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Magnetically actuated surgical systems represent a disruptive class of mechatronic devices that offer a promising approach to enhance minimally invasive (MIS) procedures by reducing tissue trauma. This literature systematic review synthesizes 10 years evidence, from 2016 to 2026, on magnetic mechatronics and robotics in hepatopancreatobiliary (HPB), bariatric, gynecologic, urologic, and neurosurgical applications, focusing on design principles, actuator-sensor fusion, and performance compared to non-magnetic systems. Following PRISMA 2020 guidelines, we searched Scopus using specific Boolean strings for magnetic actuation in the surgical field. Eligibility required experimental validation and clinical translation, prioritizing Q1 and Q2 journals. After title, abstract, and full-text screenings, 187 of 68,956 studies were included. Data extraction focused on technical metrics like coupling efficiency and positional precision, alongside clinical outcomes such as safety and invasiveness. In this sense, a narrative synthesis grouped findings by mechanism and specialty. In correlation, key findings highlight coupling models such as dipole-dipole and gradient-driven force transmission. Indeed, performance envelopes showed sub-millimetric accuracy and improved workspaces for retraction and anchoring over conventional tools, though thermal and saturation limits persist. These systems demonstrate potential for multispecialty translation, establishing a mechatronic framework to guide future platform designs. Limitations include prototype heterogeneity and limited large-scale clinical data. This analysis underscores engineering constraints and opportunities for advanced actuator-sensor integration in MIS procedures.
Surgical never events, including wrong-site surgery, retained foreign objects, and wrong implants or prostheses, persist globally despite successive patient safety frameworks. Human factors are consistently identified as contributors, yet prior systematic reviews have not applied a structured health care-specific analytical taxonomy to this evidence base. This two-phase updated systematic review searched MEDLINE, CINAHL, and specialist journals from inception to December 2025, identifying 39 studies. Human factors findings were mapped against the five domains of the SHEEP model (Systems, Human Interaction, Equipment, Environment, Personal). Human Interaction and Systems were the dominant domains, co-occurring in the majority of studies. Equipment was the least prevalent domain, indicating that technology remains an adjunct rather than a primary prevention strategy. Sustained reduction in surgical never events requires investment in checklist fidelity, speaking-up culture, and organisational responses that prioritise learning over blame rather than reliance on guidance alone.Summary of Major ThemeSurgical never events, including wrong-site surgery, retained foreign objects, and wrong implants or prostheses, represent a persistent patient safety challenge despite successive national and international policy frameworks. Human factors are consistently identified as contributory across the published literature, yet no prior systematic review has applied a structured health care-specific analytical taxonomy to this evidence base. This two-phase updated systematic review applied the Systems, Human Interaction, Equipment, Environment and Personal (SHEEP) model across 39 included studies spanning inception to December 2025, producing domain-level frequency data unavailable from prior narrative reviews. Human Interaction and Systems were identified as the dominant domains, co-occurring in 77% of studies, confirming that never events arise from the simultaneous breakdown of communication and organisational safety systems rather than from isolated individual failures. Equipment was the least prevalent domain, indicating that technology-based prevention strategies remain an adjunct to cultural and systems change.
The increasing volume and complexity of orthopedic surgery have expanded the involvement of ward-based registered nurses in postoperative wound care. Although registered nurses receive foundational wound care education as part of their professional preparation, those without specialist wound care credentials may encounter challenges when managing complex orthopedic surgical wounds. Their experiences, role boundaries, and perceived support needs remain insufficiently explored. This study aimed to explore ward-based registered nurses' perceptions of their roles and professional boundaries in orthopedic surgical wound management and to identify perceived strategies for supporting their practice. A descriptive qualitative study was conducted in an orthopedic ward of a tertiary hospital in China. Fourteen ward-based registered nurses were purposively recruited and participated in semi-structured interviews. Data were analysed using Braun and Clarke's thematic analysis approach. Four themes were identified: negotiating professional boundaries within clinical hierarchies, evolving role identity in orthopedic surgical wound care, developing professional capacity for safe and responsive wound management, and sustaining practice development through continuing education and organizational support. Participants described surgical wound care as an expanding but ambiguously defined area of nursing practice. Their accounts highlighted a mismatch between foundational wound care education and the demands of complex orthopedic surgical wounds, variability in physicians' treatment preferences and local ward routines, limited decision-making authority, and inconsistent interprofessional collaboration. Participants also emphasized the importance of timely nursing involvement, clinically relevant continuing education, standardized protocols, and clearer escalation pathways for supporting safe and coordinated wound care. Ward-based registered nurses without specialist wound care credentials make important contributions to orthopedic surgical wound management through ongoing assessment, timely dressing care, patient education, and communication with physicians and wound care specialists. However, their expanding role is shaped by unclear professional boundaries, variable local practices, limited authority in wound-related decision-making, and uneven access to continuing education. Clearer role delineation, standardized protocols, structured continuing education, and collaborative escalation pathways are needed to support safe and consistent wound care.
