Inguinal hernia surgery may trigger inflammation, and circadian variations in surgical timing could affect this response along with postoperative recovery. This study investigated how surgery timing influences inflammation, sleep quality, recovery, and pain in patients undergoing hernia repair. This prospective, randomized controlled trial was conducted at Ankara Bilkent City Hospital, with 70 patients undergoing elective unilateral inguinal hernia repair performed with a standardized open surgical technique. Participants, aged 18-70 and classified as ASA (American Society of Anesthesiologists) I-II, were randomized into two groups based on surgery timing: morning group (08:00-12:00, Group D) and evening group (18:00-22:00, Group N). Both groups followed standardized institutional fasting protocols, resulting in comparable fasting durations prior to surgery. All patients completed the Athens Insomnia Scale (AIS) preoperatively, and blood samples were collected to measure inflammatory markers including Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Mean Platelet Volume (MPV), Systemic Inflammation Index (SII), C-reactive Protein (CRP), fibrinogen, Erythrocyte sedimentation rate (ESR), procalcitonin (PCT), ferritin, and Interleukin-6 (IL-6). These parameters were reassessed 24 h after surgery, and AIS was re-evaluated again on postoperative day 3. Sixty patients were included in the final analysis, with comparable demographics across groups. All inflammatory markers except MPV increased postoperatively in both groups; however, only IL-6 showed a significant between-group difference, with higher levels observed in the night group (p < 0.001). Sleep quality was better in the day group on postoperative days 1 and 3 (p = 0.05; p = 0.019), and recovery scores were also higher (p = 0.001). Pain scores were similar except at the 8th hour, where the day group reported lower NRS (Numerical Rating Scale) scores (p = 0.032). Daytime surgeries were associated with lower postoperative IL-6 levels and improved postoperative sleep quality and recovery. Although a statistically significant difference in pain scores was observed at the 8th postoperative hour, this finding was modest and did not affect overall analgesic consumption. These results suggest that surgical timing may influence certain short-term postoperative outcomes. These findings are specific to unilateral open inguinal hernia repair and may not be generalizable to more extensive, complex, or emergency surgical procedures. ClinicalTrials.gov (Registration No: NCT06345313, Date: 2024-03-27).
The diagnosis of intra-abdominal infections (IAIs) is mainly clinical. Procalcitonin (PCT) is an acute phase protein widely used to assess bacterial infections, but no biomarker has proved to be a gold standard for sepsis. Thus, identifying a highly specific biomarker for early detection of abdominal infections would be valuable. Aim of the study was to provide a preliminary evaluation of the role of circulating calprotectin (C-CLP) in the diagnosis of IAIs by comparing it with PCT and assessing its correlation with disease severity. A series of adult patients admitted with a clinical (acute abdomen or SOFA ≥ 2) and a radiological (US or CT) evidence of IAI requiring surgery were enrolled. Based on the severity of the disease, patients were divided according to CPIRO score into group A (CPIRO ≤ 2) and group B (CPIRO ≥ 3). A control group (C) included patients undergoing elective abdominal wall surgery with no infection. A total of 151 patients were included: 78 in group A, 12 in group B, and 61 in group C. Baseline characteristics of groups were comparable with the exception of median age that was lower in group C (p = 0.006). Circulating calprotectin levels at the admission were significantly higher in groups A (2.8 µg/mL) and B (4.6 µg/mL) than in controls (0.6 µg/mL, p < 0.000001), as was PCT (p < 0.000001). ROC analysis confirmed diagnostic accuracy for both biomarkers (C-CLP AUC = 0.899; PCT AUC = 0.936). An C-CLP cutoff > 1.2 µg/mL provided 82% specificity and 87% sensitivity. C-CLP correlated with CPIRO (R = 0.47), APACHE II (R = 0.46), and postoperative complications (R = 0.33). Circulating calprotectin demonstrated strong diagnostic accuracy for IAIs, comparable to PCT, and correlated with disease severity. Negative C-CLP values suggest infection is unlikely. These findings require confirmation in larger cohorts before clinical application.
