Surgical training programs primarily emphasize technical skills for diagnosis and treatment. However, communication and interpersonal skills are equally essential for residents. Trainees often face sensitive situations, such as delivering bad news and discussing end-of-life decisions and lack of communications skills could result in a negative impact on patients and malpractice claims. Despite their importance, communication skills training is often underrepresented in surgical education. This study aimed to explore the extent to which such training is offered during surgical residency in Italy, and to investigate how surgical trainees and young surgeons perceive their own communication competence and confidence, particularly in emotionally demanding scenarios. The "COSTRUIRE" (COmmunication Skills TRaining in sUrgIcal REsidency) survey, conducted from July to September 2024 by the Young Group of the Italian Society of Surgical Oncology, utilized a 30-item online questionnaire to gather data on participants' communication experiences, emotional experiences, burnout risk, and training preferences. The responses were analyzed in accordance with the CHERRIES guidelines. A total of 189 participants met the inclusion criteria, including general surgery residents (61.4%) and early-career surgeons. Most respondents (85.2%) reported having communicated a difficult diagnosis without supervision during training. While participants rated their communication skills positively, over 70% expressed a desire to have handled these conversations differently, often citing the need for better tools or support. Notably, 73.9% reported learning communication informally by observing mentors. Only 7.9% received formal training during residency, despite 91% recognizing its importance. Emotional impact was significant, with high levels of emotional involvement but also early signs of burnout. The COSTRUIRE survey identified the importance of structured communication skills training in Italian surgical residency. Addressing this gap may contribute to improving self-perceived competence and confidence in managing emotionally challenging clinical interactions.
To summarize the clinical, radiologic, and surgical characteristics of the rare but potentially fatal cases of mesenteric avulsion (MA) following blunt abdominal trauma, based on our single-center experience, and to highlight key implications for early diagnosis and management. Consecutive patients who underwent surgery between January 2017 and September 2025 and were intraoperatively confirmed to have MA were retrospectively reviewed. Demographic data, mechanism of injury, CT findings, involved intestinal segments, surgical procedures, intensive care and hospital stay, complications, and mortality were recorded. Results were analyzed descriptively. A total of 13 patients (mean age, 44.5 years (20-83) were included. The most common mechanism of trauma was motor vehicle collision (69.2%). No patient showed direct CT evidence of MA (0%); all exhibited only nonspecific findings such as free fluid, solid-organ injury, or mesenteric hematoma (100%). Intraoperative involvement included jejunal (30.8%), ileal (38.5%), colonic (15.4%), and multisegmental (15.4%) regions. Segmental resection with primary anastomosis was performed in 69.2% of patients, stoma formation in 15.4%, and damage-control surgery (diagnostic laparotomy + packing) in 15.4%. The mean ICU stay was 3.1 days, and total hospital stay was 11.2 days. Postoperative complications occurred in 30.7% and resolved with conservative treatment. Four patients (30.7%) died, primarily due to concomitant multisystem or severe cranial/thoracic trauma. In MA cases, preoperative CT typically demonstrates nonspecific findings, making prospective diagnosis difficult. Maintaining a low threshold for early surgical exploration in the presence of hemodynamic instability, peritonitis, or a high index of clinical suspicion is essential to preserve bowel viability and reduce morbidity and mortality. Our study demonstrates that jejunal-ileal predominance, frequent use of resection with primary anastomosis, and the impact of associated multiple injuries are the major determinants of outcomes. Sustaining clinical vigilance and prompt surgical decision-making remain key to improving patient survival. Our findings emphasize that mesenteric avulsion remains largely a clinical and intraoperative diagnosis, and early surgical exploration should not be delayed based on negative or nonspecific CT findings.