Randomized controlled trials comparing transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis and low surgical risk have demonstrated noninferiority of TAVR regarding all-cause mortality and stroke outcomes in 5- and 10-year follow-up. Nevertheless, TAVR remains a costly intervention, and its widescale adoption may affect healthcare expenditure in low- and middle-income countries. This study aimed to conduct a cost-utility analysis comparing TAVR and SAVR in patients with severe aortic stenosis at low surgical risk, from the perspective of the Brazilian Unified Health System (Sistema Único de Saúde - SUS). A Markov model was developed to simulate a hypothetical cohort of patients with severe aortic stenosis over a lifetime horizon. A systematic review was performed to inform efficacy and effectiveness inputs. Cost data were derived from Brazilian patient cohorts who underwent TAVR or SAVR and were expressed in international dollars (Int$). Incremental cost-effectiveness ratios (ICERs) were calculated and sensitivity analyses were performed. The estimated lifetime cost was Int$ 32,341 for TAVR and Int$ 19,778 for SAVR. Lifetime quality-adjusted life-years (QALYs) were 9.90 and 9.71, respectively. The ICER for TAVR was Int$ 64,617 per QALY gained, exceeding the Brazilian willingness-to-pay threshold of Int$ 47,619 per QALY. In probabilistic sensitivity analysis, TAVR was cost-effective in 32.8% of simulations. In patients with severe aortic stenosis at low surgical risk, TAVR was unlikely to be cost-effective compared with SAVR from the perspective of the Brazilian Unified Health System, primarily driven by cost differences between strategies.
Progress in artificial intelligence (AI)-based analysis of surgical videos has been constrained by reliance on manual frame-level annotations rather than patient-level outcomes. In addition, concerns about data privacy restrict the exchange of laparoscopic video data and, thereby, multicenter collaboration. To address these limitations, we developed a pipeline that integrates weakly supervised deep learning with Swarm Learning, a decentralized machine learning approach that enables collaborative model training without data centralization. We evaluated our pipeline using a dataset of 397 laparoscopic appendectomy recordings from six international centers for two patient-level staging tasks: (1) laparoscopic grading of appendicitis and appendiceal perforation detection; and (2) histopathologic inflammation grading. We identified optimal modeling configurations (frame sampling rates and model architectures) using the binary perforation detection task, then compared Swarm Learning with single-center and centralized learning across the laparoscopic and histopathologic disease staging tasks. In addition, we surveyed participating centers to identify barriers to clinical implementation of our learning pipeline for surgical video analysis. For binary perforation detection, frame sampling at one frame per second and use of the SurgTempoNet architecture resulted in reliable classification performance, outperforming SurgFrameNet and Multiple Instance Learning. For both laparoscopic (area under the receiver operating curve [AUROC]: 0.818±0.092) and histopathologic disease staging (AUROC: 0.626±0.029), Swarm Learning consistently outperformed single-center training and achieved performance comparable to centralized learning on external validation (AUROC: 0.795±0.092 for laparoscopic grading; AUROC: 0.610±0.018 for histopathologic grading). The user survey identified hardware failure and limited integration of the decentralized learning pipeline with electronic patient records as key barriers to clinical implementation. Weakly supervised deep learning enables the prediction of patient-level labels directly from surgical video data. Swarm Learning facilitates privacy-preserving multicenter collaboration and achieves performance on par with centralized learning, highlighting its potential for advancing clinically relevant, collaborative AI development in surgical video analysis. (Funded by the European Union and others.).
