Gastrointestinal cancer surgery commonly leads to postoperative complications and other adverse outcomes. While prehabilitation shows promise in reducing adverse postoperative outcomes, most hospitals have resource limitations that preclude its use as standard of care. Additionally, the need to expedite surgery from diagnosis often creates a narrow window for prehabilitation initiatives. Online, self-reported screening tools may address these challenges by facilitating early identification of high-risk patients and enabling targeted preoperative interventions, thereby allowing equitable allocation of limited resources. Therefore, the primary aim of this study is to evaluate the predictive utility of a tri-modal (physical, nutritional, psychological) screening tool for patients undergoing gastrointestinal cancer surgery. This prospective international cohort study will recruit 1214 adults undergoing elective gastrointestinal cancer surgery across 35 sites from 19 countries. Participants will complete an online screening tool developed through a comprehensive, multistep, predefined process. The screening tool comprises the Duke Activity Status Index, Patient-Generated Subjective Global Assessment Short Form and the Patient Health Questionnaire-4, in English, Spanish, French or Portuguese. These tools were selected based on a scoping review, followed by an international Delphi consensus process. The primary outcomes include rate of postoperative complications, major complications (Clavien-Dindo Classification grade III-V) and overall complication severity assessed by the Comprehensive Complications Index; all assessed 30 days postoperatively. Secondary outcomes include hospital length of stay, readmission rate within 30 days, discharge destination (home vs other), days at home and alive in 30 days postsurgery, 30-day all-cause mortality and 12-month survival. Primary analyses will establish optimal screening tool cut-points to stratify patients into clinically actionable risk categories for postoperative complications and examine the independent predictive value of these screening scores after adjusting for established clinical risk factors. This study has received ethical approval from the Sydney Local Health District Human Research and Ethics Committee (X25-0333 and 2025/ETH02465) and has been registered on the Open Science Framework (10.17605/OSF.IO/HVCGD). The results of Preoperative Risk Evaluation for Cancer Treatment will be submitted to reputable journals and presented at national and international conferences.
Burn injuries are a global health concern with a substantial sociological burden of disease, causing physical, psychological, and socioeconomic consequences. Despite the multidisciplinary and complex nature of the field, limited comprehensive bibliometric research has been conducted. A search of the Web of Science database was conducted to identify the top 100 most-cited burn-related publications. Bibliometric and visual analyses were performed using the VOSviewer, Bibliometrix, and Biblioshiny packages in R. Citation metrics, institutional networks, collaboration clusters, thematic keyword analysis, and author demographics were compiled and analyzed. The vast majority of included studies were published after 2000. The University of Texas System and Shriners Hospitals were the leading institutions and authors, highlighting the strength of US research and fostering a sense of achievement and trust in the field's progress. Our findings reveal dominant contributors and disparities in authorship and geographic representation, encouraging the research community to foster greater inclusivity and collaboration across regions.
