopic vision, minimized infectious complications and need for second procedure, compared to standard UAS or no sheath. However, outcomes may be influenced by surgeon experience and familiarity with suction-assisted systems. Prospective multicenter studies with larger sample sizes and varying surgeon experience levels are recommended.
27 May 2026
Read appraisal →Journal of robotic surgery
Global evolution of robot-assisted cholecystectomy research in the era of artificial intelligence: a bibliometric and knowledge-mapping study
OBJECTIVE: To systematically map the global evolution, collaborative networks, knowledge structure, and emerging research hotspots in robot-assisted cholecystectomy (RAC) using bibliometric and visualization techniques. METHODS: A comprehensive bibliometric analysis was conducted using the Web of Science Core Collection (2005-2025). Publications were retrieved using predefined search strategies and screened according to strict inclusion criteria. CiteSpace, VOSviewer, and R software were employed to analyze publication trends, co-authorship networks, institutional and national collaborations, co-citation patterns, keyword co-occurrence, and research bursts. Knowledge mapping techniques were used to visualize thematic evolution and intellectual structure. RESULTS: A total of 926 eligible publications were included. Global output demonstrated a continuous and marked increase, particularly after 2016, with citations following a similar upward trajectory, reflecting growing academic impact. The United States dominated both publication output and citation influence, while collaboration networks remained largely regionally clustered with limited cross-national integration. Research was primarily concentrated in high-impact surgical journals, with foundational contributions emphasizing feasibility, safety, and comparative effectiveness. Keyword and co-citation analyses revealed a knowledge structure centered on laparoscopic surgery, bile duct injury, and robotic systems, with emerging clusters highlighting artificial intelligence (AI) and surgical education. Evolutionary trajectory analysis demonstrated a transition from technical feasibility (early stage), to safety and evidence-based evaluation (middle stage), and to training and technological integration (recent stage). Burst detection further identified recent hotspots in AI, cost-effectiveness, and surgical training systems. Emerging evidence also indicates increasing integration of AI-driven systems into RAC, enabling intraoperative decision support, workflow recognition, and early-stage semi-autonomous surgical execution, particularly in standardized procedures such as cholecystectomy. CONCLUSION: RAC research has evolved from early exploratory studies toward increasing technological integration and methodological refinement. Although RAC is not currently among the most dominant clinical indications for robotic surgery, it provides a valuable model for studying surgical standardization, training systems, and emerging intelligent surgical technologies. While current applications remain largely assistive, emerging advances in AI and robotic technologies suggest the potential for future development toward more intelligent and partially automated surgical systems. However, most evidence currently remains experimental and has not yet translated into widespread clinical practice. Future research should focus on strengthening global collaboration, improving high-quality evidence generation, and carefully evaluating the safety, feasibility, and clinical applicability of emerging intelligent surgical technologies.
26 May 2026
Read appraisal →World journal of urology
Retrograde intrarenal surgery versus miniaturized percutaneous nephrolithotomy for renal calculi: a grade-assessed meta-analysis of randomized controlled trials with trial sequential analysis
BACKGROUND: The optimal management of medium-sized (1-3 cm) renal stones remains a clinical dilemma, with retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) serving as competing minimally invasive options. To overcome the selection bias inherent in previous meta-analyses that included observational data, we aimed to compare the efficacy and safety of both techniques by exclusively analyzing randomized controlled trials (RCTs). METHODS: A systematic literature search of five databases was conducted up to February 2026. Only RCTs comparing RIRS and mPCNL were included. The primary outcomes were the single session stone-free rate (SFR) and overall complication rate. Secondary outcomes included stone clearance-related outcomes, operative performance outcomes, and recovery-related outcomes. Data were pooled using a random-effects model, and trial sequential analysis (TSA) was applied. RESULTS: Thirty RCTs encompassing 4173 patients were included. mPCNL demonstrated a significantly higher single-session SFR compared to RIRS (R.R: 0.92, 95% C.I: 0.88-0.96, p < 0.001). RIRS showed a trend toward a lower overall complication rate although the difference did not reach statistical significance (RR = 0.79, 95% CI: 0.63-1.01; p = 0.057), reduced blood transfusion requirements, smaller hemoglobin drops, and shorter hospitalization times. However, RIRS required significantly more postoperative auxiliary procedures. Operative times and high-grade Clavien-Dindo III-V complication rates were comparable between both techniques. TSA confirmed that the cumulative evidence for single-session SFR was sufficient and conclusive, whereas TSA findings for overall complication rate should be interpreted cautiously. CONCLUSIONS: mPCNL achieves significantly higher SFR than RIRS in the management of 1-3 cm renal calculi. However, RIRS was associated with lower bleeding-related morbidity and shorter hospitalization, although no statistically significant difference was observed in the overall complication rate. Therefore, the choice between RIRS and mPCNL should be individualized, balancing maximal SFR against procedural invasiveness according to patient characteristics and stone complexity.
25 May 2026
Read appraisal →Journal of robotic surgery
AI-based automated bleeding monitoring in conventional and robot-assisted laparoscopic surgery: a systematic review
Artificial intelligence has emerged as a promising approach for improving the detection and management of intraoperative bleeding during conventional and robotic-assisted laparoscopic surgery, where delayed recognition of hemorrhage can lead to increased morbidity and procedural complexity. This review synthesizes current evidence on the use of artificial intelligence for intraoperative bleeding monitoring, with a particular focus on performance, feasibility, and clinical integration. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches of PubMed, Scopus, Web of Science, IEEE Xplore, Embase, and grey literature identified studies published between 2016 and 2025 that applied artificial intelligence to bleeding prediction, detection, localization, tracking, and quantitative blood-loss estimation during conventional and robotic-assisted laparoscopic surgery. Data relating to study design, model architectures, evaluation metrics, latency, and integration feasibility were extracted and summarized narratively. Across the included studies, artificial intelligence models demonstrated high detection accuracy in predominantly single-centre, retrospective, or simulation-based settings, with several approaches reporting promising real-time feasibility under controlled experimental conditions. Emerging work also explored bleeding source tracking, blood-loss estimation, and early integration into surgical workflows. However, most studies relied on small, single-center datasets and retrospective validation, limiting generalizability and clinical translation. Overall, artificial intelligence-based bleeding monitoring in conventional and robotic-assisted laparoscopic surgery shows increasing technical maturity and potential, though largely unvalidated in prospective clinical settings. Future research should prioritize large, multi-institutional datasets, prospective clinical evaluation, and optimized low-latency deployment within real surgical workflows to support safe and effective intraoperative use.
24 May 2026
Read appraisal →The journal of trauma and acute care surgery
Chilling the nerve, easing the pain?: A randomized clinical trial evaluating surgeon-administered bedside percutaneous cryoneurolysis for rib fracture pain.
BACKGROUND: A cornerstone of rib fracture management is multimodal pain control, which includes scheduled nonopioid analgesics, as-needed opioids, regional or neuraxial blockade, and surgical stabilization of rib fractures. However, adverse effect profiles and individual factors limit their use in all patients. Surgeon-administered, ultrasound-guided percutaneous cryoneurolysis performed at the patient bedside is a promising analgesic adjunct. METHODS: We performed a prospective, randomized clinical trial assessing benefit and safety of surgeon-administered percutaneous cryoneurolysis to our existing multimodal rib fracture pain control bundle (standard of care [SoC]) for injured adults aged 18 to 64 years. Patients with fractured ribs 3 to 9 were randomized within 72 hours of admission to receive either surgeon-administered, ultrasound-guided percutaneous cryoneurolysis at the bedside and our multimodal pain control bundle, or SoC alone. Patients undergoing surgical stabilization of rib fractures were excluded. The primary outcome was pain score at discharge. Secondary outcomes included hospital length of stay, intervention-associated adverse events, morphine milligram equivalent (MME) use, Short Form (SF)-12, and McGill Pain Score (Patient Reported Outcomes), which were assessed at discharge and 1-, 3-, and 12-month intervals after discharge. RESULTS: Forty-three patients were randomized: 24 in the intervention arm and 19 in the SoC arm, with 3 screen failures. The median age was 53 years (interquartile range [IQR], 45-60 years), 9 patients (23%) were female, the median Injury Severity Score was 13 (IQR, 10-17), and the median number of rib fractures was 6 (IQR, 4-8). Patients were well matched with no differences between groups. No intervention-associated adverse events were identified. Pain scores, MME use, and Patient Reported Outcomes were not different between groups at discharge, 1 month, 3 months, or 12 months. CONCLUSION: Application of surgeon-administered, ultrasound-guided percutaneous cryoneurolysis at the bedside is safe but was not associated with reduced pain or MME use when compared with SoC. ( J Trauma Acute Care Surg . 2026;100: 863-870. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level II.
23 May 2026
Read appraisal →Journal of robotic surgery
A randomized controlled trial comparing robotic NOSES versus robotic TME for Mid-rectal cancer: short-term oncological and perioperative outcomes
This randomized study compared perioperative outcomes between robotic natural orifice specimen extraction surgery (R-NOSES) and robotic total mesorectal excision (R-TME) in participants with mid-rectal cancer. After exclusions, 71 participants in the R-TME cohort and 69 in the R-NOSES cohort were included in the final analysis, from an initial randomized cohort of 150 eligible participants (1:1 allocation). The two cohorts had comparable preoperative characteristics. Intraoperative and pathological outcomes, including blood loss, operative duration, and harvested lymph nodes, showed no notable differences. The rates of overall complication were comparable between the two groups (R-NOSES 13.0% vs. R-TME 15.5%, P = 0.679), and anastomotic leakage did not vary significantly. Conversely, the R-TME group experienced a higher rate of wound complications (5.6% vs. 0.0%, P = 0.045). Notably, the R-NOSES group demonstrated significant advantages in postoperative recovery, including shorter time to first flatus (48 vs. 53 h, P = 0.02), earlier resumption of a liquid diet (79 vs. 84 h, P = 0.041), and markedly reduced VAS pain ratings on postoperative days 1 and 3. In conclusion, for selected patients with middle rectal cancer, R-NOSES appears to be a safe and feasible alternative to R-TME, with similar short-term oncological outcomes. It may offer some benefits in terms of faster recovery, less postoperative pain, and fewer wound-related complications.Trial Registration: ClinicalTrials.gov Identifier NCT06454201.
22 May 2026
Read appraisal →Journal of robotic surgery
Intraoperative surgical needle loss in robotic-assisted and laparoscopic surgery: a systematic review and practical troubleshooting framework
Intraoperative loss of a surgical needle during minimally invasive surgery (MIS) is uncommon but clinically important. In robotic-assisted surgery (RAS), altered sensory conditions and evolving trocar designs may influence both needle-loss mechanisms and retrieval strategy. We systematically reviewed the literature and developed a practical troubleshooting framework. PubMed, Embase, CNKI, and Wanfang were searched from inception to January 2026 in accordance with PRISMA 2020. Studies reporting intraoperative needle loss during abdominal or pelvic MIS or RAS were included. Because of substantial heterogeneity, findings were synthesized narratively. Thirty-three studies were included, comprising 27 original studies and 6 narrative reviews. Quantitative outcome aggregation was restricted to clinical patient-level studies, yielding 37 extractable lost-needle events: 22 during RAS and 15 during conventional laparoscopy. Minimally invasive retrieval was successful in 35/37 cases, whereas incision extension or open conversion was required in 2/37. Recurrent practical risk scenarios included trocar-pathway entrapment, including the hypothesized "Trocar Trap," and possible risk amplification related to absent haptic feedback in RAS. Evidence supporting adjunctive localization tools, including fluoroscopy and magnetic assistance, remained limited and largely non-comparative. Needle loss in contemporary MIS and RAS should be regarded as a workflow-sensitive patient safety event supported mainly by low-level evidence. The most relevant contemporary implications concern robotic workflow, port-pathway inspection, disciplined handoff, and selective use of adjunctive retrieval tools within a stepwise troubleshooting framework. Registration: PROSPERO (CRD420261294460).
22 May 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Wrist-Ankle Acupuncture on Postoperative Nausea and Vomiting Prophylaxis in High-Risk Female Patients: A Pragmatic, Randomized, Single-Blind, Sham-Controlled Trial
BACKGROUND: Postoperative nausea and vomiting (PONV) affects up to 80% of high-risk patients, compromising Enhanced Recovery After Surgery (ERAS) outcomes and prolonging hospitalization. This randomized controlled trial evaluated wrist-ankle acupuncture (WAA) efficacy for PONV prevention in high-risk female surgical patients. METHODS: This single-center, randomized, patient- and assessor-blinded, sham-controlled trial enrolled female patients (aged 18-60 years, ASA I-II) scheduled for elective surgery under general anesthesia with documented motion sickness or previous PONV. Participants received either WAA (sterile needles at four standardized acupoints, 30-minute retention) or sham acupuncture postoperatively. The primary outcome was 24-h PONV incidence using the Rhodes Index of Nausea, Vomiting, and Retching (R-INVR). RESULTS: Among 132 patients (median age 41 years), WAA significantly reduced 24-h PONV incidence versus sham (42.4% vs. 71.2%; RR 0.60, 95% CI 0.42-0.82; p = 0.002). Median R-INVR scores were lower with WAA [0 (0-5) vs. 8 (0-11); p < 0.001]. WAA patients reported significantly reduced nausea/vomiting at 30 min, 6 h, and 24 h (all p ≤ 0.006) and higher satisfaction scores (p < 0.001). Antiemetic use was comparable (9.1% vs. 16.7%; p = 0.299). No adverse events occurred. CONCLUSIONS: WAA significantly reduced PONV incidence and severity with sustained effects and improved satisfaction, offering a promising non-pharmacological prevention strategy.
21 May 2026
Read appraisal →Scientific reports
Quantum machine learning for predicting anastomotic leak: a clinical study
Anastomotic leak is a life-threatening complication following colorectal surgery. This study benchmarks Quantum Neural Networks (QNNs) against hyperparameter-tuned classical models (logistic regression, multi-layer perceptrons, boosting algorithms) for anastomotic leak prediction. Using a 200-patient clinical dataset strictly bounded by a priori medical constraints, we simulated QNNs with ZZFeatureMap encoding and EfficientSU2/RealAmplitudes ansatze under realistic hardware noise. To ensure statistical reliability, performance metrics were averaged across 10 independent optimization runs. The EfficientSU2-BFGS configuration achieved the highest mean AUC of [Formula: see text], while RealAmplitudes with CMA-ES maximized Average Precision ([Formula: see text]). Crucially, at a fixed, clinically necessary sensitivity of [Formula: see text], specific QNN configurations achieved significantly higher specificity (up to [Formula: see text]) and Negative Predictive Value (up to [Formula: see text]) compared to classical models (maximum [Formula: see text] and [Formula: see text], respectively), effectively minimizing false positives. However, classical models maintained superior probability calibration for continuous risk stratification. We conclude that QNNs offer robust discriminative performance for clinical screening, warranting further validation on larger, independent cohorts.