Placenta accreta spectrum (PAS) has emerged as a pressing global health concern as cesarean delivery rates continue to rise. Once regarded primarily as a placental disorder, PAS is now understood as an abnormal implantation process occurring within uterine scars. Although cesarean hysterectomy remains the predominant management strategy, growing evidence suggests that individualized, uterine-sparing approaches may reduce morbidity and better align with patient preferences. Traditional histopathologic classifications neither correlate with prenatal imaging findings nor reflect surgical complexity, thereby limiting their clinical utility. The PAS topographic classification, developed from intraoperative observations, offers a practical framework for surgical staging and guides patient-specific management strategies. Standardized prenatal ultrasound can anticipate surgical challenges and facilitate preoperative counseling. Despite this, few hospitals currently use this classification. This study qualitatively evaluated the impact of collaborative virtual educational activities designed to disseminate the concepts underlying the topographic classification on the surgical practice of PAS teams. Over a six-month period in 2024, interactive weekly webinars were conducted to discuss the evolving concepts in PAS that justify a shift toward precision medicine. Six months after the webinars concluded, a structured survey documented participants' perceptions of the impact of these sessions on the management of their PAS patients. A total of 112 invitations to participate in the survey were sent, and 91 responses were received (response rate: 81.2%). Among respondents, 97% (n = 88) reported that participation in the virtual academic discussions led to some change in their clinical practice. Thirty-four participants (37.4%) indicated that, following the webinars, they felt more confident proposing modifications to the management of patients at risk for PAS within their institutions. Participants reported that following the virtual academic discussions, they intended to use ultrasonographic evaluation to plan surgery (13 participants, 14.2%), implement individualized management based on topographic classification (18 participants, 19.8%), perform bladder dissection prior to fetal delivery in order to confirm placenta accreta spectrum (PAS) and assess its topography before selecting the appropriate treatment approach (8 participants, 8.8%). Virtual academic meetings designed to disseminate the PAS topographic classification fostered global collaboration, improved clinical practice, and enhanced mutual learning among PAS teams. Beyond technology, respectful, interactive discussions created a psychologically safe learning environment. Teleconferencing proved invaluable for education, research, and quality improvement, with continued support from professional societies essential for sustained progress.
Endodontic microsurgery is a treatment for persistent periapical pathology, where precision in root-end surgery is crucial for success. Advances in digital technology have introduced guided endodontic microsurgery, incorporating static guidance (SG), dynamic navigation (DN), and augmented reality (AR) to enhance surgical accuracy and efficiency. This systematic review and meta-analysis aimed to evaluate and compare the accuracy of SG, DN, and AR in endodontic microsurgery. This review followed PRISMA guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews database (CRD42024583867). A comprehensive search of PubMed, Scopus, and Google Scholar was conducted from inception to February 2026. Studies comparing SG, DN, and AR in endodontic microsurgery were included. Risk of bias was assessed using ROBINS-I V2, the JBI Checklist, and the QUIN tool. Meta-analysis and subgroup analysis were performed on studies with comparable accuracy parameters. Heterogeneity was assessed using Cochran's Q-test and I 2 statistics. Thirty-three studies met the predefined inclusion criteria: 1 nonrandomized clinical trial, 1 case series, and 31 in vitro and cadaver studies. Due to limited clinical studies, the clinical trial and case series identified were synthesized qualitatively, while the meta-analysis pooled only in vitro and cadaveric studies. A meta-analysis demonstrated that SG and DN significantly reduced 3D global deviation at the bur tip compared with FH (p < 0.01). While the drilled root length error did not differ between SG and DN, DN exhibited significantly greater resection angle deviation than SG (p < 0.01). AR showed potential benefits in accuracy, but the data were insufficient for meta-analysis. SG required the least operating time. SG and DN enhance accuracy and efficiency in endodontic microsurgery compared with freehand techniques in in vitro and cadaveric studies. Standardized outcome measures and further clinical trials with long-term follow-up are needed to validate these findings. Further clinical studies with long-term follow-up are warranted to confirm the effects of guided surgical endodontics on clinical outcomes.