Cardiac surgery, particularly open-heart procedures such as coronary artery bypass grafting and valve surgery, is one of the most common curative options for ischemic heart disease, congenital heart defects, and valvular disease but is also associated with severe hemodynamic hazards. Intravenous anesthetic agents such as propofol and dexmedetomidine are employed to sedate such patients in routine clinical practice. There is, however, conflicting and sporadic evidence in the literature regarding the relative effects of these two agents on hemodynamic parameters. This review systematically analyzed and contrasted the hemodynamic effects of dexmedetomidine and propofol in patients undergoing cardiac surgery. Systematic searches in the PubMed, Scopus, Embase, Web of Science, CINAHL, Cochrane Library, and Google Scholar databases were performed for randomized controlled trials published between December 2000 and 18 January 2025. Studies in which adult patients underwent cardiac surgery (e.g., coronary artery bypass grafting or valve surgery) and received dexmedetomidine or propofol for intraoperative or immediate postoperative intensive care unit (ICU) sedation were included. This was a PRISMA-guided review, and the extracted data were meta-analyzed and descriptively analyzed. The primary outcomes were hypotension and bradycardia. Secondary outcomes included vasopressor requirements, tachycardia, heart rate, atrial fibrillation (AF), ventricular tachycardia, and bleeding. Odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were pooled via random-effects models. Sensitivity analysis and assessment of publication bias were performed as needed. Compared with propofol, dexmedetomidine significantly increased the risk for hypotension (OR = 1.76; 95% CI: 1.25-2.48; p < 0.001) and bradycardia (OR = 2.89; 95% CI: 1.28-6.49; p = 0.01). Alternatively, dexmedetomidine significantly reduced vasopressor requirements (OR = 0.52; 95% CI: 0.32-0.84; p = 0.007) and lowered the heart rate (MD = - 4.78 beats/min; 95% CI: - 7.47 to - 2.26; p < 0.001). No considerable differences were observed in tachycardia, ventricular tachycardia, AF, or bleeding. Sensitivity analysis was employed to check for the stability of the findings, and no publication bias was detected. This meta-analysis revealed that, compared with propofol, dexmedetomidine is associated with a greater incidence of hypotension and bradycardia but lower vasopressor requirements. No considerable differences were observed in ventricular tachycardia, AF, bleeding or any other hemodynamic parameters. Evidence for several secondary outcomes remains limited; therefore, findings for less frequently reported endpoints should be interpreted cautiously. Not applicable.
To assess the impact of body mass index (BMI) on patient-reported outcomes after gender-affirming chest surgery in adolescents. Despite most previous studies finding no association between BMI and patient-reported outcomes in adults undergoing gender-affirming chest surgery, BMI eligibility requirements remain widely used. Moreover, little data exists regarding the impact of BMI on these outcomes in adolescents. A cross-sectional, patient-reported outcome survey study was conducted at a pediatric hospital from April to July 2024. Eligible individuals were at least 1-year postoperative from gender-affirming chest surgery. The primary outcome was the effect of BMI on scores from 7 validated patient-reported outcome measures, including BODY-Q Chest and Nipple, Gender Congruence and Life Satisfaction, Satisfaction with Decision, and Decision Regret Scale, compared between adolescent and young adult cohorts. Among 77 participants who completed the survey, 42 (54.5%) underwent surgery as adolescents and 35 (45.5%) as young adults. Patient-reported outcomes evaluating appearance satisfaction, psychosocial well-being, and decisional satisfaction were high, whereas decisional regret was low. Scores did not significantly differ between adolescent and young adult cohorts, and most patient-reported outcome measures were not significantly influenced by BMI. After gender-affirming chest surgery, both adolescents and young adults reported high appearance satisfaction, psychosocial well-being, and decisional satisfaction, along with low decisional regret. For the majority of patient-reported outcomes, these positive results were not associated with BMI, suggesting that gender-affirming chest surgery is associated with high quality of life for adolescents and young adults regardless of BMI.
This focused systematic review and meta-analysis evaluated robot-assisted inguinal lymphadenectomy (RAIL) versus open inguinal lymph node dissection (OILND) in penile cancer, aiming to provide robot-specific comparative estimates rather than a broad minimally invasive synthesis. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched through December 2025 for comparative studies. All meta-analyses were conducted using STATA 18, employing random-effects modeling. Binary outcomes were summarized using odds ratios (ORs), and continuous outcomes were presented as weighted mean differences (WMDs), with all estimates accompanied by 95% confidence intervals (CIs). Risk of bias in the included non-randomized comparative studies was assessed using the ROBINS-I tool. Four retrospective comparative studies involving 276 patients were included, and no randomized controlled trials were identified. A lower odds of total postoperative complications was observed with RAIL (OR = 0.52, 95% CI: 0.27, 0.97; P = 0.047), but this borderline finding should be interpreted cautiously given the small number of retrospective studies and potential residual confounding. Across individual studies, operative time generally tended to be longer with RAIL, whereas findings for estimated blood loss and drainage-related outcomes were inconsistent. Lymph node yield, skin-related complications, minor complications, and groins with positive nodes did not differ significantly between approaches. According to the GRADE assessment, the certainty of evidence was low for most pooled outcomes and very low for skin-related complications and lower-limb edema/lymphedema. RAIL may be associated with lower overall postoperative complications than open surgery, but the evidence remains low certainty and insufficient to establish a definitive morbidity-reduction benefit. In addition, several continuous perioperative variables showed extreme between-study heterogeneity and were not clinically interpretable as reliable pooled effects.
