Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 3 appraisals
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 →Archives of gynecology and obstetrics
Clinical outcomes and practical management implications in rudimentary horn pregnancies: a systematic review and pooled analysis (2010-2025)
PURPOSE: Rudimentary horn pregnancies are rare and carry significant maternal and fetal risks. This study aims to systematically review published cases of rudimentary horn pregnancies describing data about time of diagnosis, time of rupture, and live birth rate (LBR), with exploratory comparisons between communicating (CHP) and non-communicating horn pregnancies (NCHP). METHODS: A PRISMA-guided systematic search of PubMed, MEDLINE, and Cochrane (October 1, 2025) was performed with terms "unicornuate uterus pregnancy" OR "rudimentary horn pregnancy." Case reports, series, and reviews with defined clinical data were included; abstracts and unclear reports were excluded. Three independent reviewers extracted data using a standardized protocol. Descriptive statistics (means, medians, standard deviations, and ranges) and exploratory group comparisons (Fisher's exact test, Mann-Whitney U and Student's t test with p < 0.05 denoting significance) were performed. RESULTS: From 132 articles, 190 cases were included: 27 CHP (14.2%) and 163 NCHP (85.8%). Time of diagnosis was earlier in NCHP (15.9 ± 8.9 weeks) than CHP (22.1 ± 10.0 weeks, p = 0.01). Rupture occurred in 68 cases (35.8%), similarly in CHP (48.1%) and NCHP (33.7%, p = 0.19). Time of rupture was earlier in NCHP (18.7 ± 6.6 weeks) than CHP (23.0 ± 9.2 weeks, p = 0.02). Four cases attempted to continue pregnancy; all resulted in premature rupture. Reported live births were infrequent (11.6%) and more common in published CHP (25.9%) vs. NCHP cases (9.2%; p = 0.02). CONCLUSIONS: This descriptive synthesis indicates uterine horn communication may be associated with later diagnosis/rupture and reported live births were significantly more frequent in published CHP vs. NCHP cases. However, all comparisons are exploratory and must be interpreted with extreme caution, as data limitations preclude causal inference. Exhaustive imaging and diagnosis are essential to characterize horn type. Surgical termination is advised, but if expectant management is chosen, close monitoring and multidisciplinary care, including weekly ultrasounds, are advisable to mitigate complications.
14 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
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