Precise resection of sacral tumors remains technically demanding due to their deep anatomical location and close proximity to critical neurovascular structures. Conventional freehand techniques often result in suboptimal resection margins, excessive blood loss, and compromised lumbopelvic stability. This study evaluated whether patient-specific three-dimensional (3D)-printed guiding templates improve surgical accuracy and perioperative outcomes in sacral tumor resection and reconstruction. Nineteen patients undergoing en bloc sacral tumor resection (S1-S3 involvement) with spinopelvic reconstruction (2006-2020) were retrospectively analyzed. Patients were divided into a 3D-printing group (n = 10) and a conventional freehand group (n = 9). In the 3D-printing group, computer-aided design and 3D-printed templates were used for osteotomy, screw placement, and defect reconstruction. Perioperative metrics, surgical accuracy, and complications were compared between groups using Welch's t-test and the Hodges-Lehmann method; oncologic events during follow-up were recorded descriptively. The 3D-printing group demonstrated significantly shorter operative time (456.5 ± 62.36 vs. 574.44 ± 114.58 min, p = 0.012), reduced blood loss (4081.40 ± 838.99 vs. 5090.0 ± 1059.67 mL, p = 0.034), and fewer fluoroscopic exposures (4.2 ± 0.79 vs. 10.0 ± 1.58, p < 0.001) compared with the conventional group. Osteotomy accuracy was also superior in the 3D-printing group, with significantly lower angular deviation (3.33° ± 0.45° vs. 6.79° ± 2.16°, p = 0.0012). Postoperative complication rates were comparable (30% vs. 44.4%, p = 0.649), but hospital stay was significantly shorter in the 3D-printing group (10.7 ± 2.71 vs. 18.11 ± 4.01 days, p < 0.001). Patient-specific 3D-printed guiding templates enhance precision in sacral tumor excision and reconstruction, improving surgical efficiency and perioperative safety. This computer-assisted, template-guided approach represents a valuable advancement for complex sacral oncologic surgery.
Osteoporotic vertebral fractures (OVFs) significantly impact morbidity, mortality, function and quality of life. Stable fractures with controllable pain can be managed conservatively. Those that remain painful can be treated with minimally invasive measures of vertebral augmentation (VA). In contrast, severe and unstable OVFs risk collapse, progressive kyphosis and neurological damage. Conventional VA is considered insufficient for these unstable fractures, making surgical stabilisation necessary to restore spinal load-bearing capacity, and allow fast and painless mobilisation. However, spinal surgery in elderly osteoporotic patients is challenging due to tissue fragility and common comorbidities. In addition, poor bone quality increases the risk of surgical implant failure, new fractures, complications and re-intervention.This trial aims to assess the non-inferiority of a novel minimally invasive interventional technique, called stent-screw assisted internal fixation (SAIF), compared with multilevel surgical stabilisation in terms of quality of life and radiological outcomes such as vertebral height restoration and kyphotic correction in patients with unstable OVFs. This is a multicentre, parallel-group, randomised controlled non-inferiority trial that will be conducted in four European centres.A total of 140 patients with type Osteoporotic Fracture (OF) 3-5 OVFs (according to the AO Spine-DGOU Osteoporotic Fracture Classification System) will be randomised 1:1 to receive either SAIF intervention or surgical stabilisation.The primary outcome is to determine whether the effect of SAIF intervention is not inferior to surgical stabilisation on pain and quality of life at 1-year follow-up.The principal secondary outcomes are to evaluate whether the effect of the SAIF intervention is not inferior to surgical stabilisation in terms of radiological outcome and cost-effectiveness. Ethics approval was obtained from the Ethics Committee of the Canton Ticino, Switzerland (CE 4004). Results will be disseminated through international publications in peer-reviewed journals, in addition to international conference presentations. NCT07071870.
To characterize the clinical profile of congenital laryngeal clefts (CLCs) and to assess the outcomes of surgical repair in affected children. A retrospective review was conducted on pediatric patients (0-18 years) diagnosed with CLC and treated at our hospital between June 2019 and June 2025. Collected variables included demographic characteristics, presenting symptoms, cleft classification, comorbidities, surgical approach, and postoperative follow-up outcomes. A total of 82 patients were included, with a male-to-female ratio of 1.41:1. Infants aged 6-12 months represented the largest subgroup (37.80%). The predominant presenting symptom was choking on feeds/fluids (71.95%). Type I clefts were most common (76.83%), and the leading comorbidity was synchronous airway lesions (39.02%). All patients underwent endoscopic laryngeal cleft repair, achieving an overall success rate of 95.12%. When comparing methods of freshening cleft margins in Type I clefts, use of the Nd: YAG laser was associated with shorter operative duration and reduced intraoperative bleeding compared to conventional laryngeal forceps/scalpel techniques (P < 0.05). However, postoperative edema resolution times did not differ significantly (P > 0.05). The most frequent manifestation of CLC is choking on feeds/fluids, with Type I being the predominant form, which is often accompanied by various medical complications. Endoscopic laryngeal cleft repair demonstrates excellent efficacy. The Nd: YAG laser, with its minimally invasive nature and advantage of reduced intraoperative bleeding, represents a valuable tool for clinical application in CLC repair.