The role of surgical stabilization of rib fractures (SSRF) in older adults remains uncertain, particularly regarding functional recovery and long-term pain. This study examined whether chronological age influences postoperative outcomes and evaluated the performance of injury-severity scoring systems in geriatric patients undergoing SSRF. This retrospective cohort included 524 adults who underwent SSRF between 2012 and 2023. Patients were stratified into non-geriatric (< 65 years, n = 331) and geriatric (≥ 65 years, n = 193) groups. Demographics, injury characteristics, perioperative outcomes, pain trajectories, and functional recovery were compared. Predictors of postoperative complications and chronic pain were assessed using univariate and multivariate logistic regression. Correlations between clinical outcomes and RibScore, AIS-Thorax, and BPC18 were analyzed using Spearman coefficients. Geriatric patients were more often injured by low-energy falls and had higher rates of pulmonary contusion (74.6% vs. 63.9%) yet demonstrated complication rates similar to younger adults (14.0% vs. 12.7%, p = 0.696). Pain trajectories were comparable across all follow-up intervals. Functional recovery was slower in older adults, who required an additional month to return to baseline activity (median 3 vs. 2 months, p < 0.001). The number of fractured ribs on the operated side independently predicted postoperative complications (OR 1.863, 95% CI 1.396-2.487, p < 0.001), whereas age was not an independent predictor. Longer time-to-surgery (OR 1.341, p = 0.001), longer hospitalization (OR 1.059, p = 0.044), and postoperative complications (OR 1.941, p = 0.036) independently predicted chronic pain. AIS-Thorax showed the strongest correlations with clinical outcomes, while all three scoring systems demonstrated weak associations with postoperative pain. In appropriately selected patients, SSRF provides comparable safety and pain recovery across age groups. Although functional recovery is slower in older adults, overall outcomes remain favorable. These findings support shifting from age-based to physiology-based decision-making for SSRF.
Blunt traumatic hollow viscus and mesenteric injuries (THVMI) are uncommon but carry high morbidity if diagnosis is delayed. The Niguarda Score, based on six predefined computed tomography (CT) findings, was originally developed in 2020 to aid early identification of surgically relevant THVMI. This study aimed to perform a critical appraisal and temporal validation of the score. The data of all adult blunt trauma patients consecutively admitted to our trauma center from 2010 to 2021, who underwent contrast-enhanced CT-scan on admission, were collected and retrospectively analyzed. Patients admitted between 2010 and 2018 represented the cohort used to build the original score, and their data were re-analyzed for a critical appraisal of the Niguarda score. The data of patients admitted from 2019 to 2021 were used for temporal validation in an independent cohort from the same institution. Six CT findings-free intraperitoneal air, free fluid without solid organ injury, gastrointestinal wall alteration, mesenteric alteration, intra-mesenteric fluid, and mesenteric blushing-were scored 0-6, with one point for each present finding. The primary outcome was THVMI requiring surgical repair. Model performance was assessed in the derivation and temporal validation cohorts for discrimination (C-index), calibration slope, and overall accuracy (Brier score). Cut-offs were identified using ROC-based methods. In the derivation cohort, the score achieved AUC 0.925 (95% CI 0.874-0.976), Nagelkerke R2 0.662, and Brier score 0.111, with a calibration slope of ≈1. Internal bootstrap validation yielded optimism-corrected C-index 0.930. Temporal validation demonstrated preserved discrimination (AUC 0.914, 95% CI 0.807-1.000). The optimal cut-off in correspondence of one or more findings present gave a sensitivity of 81.8% and a specificity of 90.0%. After critical re-evaluation of the original tool, a remarkable diagnostic and predictive performance was confirmed for the Niguarda scoring model. The model also showed excellent diagnostic accuracy and calibration in the temporal validation cohort, supporting its utility as a simple and reproducible tool to guide early operative decision-making in blunt THVMI.