This study aimed to evaluate the need for intensive care unit (ICU) admission and identify factors associated with in-hospital mortality (IHM) in patients with Fournier's gangrene (FG) using traditional statistical methods complemented by machine learning-based models. This retrospective cohort study included surgically treated FG patients at a tertiary referral center. Demographic, clinical, laboratory, and perioperative variables were analyzed. Established prognostic indices, including the Fournier's Gangrene Severity Index, Uludağ Fournier's Gangrene Severity Index, Laboratory Risk Indicator for Necrotizing Fasciitis, Systemic Immune-Inflammation Index, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio, were evaluated. Patients were stratified according to ICU requirement and survival status. Multivariable logistic regression was performed to identify independent predictors. In addition, exploratory machine learning models, including k-Nearest Neighbors (KNN), Random Forest (RF), Support Vector Machine, and Decision Tree algorithms, were applied to assess predictive performance. Multivariable logistic regression analysis revealed that PLR and heart failure (HF) were independent predictors of ICU requirement. Regarding IHM, PLR remained the only independent predictor. In the exploratory ML analysis, KNN and RF showed AUC values of 0.886 and 0.873 for ICU prediction, and 0.787 and 0.765 for IHM prediction, respectively. However, given the limited sample size and low number of outcome events, these performance estimates should be interpreted cautiously. This study highlights the prognostic relevance of inflammatory markers, particularly PLR, and comorbid conditions including HF, chronic kidney disease, cerebrovascular disease and concurrent malignancy, in disease severity and IHM in FG. Machine learning-based models showed promising performance, although these findings should be considered preliminary and require validation in larger, multicenter cohorts.
Despite the growing prominence of Artificial Intelligence (AI) in surgical practice, surgical residents and postgraduates receive limited formal training. A cross-sectional survey of 322 surgical residents and postgraduates from three Chinese medical universities assessed their knowledge, perceptions, and experience regarding AI in surgical practice. Among respondents, 76.7% reported prior experience with clinical AIrelated applications and generally recognized their value. However, self-reported preparedness to critically appraise AI and use it responsibly was modest or low. In particular, over 75% of respondents expressed limited confidence in evaluating model reliability and in identifying bias or other limitations. 85.7% supported the formal integration of AI into surgical training programs. On the other hand, 267 respondents reported that they had not received any formal AI training. Interest in AI-related topic differed significantly across training stages (χ2 = 39.12, p < 0.01). Postgraduate year 1 (PGY1) residents were most interested in learning the AI basics. PGY2 residents preferred topics about Human-AI collaboration and AI-assisted imaging analysis. PGY3 residents expressed interest in AI for research design and data analysis. These findings indicate a significant gap in AI education, highlighting the need for a stage-tailored and specialty-aware structured AI curriculum to prepare surgeons for the evolving world of healthcare technology.
The growing use of robotic systems in minimally invasive surgery has enhanced precision, reduced pain, and sped up recovery. This study aims to: (1) analyze publication trends in RALS; (2) identify leading countries, institutions, and authors; (3) highlight research hotspots and influential literature; (4) explain current trends; and (5) explore future directions to guide researchers. A bibliometric analysis was conducted using publication data from January 2000 to September 2024, analyzing metrics such as publications, citations, and collaborations. Key institutions, authors, and articles in RALS research were identified, along with trends in international collaborations. Data from the Web of Science was used, with modularity Q and silhouette S metrics to assess network structures. The analysis of global RALS research from 2000 to 2024 revealed substantial growth, with annual publications rising from fewer than 10 in the early 2000s to over 300 by 2022. The U.S. led in output and collaboration, with key institutions like Johns Hopkins and Mayo Clinic, and authors such as Scambia G and Yang GZ being highly cited. Keyword analysis identified themes like "robotic surgery" and "laparoscopy," with a growing focus on advanced robotic techniques. Despite overall growth, a slight decline in publications and citations in 2023 suggests a shift toward emerging technologies. The bibliometric analysis of RALS from 2000 to 2024 showed significant growth but highlighted challenges in global access. It emphasized the need for international collaboration and AI integration while calling for further research on cost-effectiveness, outcomes, and training for equitable global access.