Flexible bronchoscopy (FOB) is frequently used in intensive care units (ICUs) for diagnostic sampling and therapeutic airway management. However, real-world practice patterns, organizational barriers, and perceived unmet needs remain poorly described. We conducted a cross-sectional international online survey targeting ICU specialists. The questionnaire explored bronchoscopy availability, indications, perceived utility, safety concerns, logistical constraints, and priorities for future improvement. Responses were collected worldwide without a predefined denominator. A total of 328 ICU clinicians responded, of whom 88% were ICU consultants. Respondents were practicing in 49 countries, including 65% from Europe. Respondents had a median of 17 years since graduation and primarily worked in mixed medical-surgical ICUs with a median of 20 beds. Bronchoscopy was performed mainly by ICU specialists (68%), and 87% reported 24/7 access. However, only 25% reported the existence of a local bronchoscopy protocol. Nearly half of respondents performed FOB almost daily, most commonly for sampling or bronchoalveolar lavage. Reported priorities were highest for immunocompromised patients (median score 8/10) and atelectasis (8/10), whereas community-acquired pneumonia ranked low (3/10). Safety concerns strongly influenced decision-making (8/10), particularly in hypoxemic patients (75%). Laboratory turnaround times varied widely, across centers. Complications were generally rated as low severity. ICU bronchoscopy is widely accessible and frequently performed, yet protocols remain uncommon and safety concerns represent major barriers, even though rarely occurring. Delays in microbiological results and variability in practice highlight important unmet needs, particularly in immunocompromised populations.
The accuracy of optical tracking tools is crucial for surgical navigation. While commercial tools are reliable, their proprietary design knowledge limits accessibility and adaptability for specialized clinical and research applications. This study introduces an open, reproducible optimization framework based on point-based rigid registration theory, defining a unified pose estimation deviation metric and deriving its analytical expression for both expectation and variance. The approach incorporates constraints for intra-group uniqueness and inter-group compatibility, using exhaustive configuration generation and geometric evaluation to rank designs by predicted accuracy. Numerical simulations confirmed the derived formula, with under 5% average prediction error for the expectation and strong agreement for the variance. Optimized four-fiducial tools were compared to commercial references via tip calibration, distance measurement, and registration tests. Most optimized tools (75%) achieved accuracy comparable to or modestly better than commercial tools (e.g., tip calibration 0.22 mm vs. 0.28 mm, distance measurement 0.18 mm vs. 0.20 mm, FRE 0.13 mm vs. 0.16 mm, TRE 0.48 mm vs. 0.51 mm). All four experiments showed a strong positive correlation between the theoretical metric and measured error (Pearson's r>0.98, all p<2.2×10-7; exact Spearman p≤2.8×10-6). Beyond these numerical results, the primary contribution is a systematic, open design methodology that formalizes knowledge historically proprietary to commercial vendors, enabling researchers and engineers to generate high-precision custom tracking tools for diverse surgical navigation scenarios.