Neoadjuvant immunotherapy combined with chemotherapy (NICT) improves tumor downstaging in locally advanced hypopharyngeal squamous cell carcinoma (LA-HSCC), but the effect of response-adapted surgery on outcomes is unclear. This study evaluated the efficacy and safety of NICT and compared minimally invasive versus open surgery on the basis of treatment response. We retrospectively analyzed 79 patients with stage III-IVB HSCC who received NICT. Treatment response was assessed per RECIST 1.1, and surgery was tailored accordingly. The objective response rate was 84.81%, and the pathological complete response rate was 59.49%. Grade ≥ 3 treatment-related adverse events occurred in 11.39% of patients. Following NICT, 73.4% of patients underwent transoral minimally invasive surgery, 17.7% partial laryngectomy, and 8.8% total laryngectomy, resulting in a laryngeal preservation rate of 91.14%. With a median follow-up of 15 months, there were no significant differences in progression-free or overall survival between surgical groups. However, the minimally invasive group had significantly better 1-year respiratory (89.66% versus 35.71%, p < 0.001) and phonatory (70.69% versus 0%, p < 0.001) function preservation compared to the open surgery group. Multivariate analysis confirmed that minimally invasive surgery independently predicted improved respiratory function. NICT enables high response and organ preservation in LA-HSCC, and minimally invasive surgery achieves comparable survival with superior functional outcomes, supporting its use in a personalized treatment approach.
Standardized prescribing models can reduce discharge opioid prescription and excess pill volumes, mitigating potential opioid dependence and diversion after abdominal operations. This study's objective was to determine which of 2 validated discharge prescribing models resulted in fewer opioids prescribed and consumed after major abdominal surgery. This was a pragmatic single-center, phase II randomized clinical trial comparing 2 discharge opioid prescribing models: linear 5x-multiplier algorithm (last-24hrs oral morphine equivalents [OME] times 5) versus capped 3-tier model (5/15/30 pills depending on 0/1-29/≥30 mg OME in last-24hrs). Adults undergoing open abdominal cancer resections by 25 surgeons (5 specialties) were included. A non-opioid analgesic bundle was used perioperatively and at discharge. Co-primary endpoints were discharge opioid volume and 14-day post-discharge consumption. Secondary endpoints included patient satisfaction and symptom inventory. The power (80%) calculation was performed using the two-sample t-test to detect a mean difference in OME with 0.05 significance (0.025 per co-primary outcomes). From April-December 2024, 150 patients (52% female; median age 63) were randomized: 73 to 5x-multiplier; 77 to 3-tier model. Operations included hepatectomy (32%), pancreatectomy (29%), nephrectomy (13%), thoracoabdominal sarcoma resection (15%), and ovarian cytoreduction (11%). Median discharge OME was 25 mg (5x-multiplier) versus 75mg (3-tier, P<0.001), with 44% of 5x-multiplier patients discharged opioid-free (1% in 3-tier). Median post-discharge 14-day opioid consumption was 0mg (5x-multiplier) versus 10 mg (3-tier, P=0.496). Refill rates were 24% (5x-multiplier) versus 18% (3-tier, P=0.426), consistent with historical rates, with no differences in satisfaction or symptom inventory scores. The 5x-multiplier algorithm resulted in fewer prescribed discharge opioids with similar 14-day consumption, refill rates, and satisfaction, compared to a 3-tier model after intra-abdominal cancer surgery.