Approximately 25% of patients with colorectal cancer (CRC) are diagnosed with distant metastases, with the liver being the most common site. A simultaneous approach to resections in these patients may lead to higher complication rates. Recent research suggests that minimally invasive surgical (MIS) techniques can help reduce this additional morbidity. This study examines a multicenter Italian experience, comparing perioperative outcomes of robotic (RS) and laparoscopic surgery (LS) in this setting. Patients from the prospective multicentre registry of the Italian Group of Minimally Invasive Liver Surgery (I Go MILS) who underwent MIS simultaneous resection for CRC with colorectal liver metastasis between 2015 and 2025 were included. Perioperative outcomes were compared between RS and LS using nearest neighbor matching with 2:1 ratio and caliper of 0.2 to mitigate the selection bias. A total of 505 patients were analyzed, including 415 undergoing LS and 90 undergoing RS. After matching, demographic characteristics were similar. Operative time, conversion rate (11.71% for LS vs 6.67% for RS, p = 0.224) and length of stay were comparable between the two groups. Robotic surgery enabled more challenging resections compared to laparoscopy and after matching for complexity was associated with lower major complications (21.62% vs 8.89%, p = 0.014). The robotic approach has demonstrated superior feasibility for technically challenging resections while maintaining similar length of stay, rate of conversion and postoperative complications, after matching for complexity RS was associated with a significantly lower rate of major complications. Robotic surgery can be an alternative to open surgery in complex cases in order to maximise the benefits of minimally invasive surgery and to have better short term postoperative outcomes.
Anal fistula poses a significant clinical challenge with escalating research interest reflected by a more than 50-fold increase in publications from 2006 to 2026. This bibliometric study systematically analyzed 505 PubMed-indexed articles to elucidate the evolving knowledge structure and research paradigms in anal fistula diagnosis and treatment. Utilizing advanced visualization and clustering techniques via the R bibliometrix package, the analysis mapped global publication trends, geographic and institutional contributions, collaboration networks, journal impact, author influence, and keyword evolution. Results identified China and the United States as leading contributors with distinct international collaboration clusters, while Korean institutions demonstrated notable productivity and specialized research focuses. Key journals such as Diseases of the Colon & Rectum concentrated the majority of domain-specific publications, predominantly within moderate impact factor tiers. Authorship networks revealed diverse, multinational collaborative clusters emphasizing both traditional surgical and emerging minimally invasive approaches. Keyword co-occurrence and citation analyses indicated a thematic shift from basic pathophysiology and surgical techniques toward patient-centered outcomes, quality of life assessments, and prospective study designs. These findings highlight the field's transition toward precision medicine and interdisciplinary integration, underscoring the importance of evidence-based clinical decision-making and international cooperation. This comprehensive bibliometric mapping offers valuable insights to guide future research priorities, foster collaborative innovation, and improve therapeutic strategies aimed at enhancing patient outcomes in anal fistula management.
Real-time indocyanine-green (ICG) fluorescence lymphography in gastric cancer (GC) surgery is gaining traction for its potential to enhance lymphadenectomy during minimally-invasive procedures. This systematic review and meta-analysis evaluated efficacy and safety of ICG-guided lymphadenectomy versus standard techniques. Following PRISMA and Cochrane guidelines, this review (PROSPERO: CRD42024628572) included randomized controlled trials (RCTs) and non-randomized controlled studies (n-RCTs) comparing ICG-guided versus standard minimally-invasive lymphadenectomy in GC patients undergoing gastrectomy. Primary outcome was number of retrieved lymph-nodes (LNs). Secondary outcomes included ideal (≥ 30 LNs) and proper (≥ 16 LNs) lymphadenectomy rates, postoperative outcomes, recurrence, and mortality. Meta-analyses used a random-effects model; evidence quality was assessed via GRADE. 21 studies involving 8633 patients were included. ICG-guided surgery retrieved significantly more LNs (MD 6.91; 95%CI 5.47-8.35; p < 0.00001; I2 68%). Subgroup analyses showed greater benefit in patients receiving neoadjuvant therapy (MD 9.3; 95%CI 6.73-11.88; p < 0.00001; I2 0%) and in overweight/obese patients (MD 10.94; 95%CI 3.25-18.64; p = 0.005; I2 79%). ICG significantly improved ideal lymphadenectomy rate (RR 1.29; 95%CI 1.15-1.45; p < 0.0001; I2 74%), though proper lymphadenectomy rates were similar. ICG reduced operative time (MD - 6.56; 95%CI - 12.31 to - 0.81; p = 0.03; I2 75%) and blood loss (MD - 10.13; 95%CI - 17.44 to - 2.82; p = 0.007; I2 83%). No significant differences emerged for postoperative complication, recurrence, or mortality. ICG lymphography significantly improves nodal yield and ideal lymphadenectomy rates in minimally-invasive GC surgery, enhancing efficiency and reducing blood loss, without increasing complications. Broader implementation is supported, especially in challenging subgroups, like obese or neoadjuvantly treated patients.