20 May 2026
Read appraisal →Acta cirurgica brasileira
Hemostatic net in cervical and facial surgeries: evidence from a systematic review and meta-analysis
PURPOSE: Hematoma remains the most frequent complication of cervicofacial surgeries. The hemostatic net (HN), a transcutaneous suture designed to minimize dead space and bleeding, has shown promise, but pooled evidence of its safety and efficacy is limited. Thus, we conducted this study to clarify the safety profile and complication rates associated with the use of HN in cervical and facial surgeries. METHODS: A systematic search of MEDLINE, Embase, Scopus, Cochrane, and Web of Science was performed through August 2025. Eligible studies involved adults undergoing cervical and/or facial surgery with HN, with no restrictions on suture caliber or spacing between stitches. The primary outcome was hematoma incidence; secondary outcomes included skin necrosis, seroma, infection, persistent skin marks, patient-reported satisfaction, and other adverse events. RESULTS: Eleven studies including 3,393 patients (2,748 HN; 645 controls) were analyzed. Single-arm meta-analysis of HN cases showed low pooled rates for hematoma (0.6%; 95% confidence interval 0.4-1.0; low certainty), skin necrosis (0.4%; 95% confidence interval 0.1-1.0; low certainty), seroma (1.5%; 95% confidence interval 0.6-4.0; low certainty), infection (0.1%; 95% confidence interval 0.0-25.5), and persistent skin marks (0.6%; 95% confidence interval 0.2-2.1). Comparative analyses showed no significant difference for hematoma (risk ratio = 0.15; 95% confidence interval 0.01-3.20; very low certainty) or seroma (risk ratio = 1.06; 95% confidence interval 0.41-2.75; low certainty). Patient-reported satisfaction data were scarce and nonspecific. CONCLUSION: The HN is a safe technique with very low complication rates, though evidence of superiority over standard surgery remains inconclusive due to limited certainty of meta-analyzed data, heterogeneity of surgical procedures, and the paucity of patient-reported outcomes.
20 May 2026
Read appraisal →BMJ quality & safety
Retrospective validation study of a large language model approach to screening for intraabdominal surgical site infections for quality and safety reporting
Surgical site infections (SSIs), particularly intra-abdominal (IAB) infections, are challenging to identify and remain a resource-intensive focus of infection prevention programmes. Current automated screening measures rely on discrete data from the electronic health record (EHR), such as microbiology results, diagnosis codes and/or return to the operating room. This approach has poor specificity, and therefore surveillance methods depend heavily on additional manual chart review by trained infection preventionists. Large language models (LLMs) offer an opportunity to improve surveillance by synthesising complex clinical documentation alongside structured data elements.We evaluated the performance of a locally hosted LLM (gpt-35-turbo-16k) to improve IAB SSI screening using perioperative clinical notes and microbiology results. The model analysed documentation across the perioperative period (3 days before through 30 days after surgery) to generate case-level SSI summaries and likelihood assessments. We compared the performance of this tool against the current EHR-based screening workflow.Among 1977 abdominal surgical cases, including 56 with confirmed IAB SSIs, the LLM screened 104 cases as high risk, identifying all infections (negative predictive value (NPV) 100%) and achieving a positive predictive value (PPV) of 53.8%. In contrast, the EHR-based workflow identified 288 cases for further review, with a PPV of only 19.4% and the same NPV of 100%. Analysis of 57 224 notes required ~107 million tokens, translating to approximately USD 0.05 per case.An LLM-based approach to SSI surveillance has the potential to substantially improve efficiency while remaining highly accurate and cost-effective. By reducing reliance on manual chart review, this strategy could allow infection preventionists to shift their attention from surveillance toward quality improvement and patient safety initiatives.
20 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Impact of the SUture BIte TEchnique on clinical outcomes after midline laparotomy closure: SUBITE-a systematic review and meta-analysis
BACKGROUND: The objective of this Systematic Review and Meta-Analysis (SR/MA) was to identify the best suture technique (short or large bites) for abdominal wall closure with respect to relevant outcome parameters such as incisional hernia (IH), surgical site infection (SSI) and linea alba (aponeurotic layer of the abdominal wall) dehiscence (LAD). METHODS: Registration was done in PROSPERO, a systematic literature search was performed in three data bases (PubMed, Embase and Cochrane). Randomised controlled (RCT) as well as non-randomised controlled trials (n-RCT) comparing the short (SB) versus large bite (LB) technique for abdominal wall closure after midline laparotomy were eligible for inclusion. Quality assessment was performed for RCTs (ROB) & n-RCTs (ROBINS-1, MINORS). The incidence of IH, SSI, LAD as well as the length of hospital stay (LOS) and time to close the linea alba (aponeurotic layer of the abdominal wall) were analysed as outcome parameters. Odds ratio with 95% confidence intervals were chosen to determine statistical significance. Heterogeneity was explored using the I2-statistics and funnel plots evaluated a possible publication bias. RESULTS: This SR/MA comprised in total 5886 patients (large bite group 3339 vs. 2547 short bite group) enrolled in 7 RCTs and 5 n-RCTs. The SB-technique was associated with a significant lower IH, SSI, FD rate and a shorter LOS compared to the LB-technique (IH: Odds Ratio OR = 0.47 (95% CI 0.38-0.58; p < 0.00001; I2 = 11%)); SSI: OR = 0.53 (95% CI 0.42-0.67; p < 0.00001; I2 = 0%); FD: OR = 0.60 (95% CI 0.38-0.93; p = 0.02; I2 = 0%); LOS: Mean difference in days MD = -1.04 (95% CI -1.70, -0.37; p = 0.002; I2 = 13%), respectively). Furthermore, pooled effect estimates derived from RCTs were comparable to n-RCTs. No statistical relevant publication bias was detected, and the confidence of resulting evidence was high according to the validated GRADE tool. CONCLUSION: This systematic review and meta-analysis demonstrate consistent reductions in incisional hernia and surgical site infection with the small bites technique for midline laparotomy closure. The direction of effect is stable across randomized and comparative studies and supported by available long-term data. The clinical relevance and consistency of these findings support preferential use of the small bites technique in routine practice. The present evidence provides a robust basis for consideration in future updates of EHS abdominal wall closure guidelines. REGISTRATION: PROSPERO, registration number: CRD420251033244, registration date: 16th April 2025.
20 May 2026
Read appraisal →European journal of pediatrics
Development and validation of an explainable machine learning model for predicting surgical intervention in pediatric intestinal obstruction
Pediatric intestinal obstruction, a critical acute abdomen condition, carries a risk of intestinal necrosis. Decisions for urgent surgery lack standardized criteria. This study aimed to develop an explainable machine learning (ML) model to predict surgical indication, reducing diagnostic variability. A retrospective study included 642 children from our center (split into training/internal validation sets) and 137 from two external centers. Surgical indication was defined based on the presence of one or more of the following: evidence of peritonitis on physical examination, radiographic signs of strangulation, or failure of conservative management for > 24 h; in cases of diagnostic uncertainty, consensus among three senior physicians was used as the adjudication standard. We built models using 35 easily obtainable features across eleven algorithms and evaluated performance via AUC and other metrics. SHapley Additive exPlanations (SHAP) provided model interpretability, and an optimal probability threshold was established for clinical stratification. At the optimal threshold determined by maximizing the Youden index, the model achieved a sensitivity of 89% and a specificity of 99% in the internal validation set. The random forest model demonstrated the highest discriminative performance. A streamlined, interpretable model using the eight most important features (including vital sign dynamics and clinical markers) showed no evidence of overfitting based on the close agreement between training and validation performance metrics. It achieved AUCs of 0.988 (internal validation) and 0.981 (external validation). The model has been translated into a convenient clinical tool.Conclusion: Our explainable ML model demonstrates strong discriminative performance in predicting the need for surgery in pediatric intestinal obstruction and is strongly associated with intestinal necrosis. By mitigating the "black-box" concern through SHAP, it offers transparent, interpretable decision support to clinicians.
20 May 2026
Read appraisal →Oral and maxillofacial surgery
Early versus delayed management of maxillofacial fractures: a systematic review and meta-analysis with context-based subgroup analysis
PURPOSE: Maxillofacial fractures are common injuries caused by traffic accidents, interpersonal violence, and falls. In resource-limited or remote settings, definitive management is often delayed due to limited diagnostic facilities, lack of surgical expertise, and referral constraints, raising concerns about increased complication rates. The current literature reports conflicting results. Some studies suggest that delayed management does not significantly affect outcomes, whereas others show higher complication rates and functional impairment. Therefore, this review aims to identify the associations between delayed management and complications. METHODS: This review followed PRISMA guidelines and was registered in PROSPERO. Observational studies published between 2005 and 2025 were systematically retrieved from PubMed, Europe PMC, ScienceDirect, and OpenAlex. Thirteen studies met the inclusion criteria, with nine included in the meta-analysis. RESULTS: Pooled analysis demonstrated no statistically significant difference in overall complication rates between delayed and early management (RR 1.07; 95% CI 0.72-1.60; p = 0.72), with no evidence of substantial publication bias. CONCLUSION: Although no significant difference in the occurrence of complications was found between delayed and early management of maxillofacial fractures, there was a tendency for complications such as infection, malunion, or nonunion to occur more frequently in the delayed management group.
19 May 2026
Read appraisal →Journal of robotic surgery
Perioperative and oncological outcomes of robotic versus laparoscopic low anterior resection in younger rectal cancer cohorts: a systematic review and meta-analysis with narrative functional assessment
Robotic low anterior resection (R-LAR) has been proposed to overcome technical limitations of laparoscopy in rectal surgery. However, previous meta-analyses have evaluated mixed-age populations, and no meta-analysis has specifically investigated younger patients (aged < 65 years) undergoing low anterior resection. This study aimed to compare operative, short-term postoperative, and oncological outcomes between robotic and laparoscopic low anterior resection in this cohort. A systematic review and meta-analysis were conducted according to PRISMA 2020 and the Cochrane Handbook, with prospective registration in Prospero. PubMed, Scopus, and the Cochrane Library were searched up to January 2026. Comparative studies evaluating R-LAR versus L-LAR in younger rectal cancer cohorts, defined as studies with mean patient age ≤ 65 years, were included. Random-effects models were used to calculate pooled mean differences (MD), odds ratios (OR), and hazard ratios (HR) with 95% confidence intervals (CI). Risk of bias was assessed using ROBINS-I and RoB2, and certainty of evidence using GRADE. A total of 16 studies were included. Compared with laparoscopy, R-LAR was associated with longer operative duration (MD 24.59 min, 95% CI 3.85-45.33, p = 0.02, I² = 96%), lower conversion to open surgery (OR 0.38, 95% CI 0.27-0.53, p < 0.0001, I² = 38%), lower overall complications (OR 0.84, 95% CI 0.73-0.97, p = 0.02, I² = 0%), lower 30-day mortality (OR 0.59, 95% CI 0.45-0.77, p = 0.006, I² = 0%), lower 30-day reoperation (OR 0.77, 95% CI 0.61-0.98, p = 0.04, I² = 0%), higher complete TME rates (OR 3.30, 95% CI 2.14-5.10, p = 0.003, I² = 0%) and shorter hospital stay (MD -0.82, 95% CI -1.50 to -0.13, p = 0.02, I²=97%). Estimated blood loss (p = 0.05) and major complications (p = 0.05) were borderline significant in favor of R-LAR. Anastomotic leakage (p = 0.17), postoperative ileus (p = 0.49), time to first flatus (p = 0.12), time to diet initiation (p = 0.10), CRM positivity (p = 0.56), lymph node yield (p = 0.09), local recurrence (p = 0.67), loop ileostomy (p = 0.56), disease-free survival (p = 0.53), and overall survival (p = 0.73) were comparable. The certainty of evidence ranged from very low to moderate. Functional outcomes were insufficient for pooling. Robotic low anterior resection in younger rectal cancer cohorts may improve several perioperative and technical outcomes without compromising oncological adequacy. Further high-quality studies are required to confirm these findings.
19 May 2026
Read appraisal →World journal of urology
Supine mini-PCNL using pneumatic lithotripsy for pediatric renal stones: safety and efficacy in low-income countries
BACKGROUND: Mini-percutaneous nephrolithotomy (mini-PCNL) is an effective surgical technique for pediatric renal stones. However, data comparing different lithotripsy modalities in this population are limited. PURPOSE: To compare the efficacy, safety, and acute renal parenchymal impact of pneumatic lithotripsy versus Holmium: YAG (Ho: YAG) laser dusting during supine mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric patients. PATIENTS AND METHODS: A double-masked, randomized clinical trial was conducted between March 2023 and October 2024. A total of 104 pediatric patients (ages 3-10 years) with solitary renal stones (10-25 mm) were randomized into two groups: Group 1 (n = 53) underwent mini-PCNL using a pneumatic lithotripter, and Group 2 (n = 51) underwent mini-PCNL using Ho: YAG laser dusting. Primary outcomes included operative time, stone-free rate (SFR), complications (Clavien-Dindo), and biochemical markers of renal injury, including Kidney Injury Molecule-1 (KIM-1) and albumin/creatinine (A/C) ratio. RESULTS: Pneumatic lithotripsy demonstrated significantly shorter mean operative times (59.5 vs. 67.6 min, p = 0.007) and lithotripsy times (p < 0.001) compared to the laser group. The stone-free rates were comparable between the pneumatic and laser groups (92.45% vs. 94.1%, p > 0.05). Group 1 (pneumatic) had a significantly shorter hospital stay (2.2 vs. 2.6 days, p = 0.004). While both groups showed postoperative elevations in injury markers, the laser group exhibited significantly higher and more sustained levels of urinary KIM-1 and A/C ratios, as well as higher postoperative RBC counts in nephrostomy samples (p < 0.05). No major complications or perforations occurred in either group. CONCLUSIONS: Pneumatic lithotripsy is a highly effective and safe alternative to laser lithotripsy for pediatric mini-PCNL. It offers comparable operative efficiency, reduced hospital stays, and potentially lower acute tubular injury as evidenced by lower KIM-1 levels. Given its lower cost and comparable stone-free rates, pneumatic lithotripsy is a favorable option for managing pediatric renal stones in resource-conscious settings.
18 May 2026
Read appraisal →Journal of robotic surgery
Perioperative outcomes of transoral endoscopic vs. robotic thyroidectomy: a systematic review and meta-analysis
BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) have emerged as scarless alternatives to conventional open thyroidectomy, offering excellent cosmetic outcomes. However, the comparative perioperative outcomes between these two minimally invasive techniques remain to be systematically evaluated. This meta-analysis aimed to compare the perioperative outcomes of TOETVA and TORT in patients undergoing thyroid surgery. METHODS: A systematic search was performed in PubMed, Embase, the Cochrane Library, and Web of Science from inception to March 1, 2026, for studies comparing TOETVA and TORT. The primary outcomes included recurrent laryngeal nerve injury, hypoparathyroidism, mental nerve injury, seroma, surgical site infection, and postoperative hemorrhage. The secondary outcome included operation time, length of hospital stay, number of lymph nodes dissected, and postoperative pain score. Pooled weighted mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Study quality was assessed using the ROBINS-I tool. RESULTS: A total of 5 studies involving 1,080 patients were included (639 in the TOETVA group and 441 in the TORT group). Compared with TOETVA, TORT was associated with significantly longer operation time (MD = -56.74 min, 95% CI [-73.41, -40.07], p < 0.05) but shorter hospital stay (MD = 0.26 days, 95% CI [0.03, 0.49], p < 0.05). The incidence of transient recurrent laryngeal nerve injury was significantly higher in the TOETVA group than in the TORT group (OR = 3.56, 95% CI [1.14, 11.06], p = 0.03). There were no significant differences between the two groups in the number of lymph nodes dissected, the number of metastatic central compartment lymph nodes, the incidence of permanent recurrent laryngeal nerve injury, mental nerve injury, transient or permanent hypoparathyroidism, seroma, surgical site infection, or postoperative hemorrhage. CONCLUSION: Although TORT is associated with longer operative time, it demonstrates potential advantages in terms of length of hospital stay and neuroprotection.The two procedures are comparable in terms of radicality of lymph node dissection, postoperative pain, and low complication rates. TORT is a safe and effective minimally invasive surgical option with better neural protection, especially suitable for patients prioritizing cosmetic outcomes. Long-term oncological safety still needs to be verified in future multicenter studies with larger samples and longer follow-up durations.