To compare perioperative outcomes of minimally invasive pancreatoduodenectomy (MIPD) to open pancreatoduodenectomy (OPD) using evidence from randomized controlled trials (RCTs). The wider adoption of MIPD has largely been fueled by observational studies rather than high-level evidence. We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Web of Science for RCTs comparing MIPD with OPD in adult patients with benign or malignant conditions requiring elective pancreatoduodenectomy. The primary outcomes were 90-day mortality, the comprehensive complication index, Clavien-Dindo grade ≥III complications, and hospital length of stay (LOS). Secondary outcomes included postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), blood loss, reoperation, operative time, and oncologic outcomes. Data were pooled as odds ratios or mean differences using a random-effects model. Risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation approach (PROSPERO ID: CRD42024592919). Ten RCTs with a total of 1794 patients were included. Meta-analysis showed there were no significant differences regarding 90-day mortality, Clavien-Dindo ≥3 complications, POPF, DGE, PPH, reoperation, readmission, or oncologic outcomes between MIPD and OPD. LOS was reduced for MIPD. No clinically relevant differences were found in the subgroup analyses of laparoscopic and robotic pancreatoduodenectomy. Certainty of evidence was moderate to low. MIPD showed no clinically relevant advantages over OPD. These findings were consistent both for the robotic and laparoscopic approach.
Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in clinically node-negative breast cancer. Traditionally, SLNB is performed using technetium-labelled (99mTc) nanocolloid, with or without blue dye. However, both tracers have important limitations. Blue dye poses safety risks, while 99mTc-nanocolloid introduces additional hospital visits, radiation exposure, logistical complexity and high costs. Indocyanine green (ICG) fluorescence is a non-radioactive alternative, offering real-time visualisation while addressing many limitations of traditional tracers. Yet, adoption of ICG-guided SLNB remains limited. This trial aims to guide the implementation of ICG-guided SLNB via axillary incision, evaluate its real-world effectiveness and inform conditions for nationwide scale-up. The INFINITE trial is a multicentre, hybrid effectiveness-implementation study employing a stepped-wedge cluster design across seven Dutch hospitals. Clusters sequentially transition from SLNB using 99mTc-nanocolloid alone (Phase I) to ICG as the primary tracer and 99mTc-nanocolloid as a within-patient control (Phase II), and finally to ICG alone (Phase III). The hybrid design enables evaluation of implementation outcomes (penetration, adoption, fidelity, appropriateness, feasibility, acceptability), intervention outcomes (effectiveness, safety, costs) and patient-reported experience (patient satisfaction). The primary outcome is penetration, the proportion of Phase III SLNB procedures performed with ICG alone. An integrated implementation approach combines the Grol and Wensing model (process model), the Consolidated Framework for Implementation Research (determinant framework) and Proctor's outcomes framework (evaluation framework). Outcomes are assessed quantitatively, supplemented by an embedded mixed-methods component to explain variation in implementation across centres. Ethical approval was obtained from the Medical Research Ethics Committees United (6 November 2024; NL87551.100.24). Results will be submitted to open-access, peer-reviewed journals and presented at conferences focused on oncological or image-guided surgery. Implementation tools, including a clinical protocol, implementation guide, educational materials and patient information, will be developed to support national adoption. NCT07146295.
Concerns persist within the surgical community that completion of an accredited surgical residency no longer consistently ensures that trainees are ready for independent practice. In response, the Independent Committee for Graduate Surgical Education (ICGSE) was established in January 2025 to address the unique requirements of surgical training. The committee's mandate was to recommend program standards that would potentially optimize education and training for surgical residents, with the goal of improving patient care. The ICGSE, consisting of 71 surgeons across 16 specialties, reviewed the history of surgical accreditation and relevant literature. Workgroup-led discussions identified strategies for improving trainee readiness and modernization of program accreditation standards. A literature review showed a "readiness gap" affecting 20%-30% of surgical trainees across multiple specialties. Key areas for improvement include:1. Designing curricula that increase clinical exposure, promote progressive autonomy, and facilitate transition to independent practice.2. Aligning training with the realities of surgical practice.3. Balancing accreditation requirements with efforts to reduce administrative burden and enhance faculty development.4. Emphasizing program evaluation beyond board passage rates and surveys to include real-time and longitudinal tracking of skill and clinical judgment acquisition.5. Supporting faculty education in teaching and assessment.6. Providing clear developmental roadmaps for lifelong learning. 1. Modernize accreditation through application of continuous quality improvement processes.2. Implement an outcomes-focused curriculum adaptable to each specialty that encourages innovation.3. Supplement case logs with an evidence-based framework for assuring procedural competency.4. Require standardized nontechnical skills training and assessment.5. Establish a longitudinal, competency-based assessment system.6. Mandate verifiable faculty development with institutional support. The ICGSE recommends that the graduate surgery education community, in collaboration with oversight organizations and professional associations, work to develop common surgery-focused accreditation standards that would drive the excellence required in surgical care.
