Surgical Innovation最新文献

BackgroundBenign biliary and pancreatic diseases, including postoperative strictures, bile leaks, and chronic pancreatitis, often require temporary ductal decompression with plastic or metal stents, which may necessitate repeat interventions due to occlusion, migration, or removal. Biodegradable stents (BDSs) have emerged as an alternative, providing temporary support with spontaneous degradation and avoiding retrieval.MethodsA systematic search of PubMed, EMBASE, MEDLINE, Scopus, and the Cochrane Library was conducted to May 22, 2025, in accordance with PRISMA guidelines. Eligible studies reported human data on BDS use for benign biliary or pancreatic disease. Outcomes included technical and clinical success, dwell time, complications, and reintervention.ResultsFifteen studies (467 patients) were included. The most frequent indication was benign biliary stricture, followed by post-cholecystectomy bile leaks and pancreatic duct strictures. Stents were placed via ERCP (n = 193) or percutaneous transhepatic cholangiography (n = 274). Polydioxanone-based devices were most common, with diameters 2-12 mm and lengths 30-125 mm. Technical success was 99.4% and clinical success 73.3%. Across studies, 108 complications were reported, most often cholangitis (n = 36), stricture recurrence (n = 19), haemobilia/bleeding (n = 16), and pain/fever (n = 11); migration and pancreatitis were less frequent. The mean reintervention rate was 35.5% (range 0-100%), largely reflecting planned management after stent degradation rather than device failure. Mean follow-up was 14.4 months (range 0.5-52).ConclusionsBDSs appear safe and effective in selected benign biliary and pancreatic conditions. Further prospective studies and randomized trials are needed to establish optimal indications and long-term outcomes.

IntroductionSocial media is a significant platform for health information. However, the quality and reliability of patient facing surgical content is uncertain. We evaluated the quality and reliability of TikTok and Instagram videos about three common general surgical procedures: laparoscopic appendicectomy; laparoscopic cholecystectomy; and inguinal hernia repair, and compared performance by platform, procedure, and creator type.MethodsWe conducted a cross-sectional study of the top fifty results per procedure per platform. Videos were classified as useful, misleading, personal experience, or irrelevant and quality and reliability assessed with the Global Quality Score (GQS) and modified DISCERN (mDISCERN) score respectively.Results300 videos, accruing 592,975 likes and 11,489 comments, were analysed. Videos were low in both quality and reliability across both platforms although higher on Instagram (GQS 1.95; mDISCERN 1.65) than TikTok (GQS 1.27; mDISCERN 0.33; both P < .0001). 53/300 (17.7%) videos were judged to be misleading. Useful content was less frequent on TikTok than Instagram (14/150, 9.3% vs 82/150, 54.7%; P < .0001). Professional content was deemed more useful than that of non professionals (54/117, 46.2% vs 42/183, 23.0%; P < .0001) with higher quality and reliability scores (GQS 1.80 vs 1.49; mDISCERN 1.36 vs 0.76; both P < .0001).ConclusionsSurgical educational videos across popular social media platforms are low in quality and reliability. Patients should be wary of the risk of possible health misinformation. Clinicians and professional bodies should be aware of the growing popularity of social media and consider the production of evidence-based content on these platforms to disseminate credible information and counter misinformation.

BackgroundThis study evaluates the learning and retention of basic suturing skills among pre-graduate medical students through instructor-assisted synchronous online (ASO) vs face-to-face (FF) instruction.MethodsA randomized controlled experimental design was used in the practice laboratory of Cumhuriyet University Faculty of Medicine. Sixty second-year medical students without prior suturing experience were randomly assigned to FF or ASO groups. Both received identical training with the same materials and instructor. Performance was assessed via the Objective Structured Clinical Examination (OSCE) 1 day after training and again after 3 months. All assessments were conducted in a single testing room by a blinded assessor. The required sample size, determined via G-Power, was 42, but 60 eligible students participated.ResultsThe FF group outperformed the ASO group in both the first (28.3 ± 4.5 vs 23.5 ± 5.6, P = 0.001) and second OSCE (30.3 ± 4.7 vs 25.5 ± 5.7, P = 0.001) and completed the first exam in a significantly shorter time (P = 0.029). The overall average score improved in the second OSCE (27.9 ± 5.7 vs 25.9 ± 5.6, P < 0.001), but score changes over time did not significantly differ between groups (P = 0.927). The cut-off score for adequate knot-tying ability was 25.5 in both exams.ConclusionsThis study aimed to adapt face-to-face surgical training to an online format, as guidance on remote technical skills instruction is lacking. While the standardized online setting ensured methodological consistency, it limited real-life applicability. FF instruction yielded superior short- and long-term outcomes in suturing skills.