American Thyroid Association (ATA) argues that the prevalence of malignancy of the indeterminate nodules may vary substantially among regions, and states that it is crucial to know the prevalence of malignancy within each indeterminate cytological category at one's institution. Our aim is to draw attention to the malignancy rates of indeterminate nodules that cannot be underestimated in an endemic region and raise awareness to differences across different populations. Between March-2021 and June-2024, 13,531 fine needle aspirations were performed on thyroid nodules in a single institution. Of these 2121 nodules were classified as indeterminate (Bethesda III-IV) and 242 patients underwent surgery. Demographic characteristics, nodule size, risk of malignancy, tumor types and subtypes were evaluated. The necessity of radioactive iodine (RAI) therapy and consequent completion thyroidectomy was investigated. Of the 242 patients 123 (50.8%) underwent lobectomy and 119 (49.2%) underwent total thyroidectomy. In total, 115 (47.5%) of 242 patients resulted in malignancy (186 patients were Bethesda-III and 82 (44.1%) of them were malignant; 56 were Bethesda-IV and 33 (58.9%) of them were malignant). Incidental carcinoma was detected in a different focus other than the indeterminate nodule in 17 patients. RAI therapy was indicated in 39 patients (33.9%) primarily based on the ATA guideline, and 24 (20.8%) patients who initially underwent lobectomy required completion thyroidectomy. Risk of malignancy in indeterminate thyroid nodules varies endemically. Each region should know their own risk and each patient's treatment should be tailored accordingly. In this way, under-overtreatment and related morbidities will be prevented.
Effective communication during trauma handover is critical to ensuring continuity and quality of care. The ATMIST framework offers a standardized format for transferring essential patient information between pre-hospital and hospital teams. To quantify the concordance between information transmitted by emergency medical services (EMS) and data documented during in-hospital trauma handovers using the ATMIST protocol at a Level I Trauma Center in Italy. We conducted a prospective observational study of trauma patients admitted between December 2023 and May 2024. Variables analyzed included demographics, mechanism of injury, vital signs, suspected injuries, and pre-hospital interventions. Concordance was defined as the presence of matching information in both pre-hospital and in-hospital records. We calculated absolute agreement percentages and unweighted Cohen's kappa coefficients to assess inter-observer agreement. Of 118 trauma patients evaluated, 85 met inclusion criteria. The overall mean absolute agreement across all variables was 74.5% (± 12.7). The highest concordance was observed for endotracheal intubation (95.5%, κ = 0.87) and patient age (94.3%, κ = 0.68). The lowest agreement was found for time of injury (κ = 0.10) and triage priority (κ = 0.12), indicating substantial variability in the transmission of time-sensitive and prioritization data. Structured handover using the ATMIST framework reliability conveyed critical clinical interventions and core patient characteristics. However, logistical and prioritization elements showed poor concordance, representing key targets for system improvement. Standardized training and the integration of digital handover tools may further enhance communication accuracy and patient safety.
Pancreaticoduodenectomy (PD) is associated with a long and complex recovery. Enhanced recovery programmes have improved short-term clinical outcomes, but there is a growing interest in patient-reported outcomes as an indicator for postoperative recovery. Health-related quality of life (HRQoL) and patient-reported postoperative recovery provide a wider perspective on the effects of surgery. However, the relationship between the two measures remains unexplored. Therefore, the aim of this study was to explore the relationship between HRQoL and patient-reported recovery in patients undergoing PD. This prospective, single-centre study included 77 participants who all underwent PD in the context of an enhanced recovery programme. Instruments used were the EQ-5D-3L and the SwQoL-24. Data was collected preoperatively and at 1,3,6,9, and 12 months postoperatively. Longitudinal trends were analysed using a mixed-effect repeated measures model. Predictive associations were explored via linear regression. The EQ-5D-3L improved, and the SwQoL-24 total score declined throughout the first year. The EQ-5D-3L Index and the VAS explained the SwQoR-24 value at six months and 12 months; R2 0.52/0.47 and 0.52/0.56, respectively. Preoperative EQ-5D-3L values predicted between (R2) 0.09-0.17 for 6 and 12-month SwQoR-24 values. Other tested factors were statistically non-significant. This study demonstrates a significant improvement in postoperative recovery as well as HRQoL during the first year after PD, with a strong association between the two measures. The findings also suggest that the EQ-5D-3L index and the EQ VAS have a significant but limited predictive value for postoperative recovery. Other demographical and care-related factors did not predict levels of recovery quality.