We aimed to (1) quantify changes in discrimination when adding intraoperative data to preoperative data and (2) compare tabular machine learning with feature engineering against a time-aware LSTM-based model. Retrospective cohort of 46 204 adults undergoing 57 055 eligible noncardiac surgery in the INSPIRE database. We extracted 38 preoperative and 49 intraoperative variables; acute kidney injury (AKI) was defined by KDIGO serum creatinine criteria and modeled as stage 2/3 postoperative AKI. Models were trained on preoperative-only and combined pre- and intraoperative data. Intraoperative series were summarized using eight statistical features for tabular models or integrated directly using an MLP+LSTM architecture. GBT with combined features achieved the highest AUROC (0.896, 95% CI, 0.878-0.914), followed by combined AutoGluon (0.893, 95% CI, 0.877-0.909) and preoperative-only GBT (0.891, 95% CI, 0.871-0.910). ASA-PS ≥3 (AUROC 0.723, 95% CI, 0.700-0.746) and adapted GS-AKI (AUROC 0.719, 95% CI, 0.700-0.739) underperformed machine-learning models. The hybrid MLP+LSTM model did not outperform simpler tabular models (AUROC 0.870, 95% CI, 0.848-0.892). The small gain from adding low-frequency intraoperative summaries suggests that most discriminative information for stage 2/3 postoperative AKI was available before surgery. Preoperative tabular ML models provided excellent prediction of postoperative AKI, and added limited incremental discrimination at the available sampling frequency. Future work should evaluate whether higher-frequency intraoperative signals better leverage time-aware architectures.
Postoperative symptoms such as pain, burning, and itching are common following open excisional hemorrhoidectomy and are often associated with several factors, including wound healing. This study evaluated the efficacy of Propionibacterium extract gel (PeG) in promoting wound healing and reducing pain, burning, and itching compared to an ointment containing hyaluronic acid and silver sulfadiazine (HA-SSD). In this multicenter, phase IV randomized controlled trial, patients undergoing open excisional hemorrhoidectomy were randomly assigned in a 1:1 ratio to receive PeG or HA-SSD. The primary outcome (wound healing) was evaluated on the basis of grade of epithelialization. Secondary outcomes (pain, burning, and itching) were assessed using a 10-point visual analogue scale at baseline and 10, 20, and 40 days postoperatively. Of the 119 screened patients, 64 (53.78%) received PeG and 55 (46.22%) received HA-SSD. The baseline characteristics were comparable. After 20 days, 46 (75.4%) of the PeG group patients had an epithelialization grade > 50% (vs n = 37, 72.6% of the HA-SSD group; p = 0.02). By day 40, complete wound healing occurred in 52 (85.3%) of the PeG group patients (vs n = 25, 52.1% of the HA-SSD group; p = 0.003). Both treatments reduced postoperative pain over time, with no significant between-group difference (p = 0.24). PeG demonstrated a superior reduction in burning (p = 0.02) and itching (p = 0.001). Patient satisfaction was higher with PeG (n = 45, 75% vs n = 9, 18.8% of the HA-SSD group, p < 0.001), with no reported adverse reactions. PeG was more efficient than HA-SSD in promoting wound healing, alleviating burning and itching, and enhancing patient satisfaction following hemorrhoidectomy. This study supports the safety and effectiveness of PeG as a therapeutic option for postoperative management. NCT06872151, retrospectively registered on 6 March 2025.
