Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 5 appraisals
Neurosurgical review
Modified tubular retractor for deep brain tumour resection: enhanced surgical outcomes in resource-constrained settings
Tubular retractors permit minimally invasive access to deep-seated intracranial tumours; however, limitations in visualisation and manoeuvrability reduce their suitability for lesions ≥ 3 cm, particularly in resource-limited centres. We evaluated a modified, low-cost tubular retractor incorporating enhanced visualisation and ergonomic features, comparing its performance with Leyla spatula-based retraction and traditional syringe-derived tubular systems. A prospective comparative cohort of 105 patients with deep brain tumours ≥ 3 cm was analysed. Patients underwent Leyla retraction (Group 1, n = 38), conventional tubular systems (Group 2, n = 32), or a modified tubular retractor (Group 3, n = 35). Outcomes included intraoperative visualisation, retractor stability, manoeuvrability, extent of resection, complications, and three-month Glasgow Outcome Scores. Owing to non-normal distribution, continuous variables were analysed using non-parametric tests and binary logistic regression. The modified tubular retractor demonstrated greater stability, broader visualisation, and enhanced instrument handling compared with conventional tubular systems. Gross total resection was achieved in 91.4% with the modified device, 78.9% with Leyla-based retraction, and 28.9% with traditional tubular systems. Logistic modelling identified retractor type (OR 2.59, p = 0.035), intraoperative visualisation (OR 2.01, p = 0.036), and histopathology (OR 1.41, p = 0.036) as independent predictors of residual tumour. The modified retractor group exhibited fewer complications, shorter ICU stays, and superior functional outcomes (GOS ≥ 4 in 91%). The modified tubular retractor demonstrated favourable operative handling and outcome trends for deep-seated tumours ≥ 3 cm, with improved visualisation, stability, and ergonomic access compared with conventional systems. However, limitations related to non-randomised design, learning-curve effects, advanced mapping, fluorescence integration, and supramaximal resection warrant cautious interpretation pending multicentre long-term validation.
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 →Biomedical physics & engineering express
Acoustic-based intraoperative assessment of femoral stem initial stability in cementless THA via sensitive frequency band identification
Intraoperative assessment of femoral stem initial stability in cementless total hip arthroplasty (THA) predominantly relies on subjective tactile and auditory feedback, which lacks standardization and increases complication risks. This study develops a quantitative framework to identify sensitive acoustic frequency bands characterizing the bone-implant fixation state. Specifically, we acquired high-fidelity acoustic signals from 118 primary cementless THA procedures. Utilizing a statistical difference analysis framework, we identified two distinct sensitive bands (640-1920 Hz and 3460-3560 Hz) to extract band power fraction features. Machine learning evaluation demonstrated that these bands significantly outperform traditional empirical partitioning, achieving a classification accuracy of 0.816±0.028, which improved to 0.834±0.042 after feature fusion. Furthermore, stratified validation confirmed high consistency across diverse bone qualities and implant designs (Summit and Corail). While robust under steady-state Gaussian noise, the system exhibited sensitivity to non-steady-state speech interference. In conclusion, the identified sensitive bands effectively reflect the mechanical evolution of the bone-implant interface, providing a physically interpretable decision-support tool for enhancing surgical safety.
27 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 →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
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