Pancreatic ductal adenocarcinoma (PDAC) has poor prognosis due to late diagnosis, limitations of computed tomography (CT) imaging, and low accuracy of clinical biomarkers. This study aimed to develop and validate a multimodal artificial intelligence (AI) approach integrating imaging-based deep learning (DL) and clinical data-driven machine learning (ML) to improve PDAC diagnosis. A retrospective cohort of 158 patients (123 PDAC, 35 benign) undergoing pancreatic surgery was analyzed. A YOLOv8-based DL model was trained on contrast-enhanced CT scans to detect pancreatic lesions, while clinical data (age, sex, serum CA19-9) were analyzed with a Random Forest ML classifier. Predictions from both models were combined into a multimodal fusion model, optimized to maximize diagnostic accuracy. Performance metrics included precision, recall, accuracy, F1-score, and ROC-AUC. The imaging-based DL model achieved strong tumor detection performance (mAP: 87.0%, precision: 86.5%, recall: 81.2%). The clinical ML model showed excellent specificity (precision: 100%, ROC-AUC: 0.931) but limited sensitivity (60%). The multimodal AI fusion model outperformed both individual models, significantly improving sensitivity, specificity, and overall diagnostic accuracy. A multimodal AI strategy integrating DL imaging analysis with ML-based clinical predictions markedly enhances diagnostic performance in pancreatic cancer. This approach offers potential as an effective decision-support tool, facilitating earlier diagnosis and optimized clinical decision-making.
Area-based centralization optimizes both patient access by minimizing long-distance transfers and enables hospitals to reach adequate surgical volumes to ensure optimal outcomes. This study aimed to analyze a Hub-and-Spoke system applied to pancreatic surgery by evaluating both patient logistics and clinical outcomes. Data from a Hub-and-Spoke system for pancreatic surgery were collected over a 3-year period. The Hub center managed patient referrals from its own region and three additional Spoke hospitals. Clinical decision-making was standardized through dedicated inter-institutional multidisciplinary team meetings. Surgical outcomes and quality metrics were collected and analyzed. Patient transfer patterns related to key steps in the care pathway were retrieved and quantified. Overall, 187 patients underwent surgical exploration at the Hub center, with pancreatic ductal adenocarcinoma as the most common indication (56.1%). A minimally invasive approach was used in 57 (33.1%) patients. Postoperative pancreatic fistula (POPF) rate following pancreaticoduodenectomy was 39.7%, with grade C POPF being 9.0%. The 90-day mortality for the entire cohort was 0.6%, with a failure-to-rescue rate of 2.8%. Textbook outcomes were obtained in 58.1% of cases. The median patient transfer distance from home to the Hub center was 43 kilometers (IQR 25-50), with an estimated travel time of 48 minutes. The cumulative distance required to complete the entire care process was 197 km (IQR 90-225) with an estimated travel time of less than 5 hours. The centralization of pancreatic care through a Hub-and-Spoke system ensured adequate surgical outcomes. Simultaneously, the model maintained patient proximity to care facilities, optimizing access to care pathways and enhancing patient-centered management.
Recently, several studies have demonstrated the safety and feasibility of laparoscopic and endoscopic cooperative surgery for duodenal tumors (D-LECS). However, the standard procedure for D-LECS has not been established. Herein, we introduce the feasibility and safety of a surgical strategy based on tumor characteristics and location in D-LECS. This retrospective single-center study included 17 consecutive patients with duodenal tumors who underwent D-LECS between October 2017 and November 2023. Two, 13 and 2 tumors were located in the first, second and third portions of the duodenum, respectively. Three tumors were protruded type and 14 were superficial type. The median tumor size was 25 (6-45) mm. Supracolic, mesenteric and inferior approaches were employed in 14, 2 and 1 case, respectively, during D-LECS. Laparoscopic reinforcement after endoscopic submucosal dissection (ESD) (D-LECS with ESD), laparoscopic suturing after full-thickness resection (FTR) (D-LECS with FTR) and Closed-LECS were performed in 13, 2 and 2 cases, respectively. The median operation time and blood loss were 237 (159-420) min and 0 (0-75) ml, respectively. En-bloc pathological curative resection was achieved in all cases. Two patients had paralytic ileus and delayed gastric emptying as postoperative complications. The median duration of postoperative hospital stay was 10 (6-22) days. One local recurrence was observed in a case of adenocarcinoma in situ during the median follow-up of 13 (2-71) months. The feasibility and safety of our surgical strategy based on the tumor characteristics and location were demonstrated in D-LECS.