18 May 2026
Read appraisal →Journal of gastrointestinal cancer
Long-term Outcomes of Protocol-based Neoadjuvant Selection and Liver Transplantation Versus Liver Resection for Perihilar Cholangiocarcinoma: A Systematic Review and Meta-analysis
BACKGROUND: Perihilar cholangiocarcinoma (CCA) is an aggressive malignancy that presents significant challenges in terms of diagnosis and treatment owing to its anatomical location. Liver resection and transplantation are the primary curative options; however, their long-term outcomes remain controversial. This study aimed to compare the long-term outcomes of protocol-based neoadjuvant selection and liver transplantation with liver resection for the management of perihilar cholangiocarcinoma. METHODS: A systematic review and meta-analysis were conducted according to the PRISMA guidelines. Electronic databases, including the Cochrane Library, PubMed/MEDLINE, and Embase, were searched for relevant clinical trials comparing liver transplantation with liver resection. RESULTS: Six studies comprising 768 patients (265 in the liver transplantation group and 503 in the liver resection group) were included. Liver transplantation was associated with significantly higher 5-year overall survival and 5-year disease-free survival. They also showed a higher 3-year disease-free survival rate. Patients in the liver transplantation group had a higher R0 resection rate. There were no significant differences in the 3- or 30-day postoperative mortality between the two groups. CONCLUSION: Liver transplantation was associated with improved long-term survival in highly selected patients; however, these findings are limited by significant selection bias and the retrospective study design. The apparent long-term benefit observed with LT must be interpreted cautiously because transplant series frequently report post-transplant rather than intention-to-treat outcomes.
18 May 2026
Read appraisal →Computers in biology and medicine
AI unleashed: A meta-analysis transforming radiological insights in diagnosing abdominal infections
INTRODUCTION: Artificial intelligence (AI)-based imaging modalities are next-generation diagnostic devices for abdominal infections that promise to provide enhanced diagnostic speed and accuracy. This systematic review and meta-analysis critically analyze the diagnostic accuracy of AI-assisted imaging modalities, including for appendicitis, pneumoperitoneum, and cholecystitis, to present a balanced estimate of their clinical utility. METHODS: A systematic literature search was undertaken in PubMed, Scopus, and Cochrane databases to search for studies that assessed the diagnostic accuracy of AI-based imaging modalities for abdominal infections. Eleven studies were included based on the inclusion criteria, and data were pooled for analysis. Diagnostic performance was measured by estimating sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), and area under the curve (AUC) using a random-effects model. Subgroup analyses were done to investigate the effect of infection type on diagnostic accuracy. RESULTS: AI-assisted imaging demonstrated an overall sensitivity of 0.891 (95% CI: 0.824-0.944) and specificity of 0.860 (95% CI: 0.784-0.922) for diagnosing abdominal infections. Subgroup analysis revealed that AI-aided computed tomography (CT) exhibited a sensitivity of 0.902 (95% CI: 0.850-0.948), while ultrasound (US) showed a sensitivity of 0.864 (95% CI: 0.792-0.922). The highest AUCs were observed for pneumoperitoneum (0.985) and appendicitis (0.947), underscoring AI's robust diagnostic capabilities across multiple pathologies. CONCLUSION: AI-imaging modalities significantly enhance diagnostic accuracy for abdominal infections, particularly for appendicitis and pneumoperitoneum. This meta-analysis underscores AI's clinical potential, though future research should prioritize multicenter studies to validate AI models' generalizability and ensure consistent performance across diverse healthcare settings.
17 May 2026
Read appraisal →Journal of robotic surgery
Comparative outcomes of da Vinci SP versus da Vinci Xi platforms in robotic cholecystectomy: a systematic review and meta-analysis
As robotic cholecystectomy adoption accelerates, the evidence comparing the perioperative outcomes of the Da Vinci Xi (DV-Xi) multiport platform to the Da Vinci Single-Port (DV-Sp) platform remains scarce. This meta-analysis provides the first systematic comparison of perioperative outcomes between these platforms. To compare perioperative safety and operative efficiency outcomes between the DV-Sp and the DV-Xi systems performing cholecystectomy. We thoroughly searched PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov from inception till December 22, 2025. The key outcomes of interest included mean operative time, console time, docking time, pain scores on the day of the operation, pain scores after 24 h, estimated blood loss, and length of hospital stay. We conducted random-effects meta-analysis and leave-one-out sensitivity analysis using RStudio v 4.5.2. The ROBINS-I was used for the risk of bias assessment. A GRADE assessment through GRADEpro was performed. Four observational studies comprising 833 patients (DV-Sp: n = 416; DV-Xi: n = 417) met the set inclusion criteria, and no RCTs were found. The DV-Sp showed significantly decreased mean operative time (MD = -2.41 min; 95% CI - 4.09 to - 0.73, p = 0.0049) and console time (MD = - 7.24; 95% CI - 9.77 to - 4.72, P < 0.0001) with no heterogeneity (I² = 0%). Two studies reported reduced pain scores in the DV-SP group. There was no significant difference found in the pooled estimates of post-operative pain scores, blood loss, docking time, and length of hospital stay between the two platforms. The DV-Sp demonstrated modest but consistent reductions in operative and console time with comparable safety to the DV-Xi system. Pain scores on the day of surgery and after 24 h of operation were reported low in the DV-SP group. While the magnitude of time differences is unlikely to impact individual patient outcomes, cumulative reductions across high-volume operating centers may translate into meaningful gains in operating room efficiency. However, substantial heterogeneity, particularly in pain-related outcomes and docking time, warrants cautious interpretation of these outcomes.
17 May 2026
Read appraisal →Techniques in coloproctology
Bridging the gap: a systematic literature review and meta-analysis on the management of rectal wall defect after transanal excision
BACKGROUND: Transanal resection techniques have gained considerable importance in the treatment of benign and malignant rectal neoplasms. However, there is no definitive consensus on whether the rectal defect should be closed or left open after excision. We sought to provide an updated pooled analysis of the management of rectal wall defect after transanal excision. METHODS: In accordance with PRISMA and Cochrane guidelines, this meta-analysis was performed using the PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Google Scholar databases to identify studies comparing perioperative outcomes after rectal defect closure versus leaving the defect open following full-thickness (FT) excision. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using Cochrane's Q test. Risk of bias and certainty of evidence were judged by ROBINS-I and GRADE, respectively. RESULTS: Six comparative studies meeting the inclusion criteria were included in the final analysis. Closing the rectal defect was associated with significantly reduced rectal bleeding (OR = 0.57, 95% CI: 0.35-0.94, p = 0.03; I2 = 26%) and re-admission rates (OR = 0.34, 95% CI: 0.16-0.76, p = 0.008; I2 = 0%) compared with the open group, while other outcomes were not significantly different. A prolonged operative time was noted when the rectal wall defect was sutured (SMD = 0.15, 95% CI: 0.03-0.28, p = 0.02; I2 = 44%). CONCLUSIONS: The present analysis revealed that both approaches are safe and technically feasible; however, closing the rectal wall defect after FT excision of rectal neoplasms was associated with lower bleeding and re-admission rates. Nevertheless, randomized studies with homogeneous protocols and consistent long-term outcome data are still needed to provide definitive answers.
17 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Complications after biosynthetic long-term absorbable mesh implantation for ventral hernia repair in clean and contaminated environments: a systematic review and meta-analysis
BACKGROUND: Ventral hernia repair (VHR) remains a common yet complex surgical procedure, with substantial recurrence and complication rates. Long-term absorbable biosynthetic meshes have been introduced to provide temporary reinforcement while potentially reducing mesh‑related morbidity. OBJECTIVE: This meta-analysis evaluates the safety and effectiveness of long-term absorbable biosynthetic meshes in VHR by synthesizing both comparative and descriptive studies. METHODS: Databases were searched up to October 2025 for studies on VHR with long-term absorbable biosynthetic mesh. Descriptive studies were pooled using random-effects models to determine event rates. Comparative studies were analyzed using odds-ratios (ORs). RESULTS: Thirty-five descriptive single-arm studies and seventeen comparative studies were included. Descriptive hernia recurrence rate was 11.6% (95%CI 9.3-14.3%), surgical site infection (SSI) 11.8% (95%CI 9.2-15.0%), surgical site occurrence (SSO) 21.9% (95%CI 15.9-29.5%), seroma 9.7% (95%CI 7.2-12.9%), and SSO/SSI requiring surgical-intervention (SSOPI) 9.7% (95%CI 7.6-12.3%). Mesh infection and explantation rates were 0.3% (95%CI 0.0-1.0%) and 0.5% (95%CI 0.0-1.6%) both also in single-arm studies. A significantly lower hazard of recurrence 0.47 (95%CI 0.24-0.93), and a non-significantly lower risk of SSI, SSO, mesh explantation, and SSOPI compared to biologic meshes was found in comparative studies. Absorbable meshes showed a non-significant difference in recurrence rate versus permanent synthetic mesh (OR 0.93, 95%CI 0.57-1.52) but significantly lower odds of mesh explantation (OR 0.46, 95%CI 0.27-0.79). CONCLUSIONS: Long-term absorbable biosynthetic meshes show low mesh infection and explantation rates in the available literature. Comparative analyses suggest lower recurrence versus biologic meshes and fewer explantations versus permanent synthetic meshes; however, these findings are based on heterogeneous, predominantly retrospective data with limited follow-up and should not be considered conclusive.
15 May 2026
Read appraisal →Journal of robotic surgery
Robotic versus laparoscopic low anterior resection for rectal cancer: an updated systematic review and meta-analysis
Robotic surgery has increasingly been adopted for the treatment of rectal cancer. However, most previous meta-analyses included heterogeneous rectal procedures, limiting conclusions specific to low anterior resection. The present study aimed to provide an updated systematic review and meta-analysis comparing robotic versus laparoscopic low anterior resection for rectal cancer. This systematic review and meta-analysis was conducted according to PRISMA guidelines and recommendations from the Cochrane Handbook. PubMed, Scopus, and the Cochrane Library were systematically searched from inception to the most recent date. Comparative studies evaluating robotic low anterior resection (R-LAR) versus laparoscopic low anterior resection (L-LAR) for rectal cancer were included. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. Certainty of evidence was evaluated using the GRADE approach. Thirty-three studies including 82,149 patients were analyzed (R-LAR: 56,290; L-LAR: 25,859). R-LAR was associated with a significantly lower conversion rate (OR 0.45, 95% CI 0.40-0.51, p < 0.00001, I²=28%), lower 30-day reoperation rate (OR 0.86, 95% CI 0.77-0.96, p = 0.01, I²=0%), reduced 30-day mortality (OR 0.65, 95% CI 0.52-0.82, p = 0.002, I²=0%), and higher rate of complete total mesorectal excision (OR 2.71, 95% CI 1.38-5.33, p = 0.01, I²=72%). Operative time was significantly longer in the robotic group (MD + 30.58 min, 95% CI 13.71-47.45, p = 0.001, I²=97%). No significant differences were observed for estimated blood loss, overall complications, major complications, anastomotic leakage, postoperative ileus, recovery parameters, length of hospital stay, readmission, circumferential margin positivity, lymph node yield, local recurrence, diverting ileostomy formation, disease-free survival, or overall survival. Robotic LAR may reduce conversion, reoperation, and short-term mortality and may improve completeness of total mesorectal excision, although operative time is longer. These findings suggest potential technical advantages of R-LAR, but high-quality randomized trials are required to determine whether these translate into meaningful clinical benefit.PROSPERO: CRD420261326600.
15 May 2026
Read appraisal →Journal of robotic surgery
Longitudinal health-related quality of life after remote-access versus open thyroidectomy for thyroid cancer: a systematic review and meta-analysis
As remote-access thyroidectomy (RAT) becomes more widely used, evidence on patient- reported outcomes, particularly health-related quality of life (HRQoL), remains scarce and inconsistent. This meta-analysis compared postoperative HRQoL between thyroid cancer (TC) patients undergoing RAT and open thyroidectomy (OT) and assessed changes over time. A comprehensive search of five major databases was conducted from inception to August 2025. Studies reporting HRQoL after RAT or OT were included. Outcomes were grouped by postoperative timepoints. Outcomes were stratified across distinct postoperative timepoints to calculate pooled standardized mean difference (SMD) or mean difference (MD). Heterogeneity was explored through rigorous subgroup analyses encompassing surgical modalities, countries, and assessment instruments. Forty-one studies met the inclusion criteria, and 29 records were included in the quantitative synthesis. RAT demonstrated early advantages in comprehensive quality of life at 1 month and 3 months, and these advantages dissipated long term. Pain trajectories exhibited a biphasic pattern: RAT was associated with lower pain scores on postoperative day 1 but paradoxically higher scores during the 1-2 week period, with subsequent convergence. Cosmetic satisfaction and swallowing function consistently favored RAT from 1-2 weeks through 6 months, while voice outcomes showed no discernible differences. RAT appears to confer selected short- to medium-term patient-reported advantages over OT, particularly in cosmetic satisfaction and swallowing function. But these benefits are heterogeneous and not consistently maintained across all domains or timepoints. Future studies should standardize cross-culturally validated PRO instruments and adopt harmonized follow-up intervals and reporting guidelines to clarify the patient-centered value of RAT.
15 May 2026
Read appraisal →Journal of robotic surgery
Robotic versus laparoscopic intracorporeal anastomosis learning curve: a systematic review
The learning curve for robotic colorectal surgery is increasingly characterised. However, the specific learning curve for intracorporeal anastomosis (IA) remains poorly defined. This review compares robotic and laparoscopic IA with respect to operative time, cases required for proficiency, complication rates, and conversion to extracorporeal anastomosis (EA). A systematic review was conducted in accordance with PRISMA guidelines. The protocol was registered on Open science framework ( https://doi.org/10.17605/OSF.IO/K4MYZ ). On March 18, 2025, OVID and PubMed were searched using the search terms; "laparoscopic," "robotic," "anastomosis," "learning," "education," and "training." Yielding a total of 273 results from PubMed (179) and OVID (94). After screening a total of thirteen studies were included. Thirteen studies met inclusion criteria, including eight comparative analyses and six directly comparing robotic and laparoscopic techniques. Four studies evaluated robotic learning curves without a comparator group, while one was a literature review incorporating institutional experience. Most studies were retrospective (n = 8), with two prospective clinical studies and two experimental simulation-based studies. Hybrid approaches (robotic mobilisation with laparoscopic EA) contributed to heterogeneity (Reitz et al. 2018, https://doi.org/10.1007/s00464-018-6074-7 ). Learning curve assessment was heterogeneous, with most studies using cumulative sum (CUSUM) or risk-adjusted CUSUM (RA-CUSUM) analyses based on operative time or technical performance metrics. Proficiency in robotic IA was reported after approximately 11-29 cases in some series and around 20 cases in others, although larger studies of robotic colorectal surgery demonstrated broader ranges of up to 100 cases. Robotic right hemicolectomy with IA demonstrated a shorter learning curve and reduced anastomosis time compared with laparoscopic IA. Complication rates, conversion rates, and oncological outcomes were comparable between approaches (Gachabayov et al. 2019, Surg Technol Int, 34:163-168). Robotic intracorporeal anastomosis, particularly in right hemicolectomy, appears to have a shorter and less technically demanding learning curve compared with laparoscopic techniques, without compromising safety or oncological outcomes. These findings support a potential role for robotic platforms in facilitating adoption of intracorporeal anastomosis. However, current evidence is limited by retrospective design, small cohorts, and inconsistent definitions of proficiency (Gachabayov et al. 2019, Surg Technol Int, 34:163-168; Van Eetvelde et al. 2022, https://doi.org/10.1007/s11701-022-01514-6 ).