Curative-intent surgery in patients with perihilar cholangiocarcinoma (pCCA) is associated with substantial surgical risks and high early-recurrence rates. This study aimed to develop an ABC system for preoperative staging of patients with pCCA. This retrospective international multicenter cohort study included patients with resected pCCA across 27 participating centers from 9 countries (2006-2022). The prognostic performance of the ABC system for overall survival (OS) and recurrence was assessed using multivariable (cause-specific) Cox regression. Among 1307 included patients (median age, 66 [IQR, 57 to 73] years), independent prognostic factors for OS were: tumor size ≥25 mm (adjusted hazard ratio [aHR], 1.32 [95% CI, 1.13 to 1.55]; P=0.0003), CA19-9 ≥500 U/mL (aHR, 1.49 [1.22 to 1.81]; P<0.0001), and WHO performance status ≥1 (aHR, 1.35 [1.12-1.63]; P=0.002). The ABC score for OS consisted of 1 point for each independent prognostic factor (0-3 points); the ABC score for recurrence did not include WHO PS ≥1 (0-2 points). Compared to the ABC-0 group, the highest ABC risk group had a 3.4 times higher 90-day mortality risk (21 vs 6%; P=0.005), a 3.3 times higher 6-month recurrence rate (18 vs 5%; P<0.0001), a 3.0 times shorter median OS (13 vs 39 months; P=0.0001), and a 3.6 times lower 5-year OS rate (11 vs 35%; P=0.018). The prognostic value of the ABC score for OS remained similar in a sensitivity analysis including only patients with a resection post-2015 (Pinteraction=0.90). Following the ABC system, we should be reluctant to offer resection to patients with an ABC score of 3 with a tumor size ≥25 mm, CA19-9 ≥500 U/mL, and a WHO PS ≥1.
Background/Objectives: Intraoperative ultrasound (IOUS) has become an integral component of modern hepatic oncology surgery, providing real-time imaging guidance during liver resections for hepatocellular carcinoma, colorectal liver metastases, and other primary or secondary hepatic malignancies. Despite substantial improvements in preoperative imaging modalities, occult lesions, disappearing metastases after chemotherapy, and complex vascular relationships continue to represent major intraoperative challenges. This structured narrative review aimed to evaluate the contemporary role of IOUS in hepatic oncology surgery, with particular emphasis on contrast-enhanced intraoperative ultrasound (CE-IOUS), minimally invasive liver surgery, navigation-assisted hepatectomy, and emerging artificial intelligence-based technologies. Methods: A structured literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases. Peer-reviewed studies, international guidelines, consensus statements, systematic reviews, and technological reports addressing IOUS applications in liver surgery were analyzed. Particular focus was placed on studies evaluating lesion detection, intraoperative strategy modification, disappearing colorectal liver metastases, parenchymal-sparing hepatectomy, laparoscopic and robotic liver surgery, navigation systems, augmented reality integration, and AI-assisted imaging technologies. Results: Contemporary evidence demonstrates that IOUS continues to significantly influence intraoperative decision-making despite advances in magnetic resonance imaging and multidetector computed tomography. CE-IOUS improves the detection of occult hepatic lesions and residual disease after systemic chemotherapy, particularly in disappearing colorectal liver metastases. IOUS-guided anatomical and parenchymal-sparing resections contribute to the preservation of functional liver parenchyma while maintaining oncologic radicality. In minimally invasive liver surgery, laparoscopic ultrasound remains essential for lesion localization and vascular mapping. Recent developments integrating navigation systems, augmented reality platforms, and AI-assisted image recognition suggest a progressive transition toward digitally integrated precision liver surgery. Conclusions: IOUS remains a cornerstone of modern hepatic oncology surgery and continues to evolve from a localization tool into a comprehensive platform for precision-guided liver resection. The integration of CE-IOUS, navigation technologies, and artificial intelligence may further enhance intraoperative accuracy, oncologic safety, and individualized surgical planning in the future.
This study describes the establishment and assesses the early outcomes of a novel urogynecology fellowship training program in a low-resource setting at Mbarara University of Science and Technology (MUST), with the aim of informing similar efforts in other low-resource settings. We conducted a mixed-methods implementation and program evaluation study. Quantitative service delivery indicators were assessed using a quasi-experimental before-after design, and qualitative data were derived from descriptive trainee narratives. The intervention consisted of a competency-based 2-year, part-time modular fellowship integrating supervised clinical and surgical apprenticeship. It blended local and international didactic instruction that required scholarly output. Fellows' competencies were assessed using the Performance-Based Assessment method from the FIGO Global Competency-Based Fistula Surgery Training Manual. Primary outcomes included changes in fellows' competencies, urogynecology surgical volumes, geographical service coverage, and research output. Quantitative outcomes were summarized descriptively, and qualitative data were analyzed using inductive thematic analysis. Five fellows (four from Uganda and one from South Sudan) were selected from 22 applicants. At evaluation, fellows had completed 25% of the curriculum. Performance-based assessments demonstrated progressive improvement in fellows' clinical and surgical competencies. Training sites expanded from four to 11, and annual urogynecology surgical volume increased from 300 procedures in 2024 to 548 in 2025. Program-associated research output rose from two to eight peer-reviewed publications. Infrastructure upgrades were achieved at some of the training sites. The MUST urogynecology fellowship demonstrates that partnerships enable establishment of subspecialty training programs addressing workforce gaps and improving access to specialized surgical care in low-resource settings.