The anterior approach (AA) with liver hanging maneuver (LHM) has been proposed as an alternative to the conventional approach (CA) for major hepatectomies. Despite its potential advantages, LHM remains underutilized, partly due to concerns about vascular injury and tumor rupture. Three-dimensional visualization technology (3DVT) may improve anatomical comprehension and inform preoperative decision-making in selecting surgical strategies. We retrospectively analyzed 20 patients undergoing major hepatic resections (right/left hepatectomy and right posterior sectionectomy) between 2019 and 2024. Four expert hepatobiliary surgeons (HPB) and four postgraduate surgical trainees (PGY5) independently assessed surgical strategy based on 2D imaging, followed by reevaluation with 3D reconstructions. Patient-specific 3D structures were generated using an AI-assisted segmentation pipeline and systematically revised by physician specialists, a board-certified abdominal radiologist and two hepatobiliary surgeons. Intra-rater concordance was evaluated using Cohen's Kappa. Primary endpoint was the rate and directionality of surgical plan modifications due to 3DVT. Secondary endpoints included perioperative outcomes and segmentation performance metrics. 3DVT prompted significant changes in surgical planning, particularly in assessing LHM feasibility. Trainees exhibited a higher proportion of positive shifts in decision-making (No → Yes: 17.6%) compared to experts (10.8%), whereas experts more frequently reversed previously affirmative decisions (Yes → No: 9.5%). In select raters, negative Kappa values indicated systematic reassessment driven by 3D data. No significant differences in intraoperative blood loss, operative time, transfusion rate, complications, or mortality were observed between AA + LHM and CA cohorts. 3D segmentation achieved high concordance with manual ground truth (median Dice similarity coefficient for liver parenchyma: 0.98). 3DVT exerts a quantifiable influence on preoperative strategy, particularly for complex hepatic resections. It facilitates surgical planning among trainees and enhances precision among experienced surgeons. Integration of 3DVT may support safer adoption of technically demanding maneuvers such as LHM, especially in minimally invasive settings.
Massive abdominal wall defects resulting from radical abdominal wall endometriosis (AWE) resection present a major reconstructive challenge. This study aims to assess feasibility and short-term safety of a standardized retromuscular-onlay dual-mesh repair technique in this setting. In this single-center retrospective study, 9 patients with massive abdominal wall endometriosis underwent radical excision and standardized retromuscular-onlay dual-mesh reconstruction between January 2024 and June 2025. A series of postoperative complications was analyzed, including surgical site infection, symptomatic seroma, hematoma, wound pain and numbness, mesh infection, incisional hernia, and recurrence of abdominal wall endometriosis. All nine patients, with a history of cesarean delivery, were diagnosed with type III AWE. Clinical presentation uniformly featured a palpable abdominal wall mass and pain accompanying the menstrual cycle. Previous surgical intervention for AWE had been undertaken in 22.2% (2/9) of patients. All reconstructive procedures were successfully performed. We recorded a mean specimen diameter of 9.61 ± 2.56 cm, an operative time of 114.00 ± 41.81 min, and an estimated blood loss of 15.70 ± 11.61 mL. The mean postoperative hospital stay was 8.50 ± 2.72 days, and drains were maintained for a mean of 5.00 ± 1.05 days. In this small cohort study, no surgical site infections, mesh infections, hematomas, or symptomatic seromas requiring intervention occurred. At a mean follow-up of 6 months, no clinical recurrence of AWE or incisional hernia was observed. Only one patient (11.1%) reported a slight numbness in the skin of the surgical area. This standardized dual-mesh reconstruction technique appears feasibility and short-term safety for massive AWE-related abdominal wall defects, with encouraging short-term outcomes and low early complication rates in this initial experience. Longer-term follow-up and prospective multi-center studies are needed to confirm durability.