14 May 2026
Read appraisal →Endocrine pathology
Impact of Molecular Testing on Surgical Decision-Making in Indeterminate Thyroid Nodules: A Global Meta-Analysis Across Test Generations
Thyroid nodules with indeterminate cytology represent a clinical challenge owing to uncertain malignancy risk, often leading to diagnostic surgery. Molecular testing has emerged as a promising adjunct to improve risk stratification and guide surgical decision-making. However, the clinical utility and impact of different molecular platforms remain debated. The present study evaluates the impact of molecular testing on surgical decision-making in indeterminate thyroid nodules and compares outcomes between first- and second-generation molecular platforms. A PRISMA-guided systematic review and meta-analysis identified 132 studies including 66,448 thyroid nodules, of which 30,292 (45.6%) were indeterminate (Bethesda III/IV). Pooled analyses included studies directly comparing conventional management with molecular testing or different molecular platforms. Primary outcomes were surgical resection rates and risk of malignancy (ROM), stratified by diagnostic approach and test generation. Conventional management demonstrated significantly higher surgical rates than molecular testing group (OR = 2.258, 95% CI: 1.548-3.293, p < 0.001). ROM among resected nodules was lower in the conventional management compared with the molecular testing group (OR = 0.594, 95% CI: 0.388-0.911, p = 0.017). First-generation molecular tests showed higher surgical rates and lower ROM than second-generation assays (OR = 1.709, 95% CI: 1.122-2.601, p = 0.013; OR = 0.665, 95% CI: 0.515-0.858, p = 0.002, respectively). Exclusion of non-invasive follicular thyroid neoplasm with papillary-like nuclear features attenuated differences in malignancy rates. Molecular testing significantly reduces surgical interventions in indeterminate thyroid nodules without evidence of reduced detection of clinically significant malignancy, particularly with second-generation platforms supporting more individualized and evidence-based management strategies.
14 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Obturator hernia in adults: a systematic review of CT diagnosis and surgical management
PURPOSE: Obturator hernia is a rare but life-threatening pelvic floor hernia occurring predominantly in elderly, underweight women and is associated with delayed diagnosis and high perioperative mortality. This systematic review evaluated the diagnostic performance of computed tomography (CT), factors associated with bowel resection, and short-term outcomes of open versus laparoscopic repair in adults. METHODS: A systematic review was conducted per PRISMA 2020. PubMed/MEDLINE, Scopus, and Web of Science were searched from January 2004 to January 2026. Studies reporting at least three surgically confirmed adult cases were eligible. Three consecutive institutional cases were incorporated as an illustrative clinical adjunct. RESULTS: Twenty-two studies including 876 patients were analysed. The mean age across included studies was 79.7 years; 91.5% were female. Reported preoperative CT sensitivity across included studies was 93.2% (range 66.7-100%). Bowel resection was required in 31.6% and was associated with higher 30-day mortality (19.6% vs. 3.9%). Laparoscopic repair appeared to be associated with lower wound morbidity, shorter hospital stay (5.3 vs. 12.6 days), and lower recurrence (0% vs. 2.8%) in selected patient cohorts, although case-mix differences preclude direct comparison. Mesh was used in 44.3% overall. In three institutional cases (all elderly cachectic women presenting emergently), one underwent TAPP and two underwent open midline laparotomy; primary suture repair was performed in all owing to contamination, bowel compromise, or extreme frailty. CONCLUSION: CT remains the diagnostic cornerstone in obturator hernia. Surgical strategy should be individualised based on haemodynamic status, contamination, and frailty. Reported outcomes represent descriptive trends rather than pooled statistical estimates due to heterogeneity of available data.
14 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Open versus laparoscopic repair in pediatric incarcerated inguinal hernia: a systematic review and meta-analysis
PURPOSE: The optimal surgical approach for pediatric incarcerated inguinal hernia remains controversial. This study aimed to systematically compare the clinical outcomes of laparoscopic repair (LH) and open repair (OH) in children with incarcerated inguinal hernia through a systematic review and meta-analysis. METHODS: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from database inception to March 2026. Comparative studies evaluating LH versus OH in pediatric incarcerated inguinal hernia were included. Primary outcomes included operative time, intraoperative blood loss, and length of hospital stay. Secondary outcomes included intraoperative injury, wound infection, testicular atrophy, and recurrence. Pooled mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using Review Manager 5.4. RESULTS: Nine studies involving 584 pediatric patients were included in the meta-analysis. Compared with OH, LH was associated with significantly shorter operative time and reduced intraoperative blood loss. The length of hospital stay was also significantly shorter in the LH group. In addition, LH showed a significantly lower risk of intraoperative injury and recurrence. No statistically significant differences were observed between the two groups in terms of wound infection or testicular atrophy. CONCLUSIONS: Laparoscopic repair appears to be a safe and effective alternative to open repair for pediatric incarcerated inguinal hernia. Further high-quality prospective studies are warranted to confirm these findings.
14 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Chronic pain after Shouldice versus Lichtenstein inguinal hernia repair: a systematic review and meta-analysis
PURPOSE: The Lichtenstein (mesh) and Shouldice (non-mesh) techniques are the main options for open inguinal hernia repair. This systematic review and meta-analysis compared the prevalence of chronic postoperative pain between them. METHODS: A systematic search was conducted in Medline, Embase and Cochrane databases for studies comparing the prevalence of chronic pain after Shouldice and Lichtenstein techniques in adult patients undergoing inguinal hernia repair. Meta-analysis was performed using RevMan and the effect model was determined based on heterogeneity, assessed by the I² statistic. Subgroup analyses were conducted by mean follow-up duration and study design. RESULTS: Ten studies with 4,122 patients (59.8% Lichtenstein) were included. Shouldice repair was associated with a 34% relative risk reduction in chronic postoperative pain compared to Lichtenstein (RR 0.66; 95%CI 0.56-0.78; p < 0.00001; I² = 5%). Conversely, the Shouldice technique demonstrated a higher risk of long-term hernia recurrence (RR 2.54; 95%CI 1.15-5.63; p = 0.02). There were no statistically significant differences between the two techniques regarding early postoperative complications (RR 1.01; 95%CI 0.85-1.19; p = 0.95) or mean operative time (MD 5.96 min; 95%CI -0.79 to 12.71; p = 0.08). CONCLUSION: Although the Lichtenstein repair is more widely practiced, the Shouldice technique yields significantly lower rates of chronic postoperative pain, albeit with a higher risk of long-term recurrence. This trade-off highlights Shouldice as a potential alternative in selected patients.
14 May 2026
Read appraisal →World journal of urology
Complications of thulium fiber laser lithotripsy: a systematic review and meta-analysis by the EAU-YAU endourology and urolithiasis working group
BACKGROUND: Thulium Fiber Laser (TFL) has emerged as a promising alternative to Holmium: YAG for lithotripsy, yet its safety profile remains fragmented across various trials. This study aims to synthesize available evidence to determine the pooled complication rates associated with TFL lithotripsy . METHODS: A systematic review was conducted following PRISMA guidelines. We searched PubMed, Cochrane CENTRAL, and ClinicalTrials.gov for studies reporting complications of TFL in adult patients with urolithiasis. The primary outcome was the overall complication rate. Secondary outcomes included Clavien-Dindo grading, specific adverse events (fever, sepsis, injury), and stone-free rate (SFR). A random-effects meta-analysis was performed using the Freeman-Tukey double-arcsine transformation. RESULTS: Thirty-eight studies involving 3,329 patients were included. The pooled overall complication rate was 10.42% (95% CI: 8.01%-13.10%; I²=81.9%). Major complications (Clavien-Dindo III-V) were rare, with a pooled rate of 1.19% (95% CI: 0.68%-1.84%). Specific event rates included fever (2.45%), ureteral injury (1.37%), bleeding (1.07%), urosepsis (0.77%), ureteral strictures (0.70) and acute pyelonephritis (0.59%). Meta-regression identified operative time as a significant predictor of complications (p = 0.041), whereas stone size was not (p = 0.358). Subgroup analysis showed higher complication rates in pure renal stone treatments (13.83%) compared to ureteral stones (10.64%). The pooled Stone-Free Rate (SFR) was 87.61% (95% CI: 83.61%-91.12%). CONCLUSION: Thulium Fiber Laser lithotripsy demonstrates a pretty favorable safety profile with a very low incidence of high-grade complications (< 1.2%) and high efficacy.
14 May 2026
Read appraisal →Pediatric surgery international
Selective non-operative management of post-appendectomy abscesses in children: a comprehensive systematic review and pairwise meta-analysis
Post-appendectomy intra-abdominal abscess remains a common complication following pediatric appendicitis. Although drainage has traditionally been considered standard treatment, increasing evidence suggests selected patients may be successfully managed with antibiotics alone. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251075191). PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 20, 2025. Eligible studies included pediatric patients (0-18 years) with post-appendectomy abscess managed with antibiotic vs. invasive drainage. The primary outcome was failure of first-line treatment requiring escalation. Secondary outcomes included recurrence and length of hospital stay. Ten observational studies involving 363 pediatric patients were included (152 drainage, 211 conservative). Treatment success was 80.9% with drainage and 89.1% with antibiotics. Pooled analysis demonstrated no statistically significant difference in treatment success (RR 1.00; 95% CI 0.95-1.05) or recurrence (RR 0.99; 95% CI 0.57-1.74). Drainage was associated with longer hospital stays (MD 3.40 days; 95% CI 0.65-6.14; p = 0.02). Subgroup analyses demonstrated consistent findings. All included studies demonstrated a serious risk of bias due to confounding by indication. An antibiotics-first approach appears viable for clinically stable pediatric patients, achieving comparable outcomes with shorter hospitalization.
13 May 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Vascular and Wound-Healing Implications of Single-Stage Versus Multistage Repair of Anorectal Malformations: A Systematic Review and Meta-Analysis
BACKGROUND: Anorectal malformations (ARMs) are managed using either single-stage or multistage surgical repair. However, concerns persist regarding wound-related complications and long-term functional outcomes, which remain inconsistently reported across surgical approaches. OBJECTIVE: To compare wound-related complications and long-term functional outcomes following single-stage versus multistage repair of ARMs, with emphasis on wound perfusion, dehiscence, and vascular healing dynamics. METHODS: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251006245). PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for studies published between 2000 and 2024 comparing single-stage and staged ARM repair in neonates and infants. Outcomes included wound dehiscence, surgical site infection (SSI), stenosis, prolapse, redo surgery, constipation, soiling, and voluntary bowel movements. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS: Nineteen studies involving 1,972 patients were included. Single-stage repair was associated with a significantly higher risk of wound dehiscence (OR 3.31; 95% CI 1.90-5.79; p < 0.0001), while no significant differences were observed for SSI, stenosis, prolapse, redo surgery, constipation, soiling, or voluntary bowel movements. Moderate to high heterogeneity was noted for selected outcomes. CONCLUSIONS: Single-stage repair provides comparable infection rates and long-term functional outcomes to multistage surgery but carries an increased risk of wound dehiscence. Optimizing tissue perfusion and minimizing tension are essential to improve outcomes. This study highlights the important role of vascular and wound-healing mechanisms in determining outcomes after anorectal malformation (ARM) repair. While single-stage surgery reduces the burden of multiple procedures, it exposes perineal tissues to fecal contamination and potential microvascular stress, which may increase the risk of wound complications.An understanding of tissue perfusion, venous drainage, and local tissue tension is critical during neonatal reconstructive surgery. Incorporating techniques that preserve vascular integrity, minimize tension, and protect the surgical site can help optimize postoperative healing and reduce the risk of wound dehiscence.
13 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Can preoperative optimization improve abdominal wall surgery outcomes? a qualitative systematic review.
BACKGROUND: Ventral hernia repair (VHR) is commonly performed in patients with multiple modifiable risk factors. Preoperative rehabilitation programs aim to optimize these risk factors and improve surgical outcomes; however, their implementation and effectiveness remain variable. This systematic review evaluates current evidence on the role of preoperative optimization in patients undergoing VHR. MATERIALS AND METHODS: Cochrane Central, Embase, and PubMed were searched for studies comparing preoperative interventions versus standard care in patients undergoing VHR. The primary outcome was characterization of rehabilitation strategies. Secondary outcomes included surgical utilization, emergent repair, readmission, surgical site infection (SSI), surgical site occurrence (SSO), recurrence, reoperation, and mortality. RESULTS: Six studies were included, comprising a total of 3,556 patients, of whom 1,805 (50.7%) underwent preoperative optimization. Preoperative optimization interventions were highly heterogeneous and primarily consisted of multidisciplinary programs focused on exercise, weight loss, and lifestyle modification. Control groups varied widely, precluding formal meta-analysis. Studies requiring predefined optimization targets reported unsuccessful rehabilitation rates of 5.1%-45%. Emergent repair occurred in 6.8% of intervention patients in one study. SSI rates seemed lower and ranged from 4.2% to 11.8% in intervention groups versus 11.0%-16.7% in controls, SSO and reoperation rates were generally lower in optimization groups. CONCLUSION: Structured preoperative optimization pathways may be associated with improved short-term outcomes in select patients undergoing VHR. However, the current literature is heterogeneous, and standardized protocols and prospective studies are needed to better define optimal implementation strategies and long-term effectiveness.
11 May 2026
Read appraisal →Pediatric surgery international
Total versus partial fundoplication in children with gastroesophageal reflux disease: a systematic review and comparative meta-analysis of 2633 patients highlighting the trade-off between reflux control and postoperative dysphagia
INTRODUCTION: Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention when medical therapy fails. Nissen (total) and Toupet (partial) fundoplications are the most frequently performed antireflux procedures; however, their comparative effectiveness and safety in the pediatric population remain uncertain. METHODS: A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL from database inception to 2025. Eligible studies included randomized controlled trials and observational studies comparing total and partial fundoplication in patients younger than 18 years with GERD. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models in R software. RESULTS: Eighteen studies including 2,633 children were analyzed. Total fundoplication was associated with a significantly higher risk of postoperative dysphagia compared with partial fundoplication (RR 1.69; 95% CI 1.07-2.68; p = 0.024; I²=12%; n = 1,154), corresponding to an absolute risk increase of 5.7% and a number needed to harm (NNH) of 17. No significant difference was observed in reflux recurrence (RR 0.72; 95% CI 0.21-2.42; p = 0.59; I²=71% n = 834), although event rates were numerically lower after total fundoplication (6.8% vs. 13.7%), corresponding to an absolute risk reduction of 6.9% (NNT = 15). Intraoperative complications (RR 1.11; p = 0.84), postoperative complications (RR 1.49; p = 0.12), reoperation rates (RR 0.95; p = 0.88), and mortality (RR 1.09; p = 0.74) were comparable between procedures. CONCLUSIONS: Total and partial fundoplication demonstrate similar effectiveness for reflux control and overall safety in pediatric GERD. However, total fundoplication is associated with a higher risk of postoperative dysphagia, suggesting that partial fundoplication may offer functional advantages in selected patients.
10 May 2026
Read appraisal →World journal of urology
Clinical and procedural factors influencing ureteral stent dwell time and removal methods after endourological procedures: a systematic review.