The implications of complex robotic surgery on the well-being of surgeons remains widely unexplored. The DEXTER Robotic Surgery System offers an open concept where the surgeon console can be used in a sterile manner, allowing flexibility to switch between the robotic system and conventional laparoscopy. The aim of this study was to evaluate surgical ergonomics during the use of the DEXTER Robotic System. A prospective, non-randomized international multicenter trial evaluating surgical ergonomics during the routine clinical practice was performed in Switzerland and USA. A photo camera captured the surgeon's posture at the console during surgery. Using picture editing programs, image analyses were created showing the surgeon's average posture and corresponding angles. Furthermore, sound levels were measured during cases. Data were compared to previous measurements (n = 33 surgeries) of a closed console robotic system using the same methodology. A total of 83,025 images from 40 surgical procedures were analyzed, performed by five surgeons. Knee, back, and elbow angles were within recommended ergonomic limits whereas neck and hip positions were classified as high-risk. Compared with a closed console robotic system, neck posture was significantly improved (p value 0.0001). Mean sound levels were 60.24 dB for all surgeries. Comparison to a robotic system with a closed console revealed a statistically quieter OR setting for the open DEXTER system (mean sound level 64.35 dB vs. 59.5 dB; p value 0.0001). The application of ergonomic measurements during a real-life setting for robotic surgery helped to reveal ergonomic advantages and challenges faced when using a new robotic technology. This is the first study providing ergonomic insights in the DEXTER surgical system, identifying individual possibilities for improvement. Future studies and recommendations will may lay the foundation for a personalized training and education in surgical ergonomics leading to a healthier workspace for all surgeons and their future careers.
To compare perioperative and functional outcomes of standard holmium, Moses 1.0, and Moses 2.0 laser enucleation performed at an academic center with trainee involvement. We retrospectively reviewed men undergoing HoLEP between June 2022 and May 2024. Patients were grouped by laser platform: standard holmium, Moses 1.0, or Moses 2.0. Baseline demographics, perioperative data, complications, and functional outcomes up to six months were analyzed using analysis of variance or Kruskal-Wallis tests. Among 389 patients (standard holmium 206; Moses 1.0 126; Moses 2.0 57), baseline characteristics were similar. Median operative times were 95, 105, and 100 min for standard holmium, Moses 1.0, and Moses 2.0, respectively (p = 0.25), and median prostate weights were comparable (84 g, 85 g, 79 g; p = 0.44). Hospital stay was slightly longer with Moses lasers (1.6 vs. 1.4 days, p < 0.001), though this difference is unlikely to be clinically significant. Objective measures of bleeding-postoperative hemoglobin drop (1.7-2.0 g/dL) and transfusion rates (0-1.6%)-did not differ significantly between groups. Postoperative catheter duration, hospital stay, and complication rates were also comparable. Functional outcomes improved in all groups through 6 months, with no intergroup differences. HoLEP is safe and effective across conventional holmium, Moses 1.0, and Moses 2.0 platforms, with comparable perioperative and functional outcomes. Although the literature suggests that Moses 2.0 may facilitate same-day discharge, its absence should not limit HoLEP availability, and platform selection may reasonably reflect institutional resources and surgeon preference.