Head-Mounted Devices (HMDs) are wearable display systems that present immersive 3D virtual information directly in the user's line of sight. The review investigates the role and effectiveness of HMDs utilizing Mixed Reality (MR), Augmented Reality (AR), and Virtual Reality (VR) technologies in surgical education, preoperative planning, and intraoperative navigation, and identifies existing barriers to their broader adoption within the domain of surgical training and practice.​ A systematic literature search following PRISMA guidelines was performed, focusing on studies covering Virtual, Augmented, or Mixed Reality applications in surgical education, navigation, and planning. The search yielded 4783 studies published between 2019 and 2025; out of these, 33 were selected for detailed review based on predetermined inclusion criteria.​ Most included studies emphasized simulation-driven training protocols (27%) and modules for preoperative surgical planning (42%), with only a minority addressing intraoperative navigation systems (18%). Other studies (12%) were related to Marker-less image registration and usage of HMDs in bedside teaching during Covid. Typical limitations were small participant sizes, non-standardized outcome measures, and a lack of unified assessment frameworks. Reported benefits of HMD platforms included enhanced immersion, improved spatial orientation, procedural accuracy, and replication of surgical scenarios, exceeding the value of traditional approaches.​ HMD-based platforms provide significant advantages in surgical education and practice, facilitating superior simulation experiences, preoperative planning, and intraoperative navigation. Despite these advances, broader usage is limited by the absence of standardized evaluation tools, heterogeneous outcomes, and validation across larger, diverse cohorts. Future research should prioritize multicentric validation, curricular integration, and development of objective assessment tools.
Continuous quality improvement rounds (CQIRs) play an important role in medical education, quality assurance, and accreditation in Canadian hospitals. This study aimed to establish a more thorough understanding of their specific application and perceived value in general surgery departments within hospitals in British Columbia (BC), Canada. A 27-item (and one additional optional item) cross-sectional survey was conducted between August-December 2023 amongst general surgery department heads across BC hospitals, with the goal of obtaining information on CQIR logistics such as scheduling, format, and content, as well as surgeons' subjective assessments of impact on quality improvement, educational value, and barriers to participation. Thirteen complete responses representing surgical departments across the province were qualitatively analyzed. Most reported monthly or every 4 months CQIR meetings, lasting at least one hour, with strong attendance by attending surgeons. Noted areas for improvement included the absence of specific inclusion criteria, the need for standardized error classification, and lack of post-CQIR engagement for learning assessment. Respondents expressed satisfaction with CQIR effectiveness but communicated a desire for more in-person meetings and increased structure. CQIRs in BC are effective but occur less frequently than is ideal for medical education and quality improvement. This study suggests an increase in meeting frequency and organization in case selection and analysis may enhance the delivery and application of key learning objectives. Future research in this area is needed.
Enhanced Recovery After Surgery (ERAS) pathways safely reduce length of stay (LOS) and resource use in many surgical fields, but their economic impact in thyroidectomy within the Italian National Health Service (SSN) is unclear, particularly under Diagnosis-Related Group (DRG) rules that penalize early discharge. A decision-analytic model compared an ERAS-inspired thyroidectomy pathway-same-day discharge after hemithyroidectomy and 24-hour discharge after total thyroidectomy-with a conventional DRG-driven pathway based on ≥2 postoperative inpatient days. The analysis adopted a hospital/provider perspective over 30 days, using data from a high-volume endocrine surgery unit and contemporary ERAS literature. Outcomes included LOS, postoperative complications, 30-day readmissions, direct hospital costs, and contribution margin under current SSN tariffs (including early-discharge penalties) and under a neutral reimbursement scenario. In hemithyroidectomy (400 cases/year), ERAS reduced mean LOS from 2.6 to 0.33 days (-2.27 days; p<0.001), freeing 908 bed-days annually and lowering variable costs by €1,332 per patient, without increasing complications or readmissions. Despite a 30% DRG penalty for LOS <2 days, the contribution margin increased by €147 per case. In total thyroidectomy (600 cases/year), ERAS reduced LOS from 3.1 to 1.16 days (-1.94 days; p<0.001) and variable costs by €1,079 per patient, again without compromising safety. However, DRG penalties reduced the margin by €481 per case, resulting in an annual loss of approximately €289,000 despite substantial real-resource savings. Overall, ERAS reduced mean LOS by 2.1 days and variable costs by €1,190 per patient across 1,000 procedures. ERAS thyroidectomy is clinically safe and markedly reduces LOS and hospital costs, but current SSN DRG rules penalizing early discharge blunt or reverse its financial benefits for public hospitals, particularly for total thyroidectomy. These findings highlight a structural mismatch between surgical efficiency and reimbursement incentives and support revising thyroidectomy tariffs to reward evidence-based early discharge. Because this is a model-based economic evaluation, these results should be interpreted as scenario-based evidence rather than as definitive real-world cost-accounting estimates.