INTRODUCTION: Ureteral stents are routinely used following endourological procedures to ensure adequate drainage and prevent obstruction. However, stent-related morbidity remains common, and optimal stent dwell time and removal methods are not well defined. This systematic review aimed to evaluate clinical and procedural factors influencing ureteral stent dwell time and the methods used for stent removal after endourological interventions. METHODS: A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO. MEDLINE and Embase were searched from inception to October 2025. Randomized controlled trials and comparative observational studies evaluating ureteral stent dwell time and/or removal methods in adults undergoing endourological procedures were included. Risk of bias was assessed using RoB 2 and ROBINS-I tools. RESULTS: Thirty-two studies encompassing 4,373 patients were included. Reported stent dwell times varied widely, most commonly ranging between 10 and 14 days in uncomplicated cases, with longer durations associated with increased rates of encrustation and removal difficulty. Removal techniques included rigid cystoscopy (48.7%), flexible cystoscopy (19.9%), extraction strings (23.5%), and device-assisted methods (7.9%). Less invasive approaches, particularly flexible cystoscopy and extraction-string removal, were consistently associated with reduced pain scores and improved patient comfort, although extraction strings carried a small risk of premature dislodgement. CONCLUSIONS: While practice patterns vary, the evidence suggests that a 10-14 day dwell time might be the optimal window to balance healing with the prevention of encrustation. Less invasive removal approaches, particularly flexible cystoscopy and extraction-string techniques, were generally associated with lower pain scores and high procedural success rates in selected patients. While these methods are safe and better tolerated, extraction strings carried a small, reproducible risk of premature dislodgement. High-quality prospective studies are needed to define determinant-based, individualized stent management strategies.
10 May 2026
Read appraisal →Journal of wound care
Exudate management with a next-generation multilayered foam dressing in traumatic and surgical wounds: a prospective, multicentre study
OBJECTIVE: The aim of this study was to evaluate the efficacy, performance and safety of ConvaFoam (Convatec Ltd., UK), a next-generation multilayered foam dressing, in indicated surgical and traumatic wounds. METHOD: This prospective, multicentre, open-label study (ClinicalTrials.gov: NCT05632276) evaluated ConvaFoam dressings in surgical and traumatic wounds. Eligible patients were managed with ConvaFoam dressings in accordance with their instructions for use (maximum seven-day wear time) for ≤4 weeks. The primary endpoint was the proportion of patients and total dressings with excellent exudate management (defined as absence of strikethrough or periwound maceration). Secondary endpoints included: exudate management in dressings worn for seven days; healing rate; wear time; pain on application; usability; and safety. RESULTS: The study enrolled 52 patients (mean age: 48.2 years) with surgical (54%) or traumatic (46%) wounds. Median dressing wear time was five days (interquartile range: 1-7 days). Among patients who completed the study, 81% (38/47) were observed to have achieved excellent exudate management throughout all wound care visits (90% confidence interval (CI): 71, 90%). Excellent exudate management was also observed in 93% (209/224) of total dressings applied (90% CI: 90, 97%), including in 96% (47/49) of dressings worn for seven days. Only one patient in the study experienced periwound skin maceration at any study timepoint. Wound healing was observed in 93% of surgical wounds and 25% of traumatic wounds during the study period. Low levels of pain and high user satisfaction as per numeric pain scale and utility questionnaire, respectively, were reported. CONCLUSION: ConvaFoam dressings demonstrated excellent exudate management in >90% of dressing changes, and may promote an optimal environment for healing in surgical and traumatic wounds.
10 May 2026
Read appraisal →Annual review of biomedical engineering
Artificial Intelligence-Based Analysis of Laparoscopic Imaging for Intraoperative Surgical Decision Support
Across surgical specialties, minimally invasive (laparoscopic) surgery has become a standard technique, as it is associated with less trauma, reduced postoperative complication rates, and quicker recovery for patients as compared with open surgery. Due to the limited field of view and limited haptic feedback, the surgical decision-making process in laparoscopic surgery is currently guided solely by surgeons' visual interpretation of the laparoscopic video stream. Modern artificial intelligence (AI) methods excel at the interpretation of visual data and find applications in clinical routine in fields such as radiology and endoscopy. AI methods could help augment laparoscopic surgery through objective real-time analysis of the laparoscopic video stream. Research studies have demonstrated the feasibility of AI-based surgical scene and process understanding. This review provides an overview of these AI applications, focusing on approaches that could, in the next decade, be translated into intraoperative surgical decision support tools for increased surgical quality and patient safety.
9 May 2026
Read appraisal →Journal of surgical education
Non-Invasive Assessment of Continuous Real-Time Workplace Stress Among Surgeons and Surgical Trainees: A Scoping Review
OBJECTIVES: To describe how physiological parameters were used to characterize continuous, real-time workplace stress among surgeons and surgical trainees, and to identify the advantages and disadvantages of using wearable devices. DESIGN: We conducted a scoping review to examine how wearable devices were used to objectively measure surgeons' and trainees' physiological stress in the workplace. Peer-reviewed English articles published up to September 2023 in Medline (Ovid), Cochrane Library (Wiley), Embase (Elsevier), and PsycINFO (Ebsco) databases using wearable devices used to measure continuous, real-time physiological parameters representing workplace stress among surgeons and surgical trainees were included in the review. SETTING: We included studies that assessed physiological stress in the workplace (e.g., operating room and other clinical environments). PARTICIPANTS: Surgeons and surgical trainees. RESULTS: A review of 61 articles that met inclusion criteria revealed that the most commonly used wearable devices were Polar 13 (21.3%), Medilog: 6 (9.8%), Holter ECG device: 7 (11.5%), and WHOOP! : 6 (9.8%). Physiological parameters used to measure continuous, real-time workplace stress were heart rate, heart rate variability, blood pressure, respiratory rate, and electrodermal activity. Physiological parameters indicated that surgeons were more stressed in the operating room than in other clinical environments. Intraoperative surgeons' stress increased with performing critical steps of the operation, teaching a trainee, the number of intraoperative events, e.g., bleeding, and decreased with years of experience. There was a negative relationship between stress and the surgeon's intraoperative performance. The advantages of using wearable devices' physiologic parameters were objectivity, longitudinal measurement, and minimally obtrusive. The disadvantages were short battery life, inadequate data capture, artifacts, and data loss. CONCLUSIONS: Wearable devices can measure a range of physiological parameters that represent workplace stress continuously among surgeons and surgical trainees.
5 May 2026
Read appraisal →World journal of urology
Thulium fiber laser versus Holmium laser enucleation of the prostate: 24-month outcomes from a prospective randomized non-inferiority trial
PURPOSE: To compare 24-month outcomes of Thulium fiber laser enucleation of the prostate (ThuFLEP) and Holmium laser enucleation of the prostate (HoLEP). METHODS: A 24-month follow-up analysis of a prospective randomized trial including 150 patients (ThuFLEP n = 74, HoLEP n = 76) was conducted. Primary outcome was non-inferior International Prostate Symptom Score (IPSS) and quality of life (QoL) reduction. Secondary outcomes included urinary continence, medication use reduction, erectile and ejaculatory function, and late adverse events. RESULTS: At 24 months, non-inferiority of ThuFLEP regarding IPSS and QoL was confirmed (p = 0.03). Median IPSS improved from 21 preoperatively to 3 after ThuFLEP and from 20 to 4 after HoLEP (p < 0.001), with no significant intergroup differences at any time point (all p > 0.1). Median QoL improved from 4 to 1 in both groups (p < 0.001), likewise without significant differences at any time point (all p > 0.3). Continence rates improved from 74.0% preoperatively to 90.0%, pad usage decreased from 89.8% to 25.4% and ICIQ-SF decreased from 5 to 3 points (all p < 0.001), without intergroup differences (all p > 0.1). Use of medication for lower urinary tract symptoms decreased from 89.4% to 7.7% (p < 0.001). Ejaculatory function declined, while ejaculation-related bother remained unchanged and erectile function improved modestly, all without intergroup differences (all p > 0.1). Three late adverse events occurred exclusively in the ThuFLEP group, without statistical significance (p > 0.1). CONCLUSION: ThuFLEP remains non-inferior to HoLEP for patient-reported functional outcomes at 24 months and demonstrates comparable safety, continence, medication use reduction, and sexual function results over time. Both techniques represent effective, durable and safe surgical options for treating benign prostatic obstruction. TRIAL REGISTRATION NUMBER: DRKS00032699 (18.09.2023, retrospectively registered).
3 May 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Comparison of Functional Outcomes Between Robotic and Laparoscopic Surgery in Rectal Cancer Patients: Systematic Review and Meta-Analysis
BACKGROUND: Robotic and laparoscopic approaches are widely used for rectal cancer surgery. Although robotic systems provide enhanced visualization and dexterity, it remains unclear whether these advantages improve postoperative urinary and sexual function. METHODS: MEDLINE, Embase, Web of Science, and CENTRAL (2000-2025) were searched for studies comparing robotic and laparoscopic rectal cancer surgery. Outcomes included postoperative ileus, urinary retention, and urinary and sexual function. Random-effects meta-analysis was performed using RevMan. Study quality was assessed with MINORS, and certainty of evidence with GRADE. Publication bias was evaluated using funnel plots and Egger's test. RESULTS: Forty-four observational studies (6,121 patients) were included. Robotic surgery was associated with lower urinary retention, though this may reflect publication bias. No significant difference was found in postoperative ileus. Subgroup analyses at 3, 6, and 12 months showed no significant differences in urinary or sexual function. Although pooled results slightly favored robotic surgery, these effects were inconsistent, not sustained, and clinically modest. CONCLUSION: Robotic surgery may reduce urinary retention but shows no consistent functional superiority over laparoscopy. Outcomes at key follow-up points are comparable. As all studies were observational, evidence certainty is low, and findings should be interpreted cautiously. This study provides an updated and comprehensive synthesis of functional outcomes following robotic versus laparoscopic rectal cancer surgery, with a specific focus on clinically relevant time-point analyses (3, 6, and 12 months). Unlike prior meta-analyses, which often emphasize pooled outcomes across heterogeneous follow-up periods, this study demonstrates that no consistent or durable improvements in urinary or sexual function are observed at predefined postoperative intervals. Furthermore, by integrating GRADE-based certainty assessment, this work highlights that the current evidence is predominantly observational and of low to very low certainty. Importantly, the study incorporates contemporary evidence up to 2025, including recent systematic reviews and randomized data, and provides a clinically grounded interpretation by contextualizing effect sizes against minimal clinically important difference (MCID) thresholds. Collectively, this analysis offers a more cautious and clinically meaningful appraisal of functional outcomes, challenging assumptions of functional superiority associated with robotic rectal surgery.
2 May 2026
Read appraisal →The Cochrane database of systematic reviews
Surgery for women with anterior compartment prolapse
BACKGROUND: Anterior compartment prolapse is the most common pelvic organ prolapse. Clinicians have utilised various surgical techniques to minimise the rate of recurrent pelvic organ prolapse (POP). OBJECTIVES: To determine the benefits and harms of surgery for anterior compartment prolapse. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register on 29 April 2024. This includes records indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov and WHO ICTRP. We also handsearched journals, conference proceedings and the reference lists of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared surgical operations in women with anterior compartment prolapse. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed their risk of bias and extracted their data. MAIN RESULTS: We included 41 RCTs evaluating 4531 women. The certainty of evidence ranged from very low to moderate due to risk of bias and imprecision. Anterior native tissue repair versus biological graft at 1 to 2 years There is likely little to no difference between these two methods in terms of awareness of prolapse (RR 1.20, 95% CI 0.80 to 1.81; 5 RCTs, 515 women; moderate certainty). Native tissue repair likely increases the risk of recurrent anterior compartment prolapse (RR 1.53, 95% CI 1.19 to 1.97; 8 RCTs, 707 women; moderate certainty); the result suggests that if 21% of women had recurrent prolapse after biological graft, 24% to 40% would have recurrence after native tissue repair. There may be little to no difference between native tissue repair and biological graft repair groups for repeat surgery for prolapse (RR 0.99, 95% CI 0.45 to 2.17; 6 RCTs, 524 women; low certainty). Surgery for stress urinary incontinence was not reported. There is likely little to no difference between groups in dyspareunia (RR 0.87, 95% CI 0.39 to 1.93; 2 RCTs, 151 women; moderate certainty). De novo dyspareunia was not reported. Anterior native tissue repair versus transvaginal anterior permanent mesh at 1 to 2 years Native anterior tissue repair likely results in more awareness of prolapse than anterior mesh repair (RR 1.77, 95% CI 1.37 to 2.27; 10 RCTs, 1203 women; moderate certainty); the result suggests that if 13% of women were aware of prolapse after mesh repair, 17% to 29% would be aware after native tissue repair. Native tissue repair may result in slightly increased recurrent anterior compartment prolapse (RR 3.21, 95% CI 2.27 to 4.55; 20 RCTs, 2483 women; low certainty). There was moderate heterogeneity (I2 = 73%). The result suggests that if 13% of women had recurrent prolapse after mesh repair, 29% to 58% would have recurrence after native tissue repair. Repeat surgery for prolapse is probably more likely after native tissue repair (RR 2.17, 95% CI 1.31 to 3.58; 14 RCTs, 1799 women; moderate certainty); the result suggests that if 2% of women required repeat surgery after mesh repair, 3% to 8% would do so after native tissue repair. There is likely little or no difference between groups in surgery for stress urinary incontinence (RR 1.32, 95% CI 0.73 to 2.40; 6 RCTs, 967 women; moderate certainty). There is likely little or no difference between groups for dyspareunia (RR 1.06, 0.59 to 1.90; 8 RCTs, 1096 women; moderate certainty). There is likely little or no difference between groups for de novo dyspareunia (RR 0.64, 95% CI 0.36 to 1.12; 11 RCTs, 797 women; moderate certainty); the result suggests that if 7% of women reported dyspareunia after mesh repair, 2% to 8% would do so after native tissue repair. Permanent anterior vaginal mesh versus abdominal sacrocolpopexy at 1 year There may be little to no difference between permanent anterior vaginal mesh and abdominal sacrocolpopexy groups in awareness of prolapse (RR 0.93, 95% CI 0.45 to 1.94; 3 RCTs, 441 women; low certainty). There was some heterogeneity (I2 = 37%). There is likely little or no difference between groups in recurrent anterior compartment prolapse (RR 0.95, 95% CI 0.46 to 1.97; 4 RCTs, 306 women; moderate certainty). There was some heterogeneity (I2 = 69%). The result suggests that if recurrent prolapse occurred in 26% of women after sacrocolpopexy, 12% to 51% would have recurrence after transvaginal mesh repair. There may be little or no difference between groups in repeat surgery for prolapse (RR 1.68, 95% CI 0.56 to 5.04; 3 RCTs, 455 women; low certainty). There may be little or no difference between groups in repeat surgery for mesh complications (RR 2.61, 95% CI 0.62 to 10.99; 2 RCTs, 373 women; low certainty); the result suggests that if 1% of women needed repeat surgery for mesh exposure after sacrocolpopexy, 0.5% to 12% would do so after transvaginal mesh repair. There may be little or no difference between groups in surgery for stress urinary incontinence (RR 0.78, 95% CI 0.20 to 3.12; 2 RCTs, 299 women; low certainty). There was some heterogeneity (I2 = 60%). Dyspareunia was not reported. De novo dyspareunia is probably more likely to be reported with permanent anterior vaginal mesh than after abdominal sacrocolpopexy (RR 2.15, 95% CI 1.17 to 3.98; 2 RCTs, 248 women; moderate certainty); the result suggests that if 10% of women reported dyspareunia after abdominal sacrocolpopexy, 12% to 40% would do so with permanent anterior vaginal mesh. AUTHORS' CONCLUSIONS: Recurrence is probably more likely after native tissue repair than with biological graft or absorbable synthetic mesh at one to two years. We found no data for surgery for stress urinary incontinence. Anterior native tissue repair likely increases awareness of prolapse, recurrence and surgery for prolapse compared with transvaginal anterior permanent mesh repair. It is likely that fewer women report dyspareunia after abdominal sacrocolpopexy than with permanent mesh repair. For other outcomes, there was little or no difference between the groups being compared. Many of the transvaginal permanent meshes evaluated have been removed from the market because of reported complications. Five studies tested mesh kits that are currently available. We suggest that clinicians and women use caution when utilising these products as their long-term safety and efficacy have not yet been established.