The incidence of silent brain infarction (SBI) and perioperative neurocognitive disorders (PND) is higher in cardiac surgery. However, standard preventive strategies remain unknown due to limited evidence. This multicentre, prospective, randomised controlled clinical trial with a 1-year follow-up includes patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). 912 participants are randomly assigned 1:1 into either the intervention group with neuroprotective anaesthesia targets (mean arterial pressure 65-90 mm Hg, bispectral index 40-60, bilateral regional cerebral oxygen saturation ≥60%, arterial inflow temperature <37℃ and rewarming rate <0.5℃/min after exceeding 30℃ during CPB) or the control group maintained by anaesthetists according to routine care. The primary outcome is the 7-day incidence of new-onset SBI. The key secondary outcome is the 30-day incidence of PND. The secondary outcomes include the 5-day incidence of postoperative delirium, the 30-day incidence of new-onset overt stroke, the 1-year incidence of new-onset overt stroke, the 30-day incidence of transient ischaemic attack (TIA), the 1-year incidence of TIA, the 1-year incidence of PND, the 30-day and 1-year composite incidence of major adverse events (renal insufficiency, myocardial infarction, pulmonary embolism, seizure, all-cause mortality), length of stay (LOS) in intensive care unit, LOS in hospital and hospitalisation cost. The trial was approved by the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital (Approval No. 2024-2445) and all participating centres. We will disseminate the trial findings in peer-reviewed journals and present the results at national or international conferences. NCT07048002.
Minimally invasive surgery (MIS) has reshaped modern operative care by reducing tissue trauma and accelerating recovery compared with open procedures. Despite extensive research, inconsistencies remain across specialties regarding recovery outcomes and comparative effectiveness, and open surgery remains necessary in selected complex cases where minimally invasive access may be unsuitable or unsafe. This systematic review aimed to evaluate and compare patient recovery following minimally invasive and open surgical approaches. A structured search was conducted across major databases for studies published between 2015 and May 2026, including randomized and observational comparative designs. Data were extracted using a standardized approach and synthesized narratively due to heterogeneity in study designs, surgical procedures, and outcome reporting. Key outcomes included length of hospital stay, postoperative pain, complication rates, operative time, and functional recovery. Findings indicated shorter hospital stay, reduced postoperative pain, and faster recovery in minimally invasive groups, while operative time and cost varied across procedures. Complication profiles favored minimally invasive approaches in many procedures, although differences were procedure-specific. Robotic-assisted approaches did not demonstrate uniform recovery superiority over conventional laparoscopic techniques. MIS enhances short-term recovery and supports improved patient outcomes and healthcare efficiency when applied to appropriate patients and procedures. Conventional open surgery continues to have an important role in technically demanding, advanced, or anatomically complex procedures. Further research should address long-term outcomes, cost-effectiveness, complication-specific endpoints, and technological integration to strengthen evidence-based clinical decision-making across diverse surgical populations and settings.
The aging process of the face is characterized by dermal thinning, loss of elasticity, and wrinkle formation. Injection of autologous micrografts containing fibroblasts (Am-FBs) has emerged as a promising regenerative technique. This trial aims to assess the efficacy and safety of Am-FBs for facial rejuvenation. A randomized, open-label, controlled study was conducted. Forty patients presenting with mild to moderate dermal thinning, reduced elasticity, and wrinkles were divided into two groups: a study group (SG; n = 20) that received Am-FBs treatment and a control group (CG; n = 20) treated with a hyaluronic acid (HA)-based skin booster. Both groups received treatment at baseline (T0), at one month (T1), and at three months (T2). Clinical outcomes were evaluated at T1, T2, T3 (6 months), and T4 (12 months) through patient and physician evaluations, the Wrinkle Severity Rating Scale (WSRS), and objective skin elasticity metrics. In vitro evaluation of the Am-FBs and immunophenotypic characterization of the nucleated cell population contained in the Am-FBs suspension was performed. At T4, the SG showed significantly greater improvements in wrinkle depth, skin elasticity, and WSRS score than the CG (p < 0.01). The physician's evaluation showed scores ranging from 9 to 4 (p = 0.049), whereas patient self-assessments ranged from 9 to 5 (p = 0.039). Patient satisfaction was higher in the SG. The in vitro analysis documented 2.780.750 nucleated cells/ml in Am-FBs with a viability of 89.61% and immunophenotype: CD34%0.2, CD45%0.2, CD44%98.7, CD200%80.0, Cytokeratin 15%99.4. Am-FBs significantly improve signs of facial aging and present a safe option for skin rejuvenation.