The role of surgery in malignant pleural mesothelioma (MPM) remains controversial, particularly after the negative results of the MARS 1 and 2 trials. Lung-sparing cytoreductive procedures such as extended pleurectomy/decortication (eP/D) are increasingly adopted in high-volume centers, but real-world outcomes within multimodality pathways vary widely. This study analyzes our Institutional experience with parenchyma-sparing surgery in a trimodal strategy, focusing on perioperative outcomes, recurrence patterns, and survival, with particular attention to the prognostic impact of nodal status. We conducted a retrospective observational study including consecutive patients with epithelioid MPM who underwent eP/D with curative intent between 2010 and 2022 at a single tertiary Center. All patients were evaluated within a multidisciplinary framework and routinely received platinum-pemetrexed induction chemotherapy. Clinical, pathological, perioperative, and follow-up data were prospectively recorded. Survival was analyzed using Kaplan-Meier curves and Cox regression. A total of 102 patients were included. Median age was 65.9 years, and 75% were males. Most patients (90%) received induction chemotherapy and 70% completed full trimodality therapy. Median hospital stay was 14 days (IQR 10.3-19.0). Postoperative morbidity occurred in 52% of patients, with major complications in 13%; 30 day and 90 day mortality were 1 and 3%, respectively. Recurrence occurred in 72% of cases, predominantly locoregional. Median disease-free survival (DFS) was 11.7 months (IQR 7.9-18.7) and median overall survival (OS) was 28.0 months (IQR 14.8-48.8). Nodal metastasis was associated with significantly worse OS (34.4 vs 17.4 months, p = 0.004), whereas completion of trimodal therapy did not significantly affect DFS or OS. Lung-sparing cytoreduction within a structured multimodality pathway is safe and achieves survival comparable to major international series. Pathological nodal status represents the strongest prognostic determinant and may guide risk-adapted treatment strategies in the evolving era of multimodal therapy.
Minimally invasive laparoscopic surgery often suffers from limited depth perception and constrained visual fields. To address these limitations, we introduce EasyVis2, an enhanced hands-free, real-time 3D visualization system based on the previous EasyVis1 platform. It utilizes a trocar equipped with an array of micro-cameras to provide an expanded field of view and improved 3D perception. This study aims to adapt deep learning-based multi-view pose estimation to enhance instrument tracking and visualization quality while improving computational efficiency. YOLOv8-Pose, a state-of-the-art deep neural network, was integrated into EasyVis2 for 2D pose estimation across multiple views. A customized training dataset was developed to tailor the model to the surgical domain. Multi-view 2D poses were fused to compute 3D poses, enabling real-time surface rendering of instruments. The algorithm is optimized so that real-time performance is achieved using a desktop computer equipped with a GPU. Evaluation was conducted on separate testing sets with ground truth annotations, and results were reported as the mean over testing sets. The proposed system achieved higher 3D reconstruction accuracy and faster processing speed compared to the previous version using the same number of cameras. The retrained adapted YOLOv8-Pose model achieves a 2D pose estimation precision of 96.6% and sensitivity of 95.9%. The system achieved a back-projection error of 3.809 pixels at a processing speed of 12.6 ms per frame. EasyVis2 improves 3D visualization and tracking, validating its potential for intra-operative guidance, surgical training, and future computer-assisted interventions.