28 Apr 2026
Read appraisal →Annals of medicine
Construction of an XGBoost-SHAP-based malignant transformation risk prediction model for gallbladder polyps
BACKGROUND: To develop and validate a risk prediction model for malignant transformation in patients with gallbladder polyps (GBPs) using an interpretable machine learning framework and evaluate its predictive accuracy. METHODS: A retrospective cohort of 1,027 surgical patients was enrolled from Yantai Yuhuangding Hospital (training set: n = 933) and Shanghai Eastern Hepatobiliary Surgery Hospital (validation set: n = 94). Feature selection for the training set was performed using the least absolute shrinkage and selection operator (LASSO) regression method. A predictive model was constructed with the XGBoost machine learning algorithm and evaluated using Shapley Additive exPlanation (SHAP). RESULTS: LASSO regression identified five significant risk factors for malignant transformation in GBPs: presence of concomitant cholecystitis, polyp count, polyp base width, age, and maximum polyp diameter. The area under the receiver operating characteristic curve (AUC) was 0.862 (95% confidence interval [CI]: 0.8342-0.8893) in the training set and 0.777 (95% CI: 0.6804-0.8737) in the validation set. SHAP analysis illustrated the contribution of each factor. CONCLUSION: This study developed and validated a risk prediction model for malignant transformation in patients with GBPs. The model demonstrated favorable discrimination, calibration, accuracy, and clinical applicability. Integration with SHAP technology may assist clinicians in optimizing treatment and management strategies.
27 Apr 2026
Read appraisal →Journal of plastic surgery and hand surgery
Characteristics and prognosis of skin cancer arising from burn scars: a systematic review
BACKGROUND: Burn scars are recognized risk factors for malignant skin transformation, most notably Marjolin's ulcer (MU). Despite extensive documentation in case reports and series, the epidemiological characteristics and prognosis of burn scar-related skin cancers have lacked large-scale systematic synthesis. METHODS: We conducted a systematic review in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, registered with PROSPERO (CRD42024545404), covering literature from PubMed, Scopus, and Web of Science up to 18 January 2024. Eligible studies included case reports, case series, and observational studies reporting any type of skin cancer in burn scars. Data were extracted on demographics, burn and tumor characteristics, treatment, latency, outcomes, and risk of bias using Joanna Briggs Institute tools. RESULTS: A total of 211 studies reporting 830 cases were included. The mean latency period from burn injury to cancer diagnosis was 21.7 years (SD = 19.6). Males constituted 53% of patients, with third-degree burns predominating (89.37%) and lower limbs being the most affected site (33.59%). Squamous cell carcinoma (SCC) was the most frequent malignancy (67.19%), followed by basal cell carcinoma (BCC, 3.83%) and other cancers (15.33%). Recurrence occurred in 13.2% of cases; mortality was 6.96%. SCC accounted for most deaths (63.8%), while melanoma and sarcoma exhibited high rates of recurrence and mortality. Lymph node metastasis and distant metastasis were found in 7.56 and 4.74% of cases, respectively. CONCLUSION: Skin cancers arising from burn scars, especially SCC, demonstrate aggressive clinical behavior with significant morbidity and mortality. Reduced latency periods and high metastatic potential highlight the importance of vigilant, long-term surveillance and radical initial treatment. This review provides a contemporary benchmark for epidemiological understanding and supports calls for international registries, molecular diagnostics, and standardized management protocols for burn scar malignancies.
25 Apr 2026
Read appraisal →BMJ open
Early mobilisation after abdominal surgery: a concept analysis
OBJECTIVE: To clarify and define the clinical practice concept of early mobilisation after abdominal surgery. DESIGN: A concept analysis guided by Walker and Avant's method. DATA SOURCES: MEDLINE (Ovid), AMED-(Ovid), Embase (Elsevier) and CINAHL (EBSCO) were searched through 5 December 2024. ELIGIBILITY CRITERIA: Relevant studies that included combinations of the terms 'early mobilisation', 'early ambulation', 'early acceleration', 'abdominal surgery' and 'surgical procedures' were selected. We restricted the search to English full-text publications involving adult patients, limited to the year 2000 and onward. Inclusion criteria were original research articles describing the timing and/or type of mobilisation. DATA EXTRACTION AND SYNTHESIS: The study derives its defining attributes, antecedents and consequences through data analysis. To enhance understanding of the model, we constructed related and contrary cases of the concept and outlined relevant empirical referents. RESULTS: In total, 140 studies were included in the analysis. Early mobilisation is characterised by the key defining attributes of initiating active physical movement, including standing, sitting in a chair or walking, within the first 24 hours of surgery. Antecedents include haemodynamic and respiratory stability, adequate pain management, and the patient's cognitive and physical readiness. Contextual antecedents include competent and adequately staffed healthcare teams. Consequences include improved physiological recovery and enhanced postoperative outcomes. CONCLUSIONS: This analysis provides a clarified, practice-focused definition of early mobilisation after abdominal surgery. By delineating its key attributes and contextual prerequisites, the study offers a conceptual foundation that can support clinical guidelines, promote consistent implementation and inform future research aimed at optimising postoperative recovery.
20 Apr 2026
Read appraisal →Journal of gastrointestinal cancer
Effect of Probiotics on the Clinical Outcome and Inflammatory Response in Gastric Cancer Surgery: A Double Blinded Randomized Control Trial
BACKGROUND AND AIM: Gut dysbiosis contributes to postoperative complications and worsens the inflammatory and immune dysfunction in gastric cancer (GC) patients. Probiotics may mitigate these effects by modulating gut microbiota. This study aimed to evaluate the effect of probiotics on the length of hospital stay, other post-operative clinical outcomes, nutritional status, inflammatory and immune markers in patients undergoing gastrectomy for gastric cancer. METHODS: This was a single-centred, prospective, double blinded, placebo-controlled trial. Participants were patients who underwent open gastrectomy for gastric cancer. Participants were randomized to receive probiotics or placebo for 10 days starting on postoperative day (POD) 1. Blood samples were collected preoperatively and POD 10 to assess haemoglobin, total counts, albumin, IL6, TNFα, and IgA. Clinical outcomes including time to first flatus, first passage of stools, oral diet resumption and length of hospital stay (LOHS). Postoperative complications were monitored for 30 days and classified using the Clavien-Dindo system. RESULTS: Of 42 participants (22 probiotic, 20 placebo), baseline characteristics were comparable. The probiotic group had a significantly shorter median LOHS (9 vs. 12 days, p<0.05), earlier time to first passage of flatus (2.6 vs. 4.3 days, p<0.05), earlier time to first passage of stools (3.6 vs. 5.7 days, p<0.05), and oral diet resumption (3.6 vs. 5.7 days, p<0.05). No significant differences were observed in inflammatory markers (TLC, IL-6, TNF-α), immune markers (IgA), nutritional status (albumin, haemoglobin), or postoperative complications (p>0.05). CONCLUSION: Postoperative probiotic supplementation reduced LOHS and improved gastrointestinal recovery in GC patients undergoing gastrectomy, but did not significantly affect inflammatory, immune, or nutritional markers.
20 Apr 2026
Read appraisal →BMJ open
Report cards and outcome measurements to improve the safety of surgical care (North America): an updated systematic review from Making Healthcare Safer IV
OBJECTIVES: In the USA, an estimated 40-50 million operations are performed annually, with high rates of adverse events. Since the 1980s, report cards have been used for outcome measures and to improve safety of surgical care. As part of Making Healthcare Safer IV-an initiative aimed at publishing evidence-based reviews as they are completed to help healthcare leaders, researchers and policymakers act more quickly on evidence-supported practices-we performed an updated review on the certainty of evidence on patient safety practices related to the use of surgical report cards and outcome measurements. DESIGN: Systematic review using the Grade of Recommendations Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES: PubMed, Web of Science, Scopus and the Cochrane Library were searched from November 2011 to May 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included primary research studies (randomised control trials or observational studies with a comparison group, including pre-post studies) or observational studies that investigated a surgical report card in adult or paediatric surgical patients at the hospital or surgeon level in inpatient or outpatient settings. Excluded studies included: narrative reviews, scoping reviews, editorials, commentaries, abstracts, studies that measured only patient knowledge or levels of engagement or studies using local surgical dashboard data. DATA EXTRACTION AND SYNTHESIS: Screening and eligibility were done in duplicate, while data extraction was done by one reviewer and checked by a second reviewer. Specific items in the Risk Of Bias In Non-randomised Studies - of Interventions tool and a modification of the National Institutes of Health Tool were used to assess for bias in studies. Two reviewers assessed each study for risk of bias. A modified version of the GRADE framework was used to assess the certainty of evidence. RESULTS: We identified 19 studies that met the inclusion criteria: 13 primary research studies and 6 descriptive studies of surgical collaboratives. Of the primary studies, nine used a pre-post or longitudinal study design and four used a regression discontinuity or concurrent controlled design. Seven of the studies were about the American College of Surgeons National Surgical Quality Improvement Project. Five studies were from single institutions and the remainder included nine to greater than 700 hospitals. Pre-post studies of report cards that prompted quality improvement (QI) programmes all reported improvements in outcomes, longitudinal studies reported benefits in some but not all outcomes and one in four controlled before-and-after studies reported a statistically significant mortality benefit. All studies, except for one, were at moderate or high risk of bias. Six collaboratives were identified with preliminary data. CONCLUSIONS: Based on the above evidence, the theoretical rationale and parallel evidence in other settings, we judged that it was moderate certainty that report cards and outcomes measurements can improve surgical outcomes. However, given the evidence from studies where report cards were actively linked to institutional QI initiatives, we recommend that outcome data must be paired with actionable QI efforts to meaningfully improve patient outcomes.
19 Apr 2026
Read appraisal →JMIR research protocols
Evaluating the Role of Surgical Telementoring in the Acquisition of Surgical Skills in Laparoscopic Cholecystectomy: Protocol for a Pilot Randomized Controlled Trial
BACKGROUND: Developing surgical skills among residents requires time and resources, often in conflict with the goals of efficiency and hospital economics in surgical practice. Optimizing resident training may prevent a decline in quality. Skilled surgeons are vital to effective and safe surgical performance, yet the training trajectory for surgical residents is often inefficient, particularly in the era of minimally invasive surgery. A framework that efficiently disseminates surgical skills is essential to cultivate skilled future surgeons within an acceptable time frame. Surgical telementoring (ST) aligns well with minimally invasive surgery because the mentee operating in the field shares the telementor's perspective. Despite growing experience with telemedicine, data on educational outcomes remain limited. OBJECTIVE: We aim to conduct a pilot randomized controlled trial (RCT). Data collection will inform a future full-scale RCT evaluating whether real-time ST, combined with structured postoperative coaching, is superior to traditional on-site mentoring in developing laparoscopic cholecystectomy skills among surgical residents. METHODS: Eligible residents will be randomly assigned in a 1:1 ratio to either the intervention group (real-time ST and postoperative coaching) or the control group (traditional intraoperative hands-on teaching). This research adheres to the extended SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statements for pilot RCTs and follows the intention-to-treat principle. Residents in both groups will perform 5 consecutive procedures under standardized intraoperative conditions. The primary outcomes are the Global Operative Assessment of Laparoscopic Skills (GOALS) score and the Non-Technical Skills for Surgeons (NOTSS). We hypothesize that the intervention group will show a 3- to 5-point improvement in the GOALS score compared with the control group. To achieve 0.8 statistical power, a P value <.05, and a 20% dropout rate in a definitive RCT, 12 residents per group are required. We present a pilot RCT with 5 residents per group. Challenges encountered during the trial will be reported, and amendments will be proposed to assess the need for a future definitive RCT. RESULTS: The primary outcomes will be technical and nontechnical surgical skills, measured by the GOALS and NOTSS scores, respectively. Patient-reported experience measures and satisfaction scores of eligible mentees and mentors will be analyzed as secondary outcomes. The ST system configuration at the 2 inclusion centers was completed in December 2023. Ethics approval and the most recent update report to ClinicalTrials.gov were obtained on October 23, 2023, and December 8, 2024, respectively. Recruitment of residents to the study commenced in spring 2024. Recruitment is expected to be completed in May 2026, with data analysis in November 2026 and manuscript submission of results in January 2027. CONCLUSIONS: The SURGTEACH (Surgical Telementoring in Acquisition of Surgical Skills of Laparoscopic Cholecystectomy) trial is the first pilot RCT evaluating ST for educational outcomes. This research may provide high-quality evidence to improve surgical education, particularly in rural hospitals.
18 Apr 2026
Read appraisal →BMJ open
Prevalence of incidental findings requiring interventions in CT for trauma patients in the emergency department: a systematic review and meta-analysis
OBJECTIVE: To systematically review and meta-analyse the prevalence of incidental findings (IFs) requiring interventions identified in CT performed for patients with traumatic injuries in the emergency department, including pathologically confirmed cancers and emergent non-traumatic vascular pathologies. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE and Cochrane CENTRAL databases from database inception to 22 November 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective or retrospective studies involving traumatic injury patients presented at the emergency department reporting IFs of clinical significance detected through CT with any interventions proposed were included. Studies that exclusively included paediatric populations were excluded. The systematic review methods included double-screening, dual assessment of eligibility and study validity, dual data extraction, Bayesian multivariate random-effects meta-analysis of prevalence and employing the Grading of Recommendations, Assessment, Development and Evaluations' rating for the certainty of evidence. The primary outcomes were IFs requiring any interventions, and subset IFs requiring urgent interventions. Secondary outcomes were histologically confirmed cancers and emergent non-traumatic vascular pathologies. RESULTS: 22 studies (1 with a prospective and 21 with a retrospective design) mainly from high-income countries using limited-quality data based on clinical practice involving 18 538 patients were included. 9 studies evaluated the whole body, while 13 evaluated selective body regions. The grading criteria for IFs were non-uniform, and the image interpreters involved had diverse experience and expertise. The summary prevalence estimates for IFs requiring any interventions, urgent interventions, pathologically confirmed cancers and emergent non-traumatic vascular pathologies detected in the whole body were 29.8% (95% credible interval (CrI) 20.4% to 42.9%; very low certainty), 7.6% (95% CrI 4.5% to 14.8%; low certainty), 0.6% (95% CrI 0.3% to 1.6%; moderate certainty) and 0.3% (95% CrI 0.1% to 0.9%; moderate certainty), respectively. These findings were largely identified in the chest or abdomen and pelvis, with the overall detection frequency reduced with the scanned body regions narrowed (very low to moderate certainty). Sparse data on the head, neck and spine resulted in limited results. CONCLUSIONS: IFs identified in trauma whole-body CT requiring intervention are prevalent and can lead to substantial medical costs. The widely reported prevalence range suggests variations in radiologist recommendations and reporting in clinical practice and calls for standardisations. IFs requiring urgent intervention are not rare, which leads to a diagnosis of significant diseases including cancers and urgent vascular pathologies. Future studies should report long-term, patient-relevant results based on standardised classification and reporting systems. PROSPERO REGISTRATION NUMBER: CRD42020187852.