To evaluate the value of three-dimensional visualization preoperative planning based on the open-source software 3D Slicer in endoscopic endonasal optic nerve decompression for traumatic optic neuropathy. A prospective randomized controlled study was conducted. A total of 48 patients with traumatic optic neuropathy who underwent endoscopic endonasal optic nerve decompression at the Affiliated Eye Hospital of Nanchang University between January 2023 and June 2025 were enrolled and randomly assigned to an experimental group (3D Slicer-based three-dimensional visualization planning, n = 25) and a control group (conventional two-dimensional CT planning, n = 23). The primary outcome measures included operative time, intraoperative misjudgment rate, complication rate, surgeon's subjective score (5-point Likert scale), and visual improvement at 3 months postoperatively. Continuous data were analyzed using independent-sample t-test or Mann-Whitney U test, and categorical data were analyzed using Fisher's exact test. There were no statistically significant differences in baseline characteristics or preoperative visual acuity grade between the two groups (P > 0.05). The operative time was significantly shorter in the experimental group than in the control group (129.4 ± 11.6 min vs. 150.7 ± 20.4 min, P < 0.001). Postoperative visual acuity improved significantly compared with preoperative values in both groups (experimental group: P < 0.001; control group: P = 0.003), but the intergroup difference in the grade of visual improvement was not statistically significant (P = 0.439). The intraoperative misjudgment rate was 0% (0/25) in the experimental group and 13.0% (3/23) in the control group, with no statistically significant difference (P = 0.24). The incidence of cerebrospinal fluid leakage was 4.0% (1/25) in the experimental group and 21.7% (5/23) in the control group, and the difference did not reach statistical significance (P = 0.08). The surgeon's subjective score was significantly higher in the experimental group than in the control group [5 (5,5) vs. 4 (4,4), P < 0.001]. No severe complications such as major vessel injury or direct optic nerve injury occurred in either group. Three-dimensional visualization preoperative planning based on 3D Slicer can significantly shorten the operative time of endoscopic endonasal optic nerve decompression, enhance the surgeon's confidence, and a potential reduction in cerebrospinal fluid leakage that warrants further investigation. This approach is low-cost, highly generalizable, and has good clinical application value.
Robot-assisted hepatectomy for hepatocellular carcinoma has attracted increasing attention in minimally invasive hepatobiliary surgery, yet its global research landscape has not been systematically characterized. This study aimed to investigate the overall publication profile, collaborative relationships, citation architecture, and thematic changes in the literature on robotic liver resection for hepatocellular carcinoma by using bibliometric and visualization methods. Publications indexed in the Web of Science Core Collection (Science Citation Index Expanded) between January 1, 2008, and December 31, 2025, were retrieved on April 16, 2026. After stepwise screening at the database level, 373 English-language articles and reviews were included. Bibliometrix, VOSviewer, CiteSpace, and Scimago Graphica were used to evaluate annual publication and citation trends, the contributions of countries and institutions, collaboration networks, influential references, and keyword-based research focuses. Publication output and citation activity generally increased across the study interval, with more evident growth in recent years. China showed the strongest cumulative growth in publication output and ranked first in citation counts, while Japan and the USA also demonstrated substantial citation influence. Berlin-affiliated entities, including Free University of Berlin, Humboldt University of Berlin, and Charité Universitätsmedizin Berlin, appeared among the leading institutional affiliations, although this pattern may partly reflect WoSCC affiliation parsing. The literature was concentrated mainly in journals related to minimally invasive surgery, robotic surgery, and hepatobiliary or gastrointestinal surgery. Keyword co-occurrence, clustering, burst, and timeline analyses suggested that research attention has gradually evolved beyond early feasibility and technical exploration, with growing emphasis on anatomy-based resection strategies, perioperative functional assessment, and oncologic outcome-related issues, particularly in relation to anatomical liver resection, glissonian approach, caudate lobe, liver function, recurrence, and open liver resection. Overall, this study maps the global knowledge structure and thematic development of research on robot-assisted hepatectomy for hepatocellular carcinoma and suggests that research attention has gradually shifted toward more specialized and outcome-oriented investigation over time.