Advances in surgical technology have expanded diagnostic and treatment options; however, the increasing complexity of surgical procedures has also intensified ethical issues in surgical practice.This study aimed to evaluate the development and trends of publications in the field of surgical ethics and to synthesize the findings obtained.On August 12, 2025, a comprehensive search was conducted in the Web of Science Core Collection using predefined keywords related to "surgical ethics" OR "surgical ethics" OR "operating room ethics" OR "operating room ethics" OR "surgical ethics" OR "surgical ethics" OR "operating room ethics" OR "operating room ethics" were used to conduct a comprehensive search without any time restrictions. A total of 217 publications were included. Bibliometric analysis was performed using the Bibliometrix-Biblioshiny package in R(version 4.2.2). The data were analyzed in terms of publication characteristics, keyword trends, and thematic structures. Studies on surgical ethics had an average publication age of less than 10 years, and a significant increase in publication volume was observed as of 2023. Citation rates accelerated significantly after 2020, reaching an average of 5.9 citations per document. Editorial materials accounted for 22.5% of all publications. The main research topics were bioethics, informed consent, and medical ethics.Surgical ethics is an emerging and growing field of research that has attracted increasing scientific interest in recent years. Despite this growth, the limited number of studies with high-level evidence remains a significant shortcoming. These findings provide a comprehensive overview of the current state of the literature and highlight key areas for future research.
Left lateral hepatolithiasis is the most common subtype of intrahepatic bile duct stones. Although minimally invasive left lateral sectionectomy (MLS) is widely applied, postoperative stone recurrence remains frequent, particularly in the B4 bile duct. This study aimed to evaluate the clinical value of a classification based on B4 bile duct orifice involvement and to explore optimal minimally invasive surgical strategies. A retrospective analysis was performed on 238 patients with left lateral hepatolithiasis who underwent minimally invasive surgery between January 2015 and October 2024. Patients were classified into B4 type (stones compressing or obstructing the B4 bile duct orifice) and Non-B4 type. Perioperative outcomes, postoperative complications, stone recurrence, and long-term outcomes were compared. Subgroup analyses were conducted in B4-type patients undergoing MLS or conversion to middle hepatic vein-guided anatomical left hemihepatectomy combined with transhepatic lithotomy (MATL). Logistic regression analyses were used to identify independent risk and protective factors. Compared with the Non-B4 group, B4-type patients had longer operative time, greater blood loss, and significantly higher rates of bile leakage and stone recurrence. Multivariate analysis identified B4 bile duct orifice involvement as an independent risk factor for postoperative bile leakage (OR 16.58, p < 0.001) and stone recurrence (OR 30.87, p < 0.001). Conversion to MATL was an independent protective factor against bile leakage (OR 0.04, p = 0.003) and stone recurrence (OR 0.10, p = 0.003). In B4-type patients, MATL was associated with lower complication and recurrence rates without increasing perioperative risk. Left lateral hepatolithiasis involving the B4 bile duct orifice represents a more complex subtype with higher surgical risk and recurrence potential. Individualized surgical planning based on detailed preoperative imaging and intraoperative findings is essential. MATL may be a valuable option in selected B4-type patients.
Fibroblasts associated to carcinomas express fibroblast activation protein (FAP). FAP-targeted imaging with Positron Emission Tomography (PET) with 68Ga-FAP inhibitors (FAPi-PET), is a pan-tumoral imaging that enables in-vivo visualization of the tumor stroma and detection of neoplastic foci in various cancers. The primary aim was to evaluate the diagnostic performance of FAPi-PET in detecting locally advanced gastric cancers (LAGC), including the evaluation of peritoneal disease (PD). Thirty consecutive patients with LAGC were included in this prospective study between Nov-2023 and Nov-2024 at the European Institute of Oncology in Milano. All patients had an indication to staging laparoscopy and underwent FAPi-PET within 1 week prior to surgery. Significant gastric expression of FAP (mean SUVmax 13,12 ± 5,9 SD) was detected in 29 FAPi-PET scans. The only GC without detectable gastric uptake was an early GC. The sensitivity of FAPi-PET for the identification of primary tumor was 96,7%. PD was suspected based on FAPi-PET imaging in 2 patients (mean SUVmax of 7.55 ±2.19 SD). At staging laparoscopy PD was observed in only 1 patient. Conversely, in 2 cases with a negative preoperative FAPi-PET, PD was observed during laparoscopy,. The accuracy of FAPi-PET for PD was 90% (sensitivity 33,3%, specificity 96,3%). FAPi-PET showed a high detection rate for LAGC, even in cases with diffuse histology. This technique appears to provide high specificity for PD. These promising preliminary findings, support further validation of FAPi-PET in upper-GI malignancies to evaluate its impact on clinical practice for staging and treating LAGC.