18 Apr 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
The impact of socioeconomic status in hernia treatment: a qualitative systematic review.
INTRODUCTION: Hernias are among the most common surgical conditions worldwide. However, access to optimal treatment remains disproportionately distributed. Socioeconomic disparities play a critical role in determining whether patients receive timely surgical intervention, access to minimally invasive techniques, or suffer from postoperative complications due to delayed or suboptimal care. This study aims to evaluate the impact of socioeconomic disparities on the treatment of ventral hernia repair. METHODS: This systematic review was conducted following PRISMA guidelines. A comprehensive search was conducted using MEDLINE/Pubmed, EMBASE, Web of Science, Cochrane Library, and LILACS, from inception until March 2026 without any filter applied. A search strategy was created using the MeSH terms. Our inclusion criteria comprise studies related to socioeconomic disparities in ventral hernia repair within the United States. Due to heterogeneity in study designs, socioeconomic variables, and outcome definitions, a meta-analysis was not feasible, and findings were synthesized using a narrative synthesis. A qualitative assessment of included studies was made using the Cochrane Risk of Bias tool, ROBINS-I. RESULTS: A total of 28 studies were included, encompassing 2,096,513 patients with ventral hernia. Most were retrospective cohorts, with sample sizes ranging from a few hundred to over 665,000 patients. Across studies, patients with government funded insurance (Medicaid or Medicare) generally experienced higher rates of complications, readmissions, and recurrences compared to commercial insured patients, although the magnitude of association varied. Odds ratios demonstrated increased risks of wound complications, readmission, and recurrence among government funded insured and uninsured patients, while commercial insured and higher-income patients were more likely to undergo advanced surgical approaches and had shorter hospital length of stay. Some studies also highlighted socioeconomic and racial disparities, with vulnerable populations and minority groups showing disproportionately higher complication rates and different patterns of insurance coverage. CONCLUSION: This systematic study demonstrates significant racial and socioeconomic disparities in ventral hernia repair. Government funded insurance holders or lower incomers, faced higher complication rates, more emergent presentations, and worse outcomes, including increased mortality and readmissions. Moreover, they usually have less access to minimally invasive and robotic techniques. These inequities highlight systemic barriers in healthcare access.
18 Apr 2026
Read appraisal →Journal of the American College of Surgeons
Effect of Adhesion Barrier Use During Ladd Procedure for Intestinal Malrotation on Postoperative Midgut Volvulus and Postoperative Small-Bowel Obstruction: A Retrospective Cohort Study Using a National Inpatient Database
BACKGROUND: Postoperative midgut volvulus is a life-threatening complication after the Ladd procedure. An adhesion barrier to prevent postoperative small-bowel obstruction could increase postoperative midgut volvulus incidence due to reduced adhesions. We aimed to examine the effect of adhesion barrier use during Ladd procedures on postoperative midgut volvulus and postoperative small-bowel obstruction. STUDY DESIGN: We retrospectively identified patients younger than 18 years who underwent the Ladd procedure between July 2010 and March 2021, using a Japanese nationwide inpatient database. We used propensity score overlap-weighting analyses to compare reoperation for midgut volvulus, rehospitalization, and operation for small-bowel obstruction, mortality, total rehospitalization length, and total rehospitalization cost within 1 year after the Ladd procedure between patients in whom adhesion barrier was used (barrier group) and patients in whom it was not used (nonbarrier group). RESULTS: Of the 1,159 eligible patients, adhesion barrier was used in 314 and not used in 845 patients. The proportion of reoperations for midgut volvulus did not differ between the barrier and nonbarrier groups (3.5% vs 2.7%; risk difference 0.8%, 95% CI -1.9 to 3.5). The proportion of rehospitalization due to small-bowel obstruction was lower in the barrier group than in the nonbarrier group (2.6% vs 6.3%; risk difference -3.6%, 95% CI -6.6 to -0.8). No significant differences were observed in operation for small-bowel obstruction, mortality, and total length and cost of rehospitalization. CONCLUSIONS: The use of adhesion barrier during the Ladd procedure can prevent rehospitalization due to postoperative small-bowel obstruction without increasing the incidence of postoperative midgut volvulus.
17 Apr 2026
Read appraisal →Journal of the American College of Surgeons
Predictive Model for Mild Autonomous Cortisol Secretion in Patients Evaluated in Artificial Intelligence-Driven Adrenal Incidentaloma Clinic
BACKGROUND: Mild autonomous cortisol secretion (MACS) is present in approximately 20% to 50% of adrenal incidentalomas. These patients do not exhibit the clinical manifestations of overt Cushing's syndrome, and differentiation from nonfunctional adrenal incidentalomas (NFAI) is typically made after a low-dose dexamethasone suppression test. The objective of this study was to develop predictive models to distinguish MACS from NFAI using clinical and radiological parameters. STUDY DESIGN: This retrospective study included patients evaluated in an adrenal incidentaloma clinic between February 2022 and August 2024 who were diagnosed with either NFAI or MACS. Demographic characteristics, medical and medication history, and radiological features were collected. Patients were randomly divided into training and test cohorts in a 3:1 ratio. Predictive models for MACS were developed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and random forest (RF) algorithms. RESULTS: A total of 397 patients were included, with 297 allocated to the training set and the remaining 100 to the test set. The mean age was 62.3 years, and 55% of participants (n = 220) were women. MACS was present in 34% of the study population (n = 136). The most influential predictive factors of MACS were BMI, Posterior Adiposity Index, and the number of antihypertensive medications. The LASSO and RF models achieved discrimination with area under the curve values of 0.686 and 0.736, respectively. At Youden Index thresholds balancing sensitivity and selectivity, the LASSO model had 58.8% sensitivity, 75.8% specificity, and 70% accuracy, whereas the RF model had 64.7% sensitivity, 75.8% specificity, and 72% accuracy. CONCLUSIONS: Predictive models incorporating clinical and radiological characteristics offer a promising approach for distinguishing MACS from NFAI in patients with adrenal incidentalomas.
17 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of prehabilitation strategies in enhancing recovery and postoperative outcomes in laparoscopic sleeve gastrectomy patients
OBJECTIVE: This study aims to explore the application of a multimodal prehabilitation strategy in patients undergoing laparoscopic sleeve gastrectomy (LSG) and to evaluate its impact on postoperative recovery, weight loss, and quality of life. METHODS: This was a single-center, prospective, randomized controlled trial. A total of 120 eligible patients undergoing elective LSG were enrolled and randomly assigned to either the control group (n = 60), receiving routine perioperative care, or the observation group (n = 60), receiving a structured 5-7-day prehabilitation program. RESULTS: Compared to the control group, the observation group had a significantly shorter postoperative hospital stay (mean difference [MD] -1.23 days; 95% CI -1.67 to -0.79; P < 0.001) and a lower incidence of complications (1.7% vs. 11.7%; odds ratio 0.13, 95% CI 0.02-0.89; P = 0.038). At 6 months, the prehabilitation group showed a greater reduction in BMI (MD -3.78 kg/m2; 95% CI -5.10 to -2.46; P < 0.001) and higher quality of life scores across all eight SF-36 domains (P < 0.001 for all). CONCLUSION: The application of prehabilitation strategies in patients undergoing laparoscopic sleeve gastrectomy can effectively promote faster postoperative recovery, enhance weight loss, improve quality of life, and reduce the incidence of postoperative complications. It is a safe and effective approach, worthy of clinical promotion. Furthermore, the principles of this multimodal prehabilitation framework offer valuable translational insights for optimizing perioperative supportive care in surgical oncology.
12 Apr 2026
Read appraisal →The Cochrane database of systematic reviews
Penetrating versus non-penetrating mesh fixation in laparoscopic groin hernia repair
RATIONALE: Groin hernia is a common condition, and the only curative treatment is an operation where laparoscopic groin hernia repair is the recommended choice. During laparoscopic repair, a mesh is placed in the groin, which many surgeons choose to fixate, but the best fixation method regarding chronic pain and recurrence has not been established. Theoretically, non-penetrating mesh fixation (glue or self-adhesive mesh) could result in a lower risk of chronic pain, while penetrating mesh fixation (tacks, staples, and sutures) could give a reduced risk of recurrence. OBJECTIVES: To assess the benefits and harms of penetrating versus non-penetrating mesh fixation in adults undergoing laparoscopic groin hernia repair. SEARCH METHODS: We searched CENTRAL, MEDLINE Ovid, Embase Ovid, ClinicalTrials.gov, and the WHO International Clinical Trial Registry Platform. Additionally, we performed reference checking, forward and backward citation searching, and contacted study authors to identify eligible studies. The latest search date was 14 November 2024. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) that compared non-penetrating (glue or self-adhesive mesh) with penetrating (tacks, staples, and sutures) mesh fixation in laparoscopic groin hernia repair in adults. OUTCOMES: The critical outcomes were chronic pain measured ≥ 6 months postoperatively and recurrence assessed ≥ 12 months postoperatively. Other important outcomes were acute pain, haematoma, mesh infection, serious vascular intraoperative events, operative time, and convalescence. RISK OF BIAS: We used the RoB 2 tool to assess the risk of bias for chronic pain (dichotomous and continuous), recurrence, acute pain (dichotomous and continuous), haematoma, mesh infection, serious vascular intraoperative events, operative time, and convalescence (both dichotomous and continuous). SYNTHESIS METHODS: We synthesised results for each outcome using meta-analysis where possible by applying a random-effects model, calculating the risk ratio (RR) using the Mantel-Haenszel method for dichotomous data and calculating the mean difference (MD) using the inverse-variance method for continuous data, along with 95% confidence intervals (CIs). Where this was not possible due to the nature of the data, we synthesised the results narratively. We used GRADE to assess the certainty of evidence for each outcome. INCLUDED STUDIES: We included 35 RCTs with 4329 participants. The studies randomised 2028 participants to non-penetrating mesh fixation and 2301 participants to penetrating mesh fixation, with a median sample size of 82 (range 30 to 600 participants). The mean or median age ranged from 37 to 66 years, and the majority (94%) were men. In general, the operated hernias were primary unilateral inguinal hernias. Most of the non-penetrating mesh fixation was fibrin sealant and cyanoacrylate glue, and most of the penetrating mesh fixation was permanent staples, permanent tacks, or absorbable tacks. SYNTHESIS OF RESULTS: RoB 2 assessment Regarding the overall risk of bias, most of the outcomes had some concerns or a high risk of bias. This was mostly due to missing information regarding the randomisation process, insufficient reporting of missing outcome data, or both. GRADE We assessed the certainty of evidence to be very low for most outcomes. This was mainly due to high or unclear risk of bias or due to imprecision because of few events, a wide confidence interval, or a small population. Critical outcomes Non-penetrating mesh fixation may result in little to no difference in the risk of chronic pain (RR 0.62, 95% CI 0.35 to 1.07; I² = 9%; 7 studies, 553 participants; very low-certainty evidence) and recurrence (RR 0.75, 95% CI 0.33 to 1.67; I² = 0%; 15 studies, 2165 participants; very low-certainty evidence), but the evidence is very uncertain. Non-penetrating mesh fixation may reduce the level of chronic pain (continuous), but the evidence is very uncertain (MD -0.34, 95% CI -0.56 to -0.11; I² = 98%; 7 studies, 639 participants; very low-certainty evidence). Important outcomes Non-penetrating mesh fixation may have little to no effect on the risk of acute pain (dichotomous) (RR 0.93, 95% CI 0.50 to 1.73; I² = 56%; 2 studies, 218 participants; very low-certainty evidence). Non-penetrating mesh fixation may reduce the level of acute pain (continuous) (MD -0.90, 95% CI -1.31 to -0.49; I² = 98%; 16 studies, 1611 participants; very low-certainty evidence), the risk of haematoma (RR 0.43, 95% CI 0.24 to 0.78; I² = 0%; 19 studies, 2560 participants; very low-certainty evidence), convalescence (RR 1.49, 95% CI 1.10 to 2.01; I² = 94%; 9 studies, 1116 participants; very low-certainty evidence), and the length of convalescence (MD -0.81, 95% CI -1.38 to -0.23; I² = 80%; 7 studies, 589 participants; very low-certainty evidence), but the evidence is very uncertain. Non-penetrating mesh fixation may have little to no effect on the risk of mesh infection (RR 0.34, 95% CI 0.01 to 8.23; I² not applicable; 5 studies, 1128 participants; very low-certainty evidence) and operative time (MD -0.26, 95% CI -3.11 to 2.59; I² = 94%; 20 studies, 1800 participants; very low-certainty evidence), but the evidence is very uncertain. Lastly, non-penetrating mesh fixation may result in little to no difference in serious vascular intraoperative events (RR 0.18, 95% CI 0.02 to 1.57; I² = 0%; 9 studies, 1289 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: There may be little to no difference between non-penetrating and penetrating mesh fixation regarding the risk of chronic pain (dichotomous), recurrence, acute pain (dichotomous), mesh infections, and operative time, but the evidence is very uncertain. Non-penetrating mesh fixation may result in little to no difference in serious vascular intraoperative events. While the evidence is very uncertain, non-penetrating mesh fixation may slightly reduce the level of chronic pain (continuous), the level of acute pain (continuous), and the risk of haematoma, and shorten convalescence (dichotomous and continuous). Overall, this review demonstrated little to no difference in clinically important outcomes between penetrating and non-penetrating mesh fixation in laparoscopic groin hernia repair in adults, based on low- to very low-certainty evidence. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol available via DOI: 10.1002/14651858.CD016122.
11 Apr 2026
Read appraisal →BMJ (Clinical research ed.)
Non-drug perioperative interventions to reduce postoperative pulmonary complications after abdominal surgery: systematic review and meta-analysis
OBJECTIVE: To evaluate the effectiveness of perioperative non-drug interventions in reducing postoperative pulmonary complications (PPCs) in adults undergoing abdominal surgery. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Ovid MEDLINE, Embase, and Web of Science from database inception to January 2025 and updated in January 2026, with no language restrictions. STUDY SELECTION: Randomised controlled trials assessing the effectiveness of perioperative non-drug interventions for the prevention of PPCs in adults undergoing elective abdominal surgery under general anaesthesia, with clearly defined PPCs. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients developing PPCs. Secondary outcomes included the proportion of patients with PPC subtypes according to European Perioperative Clinical Outcome definitions (respiratory infection, respiratory failure, pleural effusion, atelectasis, or pneumothorax) and hospital length of stay. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane RoB 2.0 tool. Data were synthesised using meta-analyses and trial sequential analyses, with the evidence certainty assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: 255 trials including 55 260 participants were included, evaluating 10 types of interventions with 39 subtypes for PPC prevention. PPCs occurred in 6467 (11.7%) participants across all included trials. High certainty evidence showed that low fraction of inspired oxygen (FiO2) significantly reduced PPCs (risk ratio 0.81, 95% confidence interval 0.71 to 0.92). Moderate certainty evidence showed benefit for four intervention types: lung protective ventilation (risk ratio 0.66, 0.57 to 0.76), physiotherapy (0.55, 0.46 to 0.65), analgesia (0.73, 0.64 to 0.84), and nutrition (0.74, 0.63 to 0.87), with individualised positive end expiratory pressure, composite lung protective ventilation, early mobilisation, and epidural analgesia also showing benefit at the subtype level. Trial sequential analysis confirmed sufficient cumulative evidence for all the above interventions except early mobilisation. By contrast, goal directed haemodynamic therapy, targeted blood pressure management, restrictive fluid therapy, and postoperative bi-level positive airway pressure showed no evidence of benefit, with moderate certainty. CONCLUSIONS: This synthesis establishes an evidence hierarchy for PPC prevention in abdominal surgery. Low FiO2 is the only intervention supported by high certainty evidence and should be prioritised in clinical practice. Other beneficial strategies include lung protective ventilation, physiotherapy, analgesic techniques, and nutrition interventions. Conversely, the role of goal directed haemodynamic therapy-despite its widespread use-warrants reconsideration for PPC prevention. These findings facilitate prioritisation of effective interventions and development of evidence based guidelines. STUDY REGISTRATION: PROSPERO CRD42025637449.