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Radical nephrectomy for high-complexity renal tumors, stage T2-T4, size ≥7 cm, and/or inferior vena cava (IVC) involvement, represents one of the most technically demanding procedures in urologic oncology. Robot-assisted radical nephrectomy (RARN) has expanded rapidly in adoption, yet its comparative benefit over laparoscopic radical nephrectomy (LRN) in the high-complexity subpopulation remains undefined. No systematic review has restricted analysis to T2-T4 disease or applied a multidisciplinary outcome framework spanning surgical, renal, infectious, and oncologic domains. Searches of PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, Scopus, and CINAHL retrieved comparative studies (randomized controlled trials, prospective and retrospective cohorts, case-control studies) reporting RARN versus LRN outcomes in adults with high-complexity renal tumors. Screening, data extraction, and risk-of-bias assessment were performed independently in duplicate. Pooling used DerSimonian-Laird random-effects meta-analysis. Heterogeneity was quantified using I² and 95% prediction intervals. Evidence certainty was graded with GRADE. A total of 22 studies encompassing 4,163 patients (RARN: 1,748; LRN: 2,415) met inclusion criteria. RARN was associated with a significantly lower conversion rate to open surgery (odds ratio [OR] 0.38, 95% CI 0.21-0.68; I²=11%; moderate-certainty evidence), reduced estimated blood loss (mean difference [MD] -81.4 mL, 95% CI -112.3 to -50.5; I²=48%), lower transfusion rate (OR 0.54, 95% CI 0.35-0.84), and superior eGFR preservation (MD +3.2 mL/min/1.73 m², 95% CI 0.8-5.6). Operative time was longer in the RARN group (MD +22.7 min, 95% CI 9.3-36.1). No statistically significant differences emerged in overall complication rate, major complication rate, positive surgical margin rate, or recurrence-free survival; however, RARN was associated with a modestly shorter length of stay. Subgroup analysis demonstrated the greatest RARN advantage in IVC thrombus cases (Mayo level III-IV) and tumors ≥10 cm. Among adults undergoing radical nephrectomy for high-complexity renal tumors, RARN confers a meaningful reduction in conversion to open surgery, intraoperative blood loss, transfusion requirement, and acute renal functional loss compared with LRN, at the cost of modestly longer operative time. Evidence quality is moderate for the primary outcome and low-to-moderate for secondary endpoints, reflecting a predominantly observational evidence base. A dedicated randomized controlled trial in the T3-T4 and IVC thrombus subpopulation remains the priority for future research.
Open gastrectomy (OG) has long been the standard for gastric cancer surgery. Robotic gastrectomy (RG) has emerged as a minimally invasive alternative with potential technical advantages, but large-sample meta-analyses comparing their clinical value are limited. This study aims to evaluate its clinical practical application value and provide a reference for clinical practice. A systematic search was conducted in PubMed, EMBASE, MEDLINE, Web of Science, and Cochrane Library up to July 2025, following PRISMA guidelines, with statistical analysis using STATA 12. Seventeen studies involving 31,573 patients (10,524 RG, 21,049 OG) were included. RG had longer operative time (WMD: 93.4; 95% CI: 65.89-120.9; P < 0.001) but less blood loss (WMD: -86.71; 95% CI: -120.91--52.52; P < 0.001), shorter hospital stay (WMD: -3.17 days; 95% CI: -4.17--2.16; P < 0.001), lower postoperative complication rate (OR: 0.61; 95% CI: 0.43-0.87; P = 0.006), and higher R0 resection rate (OR: 1.88; 95% CI: 1.57-2.24; P = 0.000). No significant differences were found in lymph nodes, positive lymph nodes, postoperative mortality, or 5-year survival. RG is a reasonable choice for proficient robotic surgery centers, balancing invasiveness and oncological precision. Future studies should focus on long-term outcome and quality of life to guide clinical decision-making.