Primary closure with negative pressure wound therapy (NPWT) has been investigated in patients with sacrococcygeal pilonidal sinus to enhance healing and reduce recurrence. To address existing controversies, we conducted a systematic review and meta-analysis comparing primary closure with NPWT versus non-NPWT (control) for treatment of pilonidal disease. PubMed, Embase, and Cochrane Library databases were searched from inception to December 2024 to identify studies comparing NPWT versus control in primary closure surgeries in pilonidal sinus. Statistical analyses were performed using R Software with a random-effects model. Six studies with a total of 479 patients were included, of whom 164 (34.2%) underwent NPWT. NPWT had an association with lower pain score 24 h postoperative (MD - 0.65 points; 95% CI - 0.81 to - 0.50), shorter return time to activities (MD - 2.57 days; 95% CI - 3.74 to - 1.4). However, there was no difference between groups in the time of wound closure (MD - 18.94; 95% CI - 41.68 to 3.80), rate of wound dehiscence (RR 1.03; 95% CI 0.50 to 2.14), hospital length of stay (MD - 3.05; 95% CI - 15.77 to 9.67), infection rates (RR 0.38; 95% CI 0.05 to 2.84), recurrence rates (RR 0.54; 95% CI 0.07 to 4.48), and pain 6 h post-operative, which showed a borderline trend favoring NPWT but did not reach statistical significance (MD - 1.19; 95% CI - 2.38 to 0.01). NPWT appears to shorten time to resume normal activities and pain 24 h postoperatively. Despite these promising results, more randomized clinical trials are needed for greater analysis.
Few studies have examined delayed gastric emptying (DGE) following left pancreatectomy (LP). This study aimed to assess the incidence and impact and identify predictive pre/intra-operative predictors. We conducted a retrospective, single-centre cohort including all adult patients who underwent LP from 2017 to 2024. Variables were analyzed using univariate and multivariable analysis. Among 213 LP patients, 34 (16.0%) developed DGE (grade A 11.7%, B 3.3%, C 0.9%). DGE was associated with longer hospitalization [30.50 (20.75-46.50) vs 14.00 (11.00-20.00) days, P < 0.001], higher major complications (67.6% vs 29.6%, P < 0.001), and more ICU stays (29.4% vs 13.4%, P = 0.025); even isolated grade A DGE (no other complications) prolonged length of stay than in patients without any complications [20.00 (15.00-29.50) vs 12.00 (10.00-15.00) days, P = 0.021]. DGE was linked to clinically relevant POPF (52.9% vs 29.6%; P = 0.010) and intra-abdominal abscess with invasive therapy (20.6% vs 6.1%; P = 0.015). In multivariable analysis, portal (PV)/superior mesenteric vein (SMV) resection (OR 4.525, P = 0.017) and pancreatic ductal adenocarcinoma (PDAC) histology (OR 3.121, P = 0.024) were independent predictors of DGE. DGE is a frequent and under-estimated complication after LP, prolonging postoperative hospitalization; notably, even grade A DGE was linked to longer length of stay. PDAC histology and PV/SMV resection were independent risk factors for DGE. Identifying these predictors enables prediction of DGE and supports targeted prevention and perioperative management.
Parastomal hernia repair remains a complex surgical challenge due to high recurrence rates and significant technical demands. The modified Sugarbaker technique, particularly Pauli's retromuscular adaptation, has demonstrated promising outcomes. Concurrently, the PeTEP approach enables extensive preperitoneal dissection while preserving the integrity of the abdominal wall. We present the first reported case of atotally endoscopic preperitoneal repair combining both techniques (Pe-Pauli) for the simultaneous treatment of parastomal and midline hernias. A 73-year-oldwoman with a prior Hartmann procedure and failed reconstruction presented with symptomatic parastomal and midline incisional hernias. Through a cranial endoscopic approach, trocars were placed for PeTEP, along with an additional lateral access for parastomal repair. To preserve peritonealintegrity, the Red Cross Step technique was employed, facilitating safe dissection through the transversalis fascia and the musculoaponeurotic edge of the transversus abdominis muscle. The hernia contents were reduced, the defects were closed with barbed sutures, and a 20 × 30 cm Synecor® mesh was positioned in the preperitoneal space. A second polypropylene mesh was placed to reinforce the midline. The procedure lasted 325 minutes, with an uneventful recovery and no recurrence at 6-monthfollow-up. The Pe-Pauli approach allows for anatomical extra peritoneal reconstruction of complex hernias in a single-stage procedure. Although technically demanding, it may improve outcomes in selected patients. Further studies are required to validate its long-term safety and efficacy.