In many medical specialties, robot-assisted surgery has become a crucial option for surgical interventions. However, its adoption in vascular surgery remains limited, with this discipline lagging behind other fields in both research and application of this technology. The rapid advancement of robot-assisted surgery presents both an opportunity and a challenge for the development of vascular surgery. Bibliometrics can systematically and quantitatively summarize research achievements, key research directions, and emerging trends in this field, thereby guiding future research efforts on the application of robot-assisted surgery in vascular surgery. All eligible literature in this research was retrieved from the Web of Science Core Collection, covering publications released from 1997 to 2025 that focus on the clinical applications of robot-assisted surgery within vascular surgery. Two bibliometric software programs, VOSviewer 1.6.20 and CiteSpace 6.4.R2, were adopted to implement multiple analytical procedures, including author collaboration analysis, literature co-citation analysis and keyword co-occurrence analysis. Meanwhile, the citation burst detection function embedded in CiteSpace was applied to pinpoint prevailing research hotspots and emerging frontiers in this discipline. This study included 375 eligible publications from 1,777 researchers across 503 institutions in 39 countries. Annual publication output showed a steady increase, with two notable peaks in 2022 and 2025 after a marked rise post-2020. The United States led globally with 130 papers (34.6%) and 3,687 citations, followed by China, Japan, Italy, and the UK. The Beijing Institute of Technology was the most prolific institution. Key scholars including Shuxiang Guo, Norihiko Ishikawa, and Go Watanabe shaped the field's foundation, while the International Journal of Medical Robotics and Computer Assisted Surgery and The Annals of Thoracic Surgery were the primary publishing venues. Keyword clustering identified five major research themes: robotic surgery, angioplasty, force sensing, abdominal aortic aneurysm, and percutaneous coronary intervention. Temporal keyword analysis revealed a clear shift from traditional open cardiovascular procedures (e.g., coronary artery bypass grafting, laparoscopic aortic bypass) toward robotic-assisted endovascular and extravascular interventions, such as percutaneous coronary intervention and integrated robotic revascularization. Over the past twenty-nine years, China's research institutions and scholars have achieved certain accomplishments in the application research of robot-assisted surgical techniques in the field of vascular surgery. Vascular surgery has evolved from traditional open cardiovascular procedures to novel robot-assisted surgical methods suitable for both intravascular and extravascular operations.
Laser surgical management of human papillomavirus (HPV)-related disease, such as recurrent respiratory papillomatosis (RRP), in the upper aerodigestive tract generates surgical smoke, which may represent a source of occupational viral exposure for laryngeal surgeons, phoniatricians, anesthesia providers and scrub nurses. Despite growing awareness, protective measures remain inconsistently implemented. This study aimed to develop an evidence-informed clinical consensus statement (CCS) to guide occupational HPV risk management in laryngology. A modified Delphi consensus process was conducted under the auspices of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP). A panel of 26 international experts undertook three rounds of voting on 18 statements across five domains: definitions and risk perception, personal protective measures, smoke evacuation and ventilation, preventive vaccination, and areas for further research. All panellists completed all three rounds. Of the 18 statements, one reached strong consensus, seven reached consensus, one reached near consensus and six did not reach consensus. Three statements were merged across rounds. Key areas of consensus included the recognition of surgical smoke as a potential occupational HPV exposure risk, the inadequacy of standard surgical masks, the importance of offering HPV vaccination to healthcare workers with potential occupational exposure, alongside areas for further research. This joint ELS and UEP CCS represents the first internationally coordinated effort to address occupational HPV exposure in laryngology. While consensus was reached in several key areas, the findings underscore the need for targeted research and greater consistency in protective measures, educational provision and regulatory frameworks.
Male infertility significantly contributes to the global reproductive burden and serves as a critical indicator of overall male health. As clinical pathways have historically focused on female-factor evaluation and assisted reproductive technology (ART), there is an increasing need for etiology-directed and time-sensitive male management strategies. This Clinical Recommendation, developed by the Korean Society for Sexual Medicine and Andrology Guideline Committee, synthesizes recent evidence from major international guidelines with specific considerations for the Korean healthcare environment. Management should be couple-centered, integrating the female partner's reproductive timeline to avoid preventable delays in effective therapy. Core recommendations emphasize addressing modifiable risk factors as foundational care, while restricting empiric pharmacotherapy to phenotype-driven, time-limited trials. Disease-specific pathways for varicocele, endocrine disorders, and obstructive/non-obstructive azoospermia are delineated, emphasizing the individualized selection between microsurgical reconstruction and surgical sperm retrieval. In the ART interface, the selective use of intracytoplasmic sperm injection is recommended, prioritizing safety and the prevention of multiple pregnancies. Furthermore, structured follow-up should prioritize patient-important outcomes, such as live birth and treatment burden, over intermediate semen parameter changes. By harmonizing international evidence with local clinical constraints, including national insurance structures and referral patterns, these recommendations aim to facilitate consistent, safe, and patient-centered care for infertile men in Korea.