Surgery with perioperative chemotherapy offers a potentially curative treatment for colorectal liver metastases (CRLM). Selection of candidates for resection relies on survival prediction, but available prognostic factors have limited reliability. This study evaluated the potential of preoperative CT-based radiomics to predict overall survival, focusing on the impact of the CT-surgery interval and peritumoral tissue analysis. All consecutive patients undergoing resection for CRLM (2010-2020) with contrast-enhanced CT performed ≤ 60 days before surgery and at least one CRLM ≥ 10 mm were considered. Manual tumor segmentation (Tumor-VOI) and automatic 5-mm peritumoral expansion (Margin-VOI) were performed on portal phase images. From each VOI, 110 IBSI-compliant radiomic features were extracted. Three prediction models were developed: Clinical, Clinical+Tumor-radiomics, Clinical+Tumor/Margin-radiomics. Features selection was performed using Boruta algorithm, followed by Random Forest classification with 10-fold cross-validation. Model performance was evaluated in the entire cohort and in patients with CT-surgery interval ≤ 30 days. 306 patients were included (mean age 63 years; 187 men). Five-year survival was 40.9% (mean follow-up 34 months). At internal validation, the clinical model achieved C-index = 0.629. Radiomics provided modest improvement in the entire cohort, with greater impact in the 212 patients with a CT-surgery interval ≤ 30 days: the Clinical+Tumor-radiomics model reached C-index = 0.691, increasing to 0.717 with Margin-VOI features. Clinical-radiomic models outperformed established scores (Fong, GAME, RAS-mutation clinical scores; C-indices range = 0.502-0.593). Radiomic features of CRLM and peritumoral tissue extracted from preoperative CT improve survival prediction beyond conventional clinical scores. A CT-surgery interval of ≤ 30 days appears essential to optimize model performance.
Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed weight loss surgery. Omentopexy is believed to help reduce the risk of postoperative nausea and vomiting (PONV), bleeding, gastric leakage, and gastroesophageal reflux disease (GERD). In recent years, fibrin glue posterior fixation has emerged as an alternative method shown to reduce gastrointestinal symptoms after LSG surgery. However, the comparative evidence between these two fixed techniques is still limited. This study aims to compare the clinical efficacy of two gastric fixation methods, fibrin glue posterior fixation and Omentopexy, in LSG. This retrospective study included 649 patients who underwent LSG between 2022 and 2024, divided into two groups: fibrin glue posterior fixation (n = 331) and Omentopexy (n = 318). A 1:1 propensity score-matching (PSM) was performed to balance baseline characteristics between the groups. After matching, 480 patients were included (240 per group). There were no significant differences between the fibrin glue posterior fixation group and the Omentopexy group in operative time or intraoperative blood loss (P > 0.05). The incidence of PONV in the two groups was 6.6% (16/240) and 5.8% (14/240), respectively, with no statistically significant difference (P > 0.05). The incidence of postoperative bleeding was 0.8% (2/240), and there was no significant difference between the groups (P > 0.05). There was 1 case of gastric leakage (0.4%) in the fibrin glue posterior fixation group, and no gastric leakage was observed in the Omentopexy group, and the difference between the groups was not statistically significant (P > 0.05). Neither group experienced gastric torsion. The incidence of postoperative GERD was 5.8% (14/240) and 7.5% (18/240), respectively, with no statistically significant difference (P > 0.05). In addition, both groups of postoperative bleeding patients underwent reoperation, with a reoperation rate of 0.8% (2/240), and there was no significant difference between the groups (P > 0.05). This study demonstrates that there were no significant differences in short-term postoperative complications between fibrin glue posterior fixation and Omentopexy in LSG.