11 Apr 2026
Read appraisal →BMJ open
Facilitators of and barriers to teamwork between operating room nurses and other practitioners: a meta-synthesis of qualitative studies
OBJECTIVES: Seamless collaboration in the operating room is the critical foundation for patient safety and successful outcomes. This synergy enhances efficiency, minimises errors and is a key determinant of the final surgical quality. The objective of this study is to synthesise qualitative studies on facilitators of and barriers to teamwork between operating room nurses (ORNs) and other practitioners. DESIGN: Systematic review and meta-synthesis of qualitative studies. DATA SOURCES: A systematic search was conducted across nine electronic databases: PubMed, Embase, Scopus, Web of Science (Core Collection), CINAHL, PsycINFO, CNKI, WanFang and Vip. The search covered the period from 1 January 2014 to 30 September 2025. The search strategy used both medical subject headings and free-text terms, supplemented by the snowball method and grey literature. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Qualitative studies exploring teamwork involving ORNs were included. Of 4839 initially retrieved records, 29 studies finally met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS: Two researchers independently extracted data, including the author, year of publication, country, study design, study objective, interview location, number of participants, age, methods of data collection and analysis and duration of interviews. The key findings were synthesised into two overarching themes: facilitators (eg, professional skills, role awareness, team familiarity, patient-centred culture, effective leadership) of and barriers (eg, individualistic behaviour, hierarchical culture, insufficient resources, punitive management, environmental constraints) to teamwork between ORNs and other practitioners. A meta-synthesis was conducted to synthesise study results from different groups and countries. NVivo 15 was used for data management. RESULTS: A total of 29 qualitative studies (published between 2014 and 2025) were included in this study. Key facilitators of teamwork included professional skills, role awareness, team familiarity, patient-centred culture and effective leadership. Major barriers encompassed individualistic behaviours, punitive management, hierarchical culture, environmental constraints and insufficient resources. These factors worked across individual, interpersonal and systemic levels to shape OR teamwork. CONCLUSION: Optimising OR teamwork requires a multifaceted approach simultaneously addressing these facilitators and barriers. Interventions should simultaneously cultivate individual competencies (eg, skills, role awareness), foster positive team dynamics (eg, familiarity, psychological safety, inclusive leadership), and rectify systemic issues (eg, hierarchical culture, resource constraints, punitive management). In this way, teamwork between ORNs and other practitioners can be enhanced, thereby contributing to improved perioperative safety and outcomes. PROSPERO REGISTRATION NUMBER: CRD42024506414.
9 Apr 2026
Read appraisal →Journal of Korean medical science
Effectiveness and Cost-Utility of Anti-Adhesion Agents in Intra-Abdominal Surgery Patients
BACKGROUND: Adhesive intestinal obstruction (AIO) is a common and critical complication of intra-abdominal surgery, often requiring preventative measures such as using anti-adhesion agents (AAA). However, despite their prevalence and significance, a notable lack of long-term and large-scale clinical evidence exists supporting the effectiveness and cost-utility of these agents. This study aimed to evaluate the effectiveness and cost-utility of applying AAA in patients undergoing intra-abdominal surgery. METHODS: This is a retrospective observational study utilizing the Korean National Health Insurance Database in combination with the data from the Clinical Data Warehouse collected from six university-affiliated hospitals in Korea. The study included patients who underwent intra-abdominal surgeries between April and December 2016, with 2-year follow-up. The effectiveness of AAA was assessed by the incidence rate of AIO, and cost-utility was evaluated through calculating quality-adjusted life years (QALYs) and direct costs. Subgroup and sensitivity analyses were conducted to confirm the consistency and robustness of the study findings. RESULTS: A total of 2,831 patients were included in the study. Among them, 1,365 (47.2%) received AAA while 1,466 (52.8%) did not. The group that received AAA exhibited a significantly lower incidence of AIO, with a rate of 12.4% compared to 18.5% in the non-user group. Utility scores were higher in the user group, averaging 1.992 QALYs versus 1.986 in the non-user group. Direct costs were significantly lower in the user group, totaling 3,794 USD, which is 1,330 USD less than those incurred by the non-user group. Subgroup and sensitivity analyses reinforced these findings, demonstrating consistent reductions in AIO incidence, increased QALYs, and decreased costs observed across various subgroups, particularly among older patients and those without chronic conditions. CONCLUSION: These findings highlight the clinical effectiveness and cost-utility of AAA in patients undergoing intra-abdominal surgery. By significantly reducing the incidence of AIO and lowering healthcare costs, these agents provide empirical evidence supporting their broader adoption in clinical practice. This study addresses critical gaps in the understanding of postoperative management and offers valuable insights that could inform future healthcare policies.
8 Apr 2026
Read appraisal →PloS one
Clinical impact of broad- versus narrow-spectrum empiric therapy in acute cholangitis: A Japanese claims database study
The clinical benefit of broad-spectrum empiric therapy in patients with acute cholangitis is unclear. We aimed to evaluate the impact of broad-spectrum and narrow-spectrum empiric therapies on patient outcomes using a Japanese claims database. The study included patients who were diagnosed with acute cholangitis between April 2014 and August 2022, aged 18-99 years, received antibiotics, had blood cultures collected, and underwent biliary drainage. Patients who received empiric therapy with carbapenems, piperacillin/tazobactam, or fourth-generation cephalosporins were included in the broad-spectrum group, whereas others were included in the narrow-spectrum group. Of the 4,755 eligible patients, 3,377 were categorized into the narrow-spectrum group and 1,378 into the broad-spectrum group. In the multivariate logistic regression analysis, older age, higher Charlson Comorbidity Index, the presence of sepsis, and intensive care unit admission were associated with increased 30-day in-hospital mortality, whereas the receipt of broad-spectrum empiric therapy was not (adjusted odds ratio, 1.37 [95% confidence interval {CI}, 0.84-2.23]). In the propensity score matching analysis, there was also no association between the receipt of broad-spectrum empiric therapy and 30-day in-hospital mortality (odds ratio, 1.43 [95% CI, 0.82-2.50]). Furthermore, in the propensity score-matched cohort, the broad-spectrum group had longer duration of intravenous antibiotic therapy (median interquartile range [IQR]: 8 [6 -11] day vs. 9 [7 -13] day; difference 1 day [95% CI, 0.31-1.69 day]) and length of hospital stay (median [IQR]: 13 [9 -20] day vs. 16 [11 -25] day; difference 3 day [95% CI, 1.87-4.13 day]), compared with the narrow-spectrum group. In this large-scale study using a Japanese claims database, broad-spectrum empiric therapy was not associated with improved clinical outcomes, compared with narrow-spectrum empiric therapy. Therefore, the necessity of broad-spectrum empiric therapy may be limited in clinical practice, and narrow-spectrum empiric therapy may represent an effective treatment strategy for acute cholangitis.
5 Apr 2026
Read appraisal →Biomedical physics & engineering express
Detecting early signs of patient deterioration at home using wearable sensors: a personalized anomaly detection approach
In the rapidly emerging field of transferring healthcare from hospitals to patients' homes, it is essential that signs of remote deterioration at home should be detected early to timely upscale care when needed. As patient deterioration is a rare event, datasets have insufficient event data for supervised machine learning. Personalized anomaly detection (AD) may be a good alternative. Therefore, this study aimed to obtain insight into the use of personalized AD models in detecting early signs of patient deterioration at home using wearable sensor data. To address this, Isolation Forest and Local Outlier Factor models were applied to detect signs of deterioration in terms of mortality or unplanned readmission in the 24 preceding hours in two datasets: one of heterogeneous patients, the other of postoperative patients. A pipeline was developed for continuously updating personalized AD models over time and applying them to detection windows twice per day. Results were compared with the Remote Early Warning Score. Isolation Forest (AUROC: 0.69) and Local Outlier Factor (AUROC: 0.67) models were able to find some early signs of deterioration in heterogeneous patients (n = 113). However, in postoperative patients (n = 193), Isolation Forest (AUROC: 0.41) and Local Outlier Factor (AUROC 0.44) performed badly. The Remote Early Warning Score was able to find some early signs of deterioration for both groups (AUROC: 0.63-0.76). Based on these findings, three requirements were formulated that should be fulfilled for a potentially successful application of personalized AD. First, the training set should be normal and representative of non-deteriorating patients. Second, signs of deterioration should exhibit abnormal characteristics. Third, non-deteriorating patients should not exhibit abnormal characteristics.
5 Apr 2026
Read appraisal →Journal of wound care
Micrografts-a novel ally in hard-to-heal wounds: a systematic review.
OBJECTIVE: Wound healing is complex, and hard-to-heal (chronic) wounds pose significant treatment challenges, especially in adults. Micrografts (MGs) are emerging as a promising treatment for wounds refractory to conventional approaches. MG involves transplanting a stem cell suspension to the wound to promote healing. Scientific studies on MG are increasing; however, a systematic review is needed for a comprehensive understanding of its efficacy. METHOD: A systematic review conducted on 30 March 2024 used PubMed, Scopus and Web of Science databases to evaluate skin and dermal MGs in wound healing. PRISMA guidelines were followed and predefined inclusion and exclusion criteria were applied. All authors reviewed the studies and discussed results to ensure consistency in study screening, selection and data extraction. RESULTS: A total of 1251 papers were examined, with 23 eligible for full-text review. After exclusions based on language, reviews, MG size and tissue focus, 15 articles were included in the final review: seven case reports; five case series; two prospective series (one with 70 patients, the other with 30 patients) and a case-control study. CONCLUSION: The results of the reviewed studies suggest that MGs may promote wound healing, with reported reductions in healing time and improvements in clinical symptoms in hard-to-heal wounds. However, standardisation of treatment protocols and application methods is required. The role of MGs in the treatment of acute wounds remains to be clarified.
4 Apr 2026
Read appraisal →Yonsei medical journal
Predicting Post-Induction Hypotension in Diverse Surgical Populations: A Multiclass Classification Universal Model Using Machine Learning Techniques
PURPOSE: Our study aims to develop a machine learning model that not only predicts the occurrence of post-induction hypotension (PIH) but also assesses its severity, addressing a broader patient population than previous studies which mostly focused on a single population. MATERIALS AND METHODS: In our study, we extracted data from 71473 patients aged 18 years and older who underwent general anesthesia for non-cardiac surgery at a tertiary care hospital, using the electronic medical record system for modeling. We used patient demographics, baseline and pre-induction blood pressure, preoperative laboratory tests, surgical details, and anesthetics data, focusing on predicting PIH. The severity of hypotension was assessed by integrating and calculating the integral value of hypotensive periods. We employed several machine learning techniques and evaluated their performance using accuracy, precision, F1-scores, and macro-averaged area under the curve. Additionally, SHapley Additive exPlanation values were used to determine the key factors influencing the predictions. RESULTS: A multiclass classification model, which assesses hypotension severity through the area of hypotension, surpassed the binary model with an F1-score of 0.664. Among various machine learning techniques, the eXtreme Gradient Boosting (XGBoost) model exhibited superior prediction performance, achieving an accuracy of 0.755 and an F1-score of 0.664. Models using preoperative blood pressure and demographic data outperformed those using other datasets. CONCLUSION: We found that using the XGBoost ensemble machine learning technique aids in predicting PIH before surgery, and introducing a multiclass classification model that indicates the severity of hypotension to clinicians leads to an overall enhancement in prediction performance, thereby increasing its clinical utility for real-world applications.
4 Apr 2026
Read appraisal →European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie
Latest Developments in Artificial Intelligence and Machine Learning Models in General Pediatric Surgery
Artificial intelligence (AI) and machine learning (ML) models rapidly transform health care with applications ranging from diagnostic image interpretation, predictive modeling, personalized treatment planning, real-time intraoperative guidance, and outcome prediction. However, their implementation in general pediatric surgery remains limited due to the rarity and complexity of pediatric surgical conditions, small and heterogeneous datasets, and a lack of formal AI training and competencies among pediatric surgeons.This narrative review explores the current landscape of AI and ML applications in general pediatric surgery, focusing on five key conditions: appendicitis, necrotizing enterocolitis, Hirschsprung's disease, congenital diaphragmatic hernia, and biliary atresia. For each, we summarize recent developments, including the use of AI in image analysis, diagnostic support, prediction of disease severity and outcome, postoperative monitoring, and histopathological evaluation. We also highlight novel tools such as explainable AI models, natural language processing, and wearable technologies.Recent findings demonstrate promising diagnostic and prognostic capabilities across multiple conditions. However, most AI/ML models still require external validation and standardization. The review underscores the importance of collaborative, multicenter research based on joint datasets as well as targeted AI education for pediatric surgeons to fully explore the benefits of these technologies in clinical practice.AI and ML offer significant potential to improve pediatric surgical care, but broader implementation will require multicenter collaboration, a robust dataset, and targeted AI education for pediatric surgeons.
4 Apr 2026
Read appraisal →Am Surg
Neurogenic Thoracic Outlet Syndrome: A Current Literature Review
Neurogenic Thoracic Outlet Syndrome (nTOS), the most prevalent type of thoracic outlet syndrome, results from compression of the compression of the brachial plexus as it traverses the scalene triangle and rectopectoralis minor space. It typically presents with upper extremity pain, hand weakness, paresthesia, and muscle atrophy that is often exacerbated by arm elevation or overhead activity. Etiology commonly includes congenital anatomical variants, trauma, and repetitive overhead activity. Diagnosis remains challenging as a result of significant symptom overlap with cervical radiculopathy, brachial plexopathies, and entrapment neuropathies. Work up involves a combination of thorough history and physical with electrophysiologic testing, diagnostic injections and imaging such as MRI or duplex ultrasonography. Initial therapy indicates physical therapy with a focus on decompression and postural correction. In patients with persistent symptoms, motor deficits or failed conservative management, surgical decompression using transaxillary, supraclavicular or minimally invasive techniques is indicated. Rib-sparing surgical decompression is increasingly favored given lower complication rates. Postoperative rehabilitation focuses on restoring range of motion and shoulder girdle strength. This review serves to outline clinical presentation, diagnostic strategies and operative options for nTOS while emphasizing an individualized, stepwise approach to optimize outcomes and minimize risk.
1 Dec 2025
Read appraisal →Am Surg
Enhancing Surgical Education Through Artificial Intelligence in the Era of Digital Surgery
Artificial Intelligence (AI) is transforming surgical education, playing a pivotal role in the era of digital surgery. This review, conducted from January 2023 to December 2024, examines the integration of AI into surgical training, focusing on its benefits and limitations. Thirteen studies were included, with emphasis on AI's impact in General Surgery training. Digital surgery leverages AI-powered tools such as virtual reality (VR) and augmented reality (AR) to create immersive, simulated environments where residents can practice surgical techniques safely and effectively. These platforms improve technical skills, hand-eye coordination, and error reduction, while personalized AI-driven feedback systems enhance learning and skill assessment. Digital surgery also bridges the gap between theoretical knowledge and clinical application, fostering innovative training methodologies. Despite challenges such as financial constraints and ethical concerns, AI within digital surgery emerges as a transformative force, redefining surgical education and equipping trainees with the expertise needed for modern health care.
1 Nov 2025
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