Gallbladder cancer (GBC) is an aggressive malignancy, with surgery being the only curative option for resectable cases. Surgical approaches vary based on disease stage, ranging from cholecystectomy to extended liver resection and lymphadenectomy, with or without biliary resection. This study presents our experience of robotic surgery for GBC with and without biliary resection/reconstruction. A retrospective analysis was conducted on 38 patients who underwent robotic resection for GBC between February 2016 and November 2024. Beyond the standard partial segment 4B/5 resection and portal lymphadenectomy, the cohort was divided into two groups: common bile duct (CBD) resection and non-CBD resection group. Data are presented as median (mean ± SD). The median age was 68 years (68 ± 11.49), with 71% women. Nineteen patients (50%) were diagnosed incidentally and required subsequent liver resection. Bile duct resection and Roux-en-Y hepaticojejunostomy were performed in 9 patients (23.7%), due to positive cystic duct margins. No conversions to open surgery occurred. Operative time was longer in the CBD resection group (470 vs. 219 min), which also had higher rates of vascular resection (33% vs. 3%), lymphovascular invasion (67% vs. 28%), and node-positive disease (67% vs. 24%), though the latter was not statistically significant. No differences were found in lymph node retrieval [6 (6.21 ± 4.58)], R0 resection rates (95%) or postoperative morbidity. The higher rates of lymphovascular invasion, vascular resections, and node-positive disease in the CBD resection group likely reflect more advanced disease. Robotic approach for GBC resection is feasible and safe, even when biliary and vascular resections are needed, offering an alternative minimally invasive technique to conventional open surgery.
ERAS programmes are widely used in colorectal surgery, but the impact of overall pathway compliance on outcomes in elderly colorectal cancer patients and the mechanisms linking compliance to recovery are unclear. We retrospectively analysed 206 elderly patients (median age 72 years) who underwent elective colorectal cancer resection within an ERAS pathway (2020-2023). Overall ERAS compliance was classified as high (≥ 70%, n = 114) or low (< 70%, n = 92). Outcomes included major complications (Clavien-Dindo III-V), length of stay (LOS), Comprehensive Complication Index (CCI), time to first flatus/defecation, readmission, mortality, and hospital costs. Subgroup analyses and structural equation modelling (SEM) assessed direct and indirect pathways between compliance and outcomes. High compliance was associated with fewer major complications (16.7% vs 29.3%, P = 0.048), lower CCI (18.6 ± 9.5 vs 22.1 ± 10.4, P = 0.014), and shorter LOS (8.2 ± 2.6 vs 10.1 ± 3.1 days, P = 0.003). Gastrointestinal recovery was faster (flatus 2.3 ± 0.8 vs 2.9 ± 1.0 days; defecation 3.8 ± 1.1 vs 4.5 ± 1.2 days; both P < 0.001), and costs were lower (64.8 ± 15.2 vs 72.5 ± 18.1 × 103 RMB, P = 0.003). Readmission and 30-day mortality were low and similar between groups. SEM indicated that higher compliance directly reduced complications, CCI, and LOS, and indirectly reduced 30-day readmission via complications and LOS. In elderly colorectal cancer surgery, higher ERAS compliance is associated with lower morbidity, faster recovery, shorter LOS, and lower costs without increased short-term readmission or mortality, supporting efforts to monitor and improve adherence.