BackgroundThe optimal dissection technique for flap elevation in abdominoplasty remains debated, particularly in high-risk patients after massive weight loss. The LigaSure Impact™ (LS) vessel-sealing system (Medtronic, Dublin, Ireland) is an advanced energy device used across surgical disciplines to reduce morbidity. This meta-analysis compares LS with conventional techniques to assess its effectiveness in abdominoplasty.MethodA systematic literature search identified relevant studies comparing LS with standard methods. Primary outcome was the overall postoperative complications' rate; secondary outcomes included specific wound complications, operative time, and hospital stay.StatisticsA random-effects model was used for pooled analysis. Risk differences (RD) and 95% confidence intervals (CI) were calculated for categorical outcomes; mean differences (MD) for continuous outcomes. Heterogeneity was assessed using the I² statistic.ResultsThe search yielded 3 studies totaling 205 patients. LS significantly reduced overall complication rates compared to controls (RD = -0.46, 95% CI: -0.60 to -0.32, P < 0.001). Hematoma and wound dehiscence incidences were significantly lower (P = 0.03 and P = 0.01, respectively). No significant differences were observed for seroma, infection, or fat/flap necrosis. LS use was also associated with reduced re-operation rates and shorter hospital stays, though operative time was comparable.DiscussionLS may improve surgical outcomes in post-weight-loss abdominoplasty patients by reducing complications and hospitalization. However, the limited number of studies and small sample size warrant cautious interpretation.ConclusionPreliminary evidence suggests that LS may offer potential benefits in abdominoplasty; however, current findings should be interpreted with caution because of limited quality and heterogeneity of available studies. Further research is needed.

BackgroundDespite numerous efforts to improve surgical safety, adverse events and serious surgical complications are still common. This cross-sectional study at a tertiary hospital in Ontario, Canada, aimed to examine nurses' perceptions, awareness, comfort, and readiness to use Operating Room Black Box (ORBB) technology, implemented to reduce surgical errors.MethodsA mixed method was used and data was collected through a 14-item questionnaire in summer 2022.ResultsAmong 50 nurse participants, nurses with work experience <20 years had higher overall mean scores on 9 questions than nurses working >20 years. The majority (88.0%) had no prior ORBB experience but somewhat agreed that ORBB had the potential to improve the safety culture in the operating room.ConclusionOverall, nurses demonstrated positive attitudes towards ORBB technology, indicating its potential to enhance safety culture, team communication, teamwork, situational awareness, feedback on performance, the debriefing process, transparency, and lead to technological advancements in healthcare.

ObjectivesGiven the complexity of vascular and bronchial variations during segmental resection, three-dimensional (3D) reconstruction has been proposed as an effective tool to address anatomical challenges in segmentectomy. This study aims to evaluate the utility of 3D reconstruction in enhancing anatomical comprehension, optimizing surgical planning, and improving perioperative outcomes.MethodsFrom December 2022 to March 2024, clinical data of 141 patients who underwent uniportal thoracoscopic pulmonary segmentectomy were gathered. Based on preoperative examinations, the patients were categorized into the 3D group (51 patients) and the non - 3D group (90 patients). Primary endpoints were resection margin (distance from staple line to tumor) and operative time; secondary endpoints included intraoperative blood loss, conversion to thoracotomy, postoperative complications, and hospital stay. Propensity score matching was carried out to mitigate selection bias between the two groups.ResultsAfter 1:1 propensity score matching, 51 patients were included in each group. The operation time in the 3D group was shorter than that in the non-3D group (P = 0.004). The 3D group had significantly less blood loss compared to the non-3D group (P = 0.004). No significant differences were observed between the groups regarding resection margins, harvested lymph nodes, postoperative drainage, hospital stay, and postoperative complications.Conclusions3D reconstruction enhances anatomical understanding, shortens operative time, reduces blood loss, and facilitates surgical plan adjustments, while ensuring adequate resection margins in uniportal thoracoscopic segmentectomy.

