Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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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 →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 →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 →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
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