Estimation of liver resection volume (LRV) is a key step to plane safe liver surgery. Modern 3D liver reconstruction software (3-D) allows to calculate LRV based on the portal blood supply, overcoming some limits of the conventional hand-trace method. The aim of this prospective study was to evaluate the ability of 3-D to estimate the LRV after minor anatomical resections (mAR). The consistency of virtual LRV (vLRV) and real weighted specimen (rLRV) was evaluated. Factors affecting the median discrepancy between vLRV and rLRV were analyzed. Exclusion criteria included inadequate contrast-enhanced computed tomography, left lateral sectionectomy, and changes in the surgical plan based on intraoperative ultrasound findings. Thirty-five consecutive mARs were analyzed: 4 subsegmentectomies, 9 segmentectomies, and 22 bisegmentectomies. A strong positive correlation was found between vLRV and rLRV (r = 0.945, p < 0.001). The median vLRV and rLRV were 236 mL and 180 mL, respectively. The median discrepancy between vLRV and rLRV was - 38 mL, indicating a slight tendency of the 3D software to overestimate LRV. The median discrepancy was greater in cases of large subglissonian lesions (> 3 cm) (65 mL vs. 22.5 mL for other lesion types, p = 0.028) and bisegmentectomies (60.5 mL vs. 16 mL for segmentectomies/subsegmentectomies, p = 0.001). Multivariate analysis confirmed that bisegmentectomy was the only factor independently associated with increased discrepancy [RR 2.724 (12.8-88.9), p = 0.010]. 3D software provided accurate predictions of liver specimen volume in patients who underwent minor anatomical resections.
This study compared the clinical outcomes and diagnostic accuracy of Fluorescence-guided laparoscopic lymph node biopsy (FGLLB) with conventional laparoscopic lymph node biopsy (LLB) at a single institution. We compared 42 patients who underwent FGLLB between April 2022 and September 2025 with a historical group of 55 LLB patients. The main outcomes measured were surgical time, blood loss, surgical conversion rates, hospital stay, and morbidity. Diagnostic accuracy was the secondary outcome. Surgical conversion occurred in one FGLLB patient (2.3%) and two LLB patients (3.6%) due to surgical difficulties. Surgical time was shorter in the FGLLB group (67.5 ± 33.7 min) compared to the LLB group (83 ± 22.2 min), though this difference was not statistically significant (p = 0.093). The average hospital stay was also shorter for FGLLB patients (1.6 days) compared to LLB patients (2.2 days), a difference that nearly reached statistical significance (p = 0.073). Minor postoperative complications were observed in two FGLLB patients and one LLB patient (4.7% vs 1.8%, p = 0.411). The biopsy provided the necessary diagnostic information in 97.6% of FGLLB cases and 96.3% of LLB cases. FGLLB showed good procedural and postoperative outcomes and a high diagnostic yield, comparable to traditional LLB. FGLLB was associated with shorter surgical times and hospital stays. The fluorescence guidance makes dissection more precise and safer by targeting a visible structure, which helps avoid unnecessary dissection and may contribute to the reduced surgical duration. More research is needed to confirm the reliability of this technique before it is widely adopted.
The ideal surgical treatment for pilonidal sinus disease (PSD) is controversial. The Karydakis flap (KF) was compared with midline closure (MC) and excision with healing by secondary intention (EHSI). A systematic review and meta-analysis of randomised and comparative cohort studies (through February 2025) was performed. The primary outcomes included recurrence and infection, whereas secondary outcomes were seroma, operative time, hospital stay, overall complications, and return to work. The effect sizes were identified using odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI), using random-effects models. Fifteen studies (n = 3,108) were identified for inclusion (KF = 1,257, MC = 1,593, EHSI = 258). KF was associated with a significant reduction in recurrence compared to MC (OR 0.30, 95% CI 0.16-0.59; p < 0.001; I2 = 34%) and EHSI (OR 0.29, 95% CI 0.12-0.71; p = 0.006; I2 = 11%). KF had fewer infections than EHSI (OR 0.06, 95% CI 0.007-0.486; p = 0.008) and returned to work earlier compared with MC (MD - 6.5 days) and EHSI (MD - 18.9 days). Hospital stay did not differ between KF and MC (MD - 0.08 days). KF provides lower recurrence and faster recovery compared with MC and EHSI, supporting its use as the preferred surgical technique for PSD.
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