IntroductionVascular infiltration is the main limitation of resectability in locally advanced pancreatic cancer; thus, an accurate preoperative study is mandatory to plan an appropriate surgical strategy. In recent years, medical image fusion and three-dimensional reconstruction models have gained acceptance in general surgery, especially in the hepatic field. In pancreatic pathology, 3D reconstruction also may improves preoperative staging. The study aim was to compare the performance of a 3D imaging reconstruction model with that of conventional computed tomography (CT), and magnetic resonance imaging (MRI) for evaluating infiltration of major vascular structures in patients planning to undergo upfront pancreatic surgery.Materials and MethodsPatients with pancreatic cancer who underwent upfront surgical resection at Sanchinarro University Hospital from May 2018-June 2023 were retrospectively reviewed. The performance of a preoperative 3D reconstruction with the 3D Cella Medical Solutions (3D-MSP^®) model was compared with that of traditional CT and MRI imaging.ResultsThree of 34 patients who underwent upfront pancreatic surgery with 3D reconstruction required vascular resection. For both venous and arterial involvement, 3D imaging demonstrated superior diagnostic accuracy, achieving 100% sensitivity, specificity, positive (PPV) and negative (NPV) predictive values. Compared with CT and MRI, 3D reconstruction significantly improved specificity and the PPV, which enhanced preoperative vascular staging and surgical planning.ConclusionPreoperative determination of vascular involvement was significantly better for 3D imaging reconstruction than for the other tested methods in patients with pancreatic cancer.

BackgroundThere is currently insufficient evidence to determine whether lightweight or heavyweight mesh is the better choice for ventral hernias. Recurrence and postoperative pain are associated with biomechanical responses such as inflammation, foreign body reaction, cell ingrowth, and tensile strength, which can be examined in animal studies. This study aimed to compare the biomechanical differences between light- and heavyweight meshes in animal models.MethodsA systematic search was conducted on August 14, 2023, in PubMed and Embase for studies comparing light- and heavyweight meshes implanted on animal abdominal walls. We included studies reporting on non-coated polypropylene or polyester meshes in an onlay placement. Studies were excluded if the mesh was coated, absorbable, fixated with fibrin glue, implanted in a contaminated field, or if it was an in vitro study. The study was reported according to PRISMA 2020 guideline, and risk of bias was assessed using the SYRCLE bias assessment tool.ResultsOur search yielded 4050 records, which resulted in 91 reports for full-text screening, and 20 studies were included in the final analyses. Heavyweight meshes caused more inflammation and foreign body reaction compared with lightweight meshes but displayed similar tensile strength post-implantation. There was insufficient evidence regarding cell ingrowth.ConclusionHeavyweight meshes caused increased inflammation and foreign body reaction compared with lightweight meshes. Although heavyweight meshes preimplantation have increased tensile strength compared with lightweight meshes, no difference was found post-implantation. This suggests that lightweight meshes may be a good option for ventral hernia repair.

BackgroundSingle port cholecystectomy (SPC) provides several postoperative advantages including excellent cosmetic outcomes; however, it presents technical challenges due to impaired triangulation and restricted instrument mobility. To address these challenges, we developed the FJB method, a novel liver retraction technique combining Free Jaw (FJ) clips with barbed sutures.MethodsIn the FJB method, an FJ clip is applied near the base of the gallbladder, and a barbed suture is anchored to the diaphragm, enabling cephalad traction via a pulley-like mechanism. We evaluated the clinical feasibility and safety of this technique during SPC.ResultsBetween September 2023 and April 2024, 23 SPC procedures utilizing the FJB method were performed by four surgeons at our institution. The mean installation time for the traction system was 165 seconds (range, 81-275 seconds). No intraoperative clip dislodgement, liver injury, or traction related complications were observed, including in patients with fatty liver. The FJB method consistently provided stable liver retraction, improved surgical visibility, minimized instrument collisions, and contributed to safer and more efficient procedures.ConclusionsThe FJB method is a simple, effective, and reproducible approach for achieving stable liver traction during SPC. It offers significant advantages in enhancing surgical safety and increasing overall procedural efficiency.