Surgical Innovation最新文献

BackgroundPostoperative anastomotic leaks are the most common complications following colorectal surgery, with rates reaching 24%. Previous studies on endoscopic management of anastomotic leaks (eg, EndoClip, OverStitch, and stenting) have shown similar outcomes as reoperation. Implementation of these endoscopic strategies for anastomotic leak management remains limited given sparse data demonstrating integration of these methods with conventional practices.MethodsA single-institution, retrospective chart review was conducted to identify patients who underwent a left-sided colectomy with primary colorectal anastomosis and developed clinically significant anastomotic leaks between 2018 and 2021. These patients were categorized as managed with surgery alone vs with endoscopic intervention, and patient demographics and anastomotic leak characteristics were analyzed.ResultsOf the 14 total patients identified, seven were managed with surgery alone and seven were managed with endoscopic intervention. When compared to patients managed with surgery alone, those managed endoscopically were more often hemodynamically normal; however, differences in bowel defect size or time to leak identification were not statistically significant. In three cases, the application of advanced endoscopic techniques prevented the need for further intervention. For three other patients, multidisciplinary management with endoscopy facilitated surgical creation of diverting loop ileostomy instead of a higher-morbidity end colostomy.ConclusionsThis study demonstrates a diversity of scenarios in which endoscopic management can be integrated into management of anastomotic leaks and, in some cases, avoid the need for reoperation. When feasible, a multidisciplinary approach including interventional gastroenterology should be utilized to potentially mitigate the need for end colostomy creation and optimize patient outcomes.

BackgroundPain that impacts professional and personal life are prevalent among surgeons due to poor ergonomics. The objective of this study is to determine the attitudes, perceptions, and real-world practices of ergonomics with the ultimate goal of deriving novel solutions.MethodsA survey was distributed to surgical faculty/trainees at a single institution. 43 attendings and 116 trainees were invited to participate. Data on demographics, pain experiences, ergonomic practices and attitudes, and perceived barriers to implementing ergonomic principles were ascertained.ResultsOf surveyed surgeons, 18 attendings and 11 trainees responded. 46.7% of surgeons experienced pain, particularly in the neck and back. Although most respondents made adjustments, challenges such as insufficient training, lack of proper equipment and/or instruments, and resistance from others were frequently encountered or anticipated. Most believed ergonomics improves outcomes and an interest in ergonomic training was noted.ConclusionsMany surgeons experience pain and are interested in improving ergonomics. Addressing barriers to improvement could potentially foster better practices, reduce strain on surgeons, decrease pain and injuries, increase surgeon well-being, and potentially improve patient outcomes. Further studies and innovative solutions are needed to address this problem.

ObjectiveThis study aims to assess the feasibility and effectiveness of a disposable sterile syringe-derived cannula for endoscopic carpal tunnel release (ECTR) in the treatment of carpal tunnel syndrome (CTS) and to evaluate the clinical outcomes of this technique in patients undergoing ECTR.MethodsECTR was performed on patients with CTS. A 2.5 mL disposable sterile syringe was modified into a cannula with an upper calibrated section and a transparent lower portion. A skin incision, approximately 1 cm in length, was made on the ulnar side of the palmaris longus tendon at the proximal wrist crease level. Following blunt dissection, the cannula was inserted into the wound, and both the arthroscope and a spade knife were introduced simultaneously. The instruments were advanced with the spade knife cutting the transverse carpal ligament (TCL) from proximal to distal under direct visualization. The wound was closed using silk sutures. All patients were followed for a minimum of 6 months postoperatively. At the final follow-up, the Boston Carpal Tunnel Syndrome Questionnaire's symptom severity score (SSS) and function status score (FSS), along with the visual analogue scale (VAS) for pain, were recorded and compared to preoperative values.ResultsA total of 16 patients (19 wrists) with a mean age of 52.5 years were enrolled between May 2024 and December 2024. All patients completed the follow-up, with a median duration of 8 months. At the final follow-up, VAS scores, SSS-BCTSQ, and FSS-BCTSQ demonstrated significant improvements from baseline (P < 0.001). No intraoperative or postoperative complications were reported.ConclusionThe use of a 2.5 mL disposable sterile syringe to create a cannula for ECTR in CTS treatment is a safe, and feasible approach.

BackgroundWithin the competencies in education for general surgery residents, the development of Laparoscopic Surgery Skills is of the utmost importance. We evaluated the usefulness of cadavers preserved with a formaldehyde-free solution in the acquisition/development of Skills for Laparoscopic Surgery once basic skills have been developed.MethodsThis is a single-center, single-blind, randomized educational intervention clinical trial. Participants took a theoretical and practical module on the acquisition of skills in laparoscopy and took a pre-test focused on intracorporeal enterorrhaphy. Subsequently, they were randomized by blocks into 3 branches continuing their training in skill acquisition models, silicone models, or Formaldehyde-free solution preserved corpses, and finally they performed a post-test. Two blind experts evaluated participants using the GOALS and OSATS scales for laparoscopic surgery.ResultsN = 37 participants were obtained. No relationship was found between the branch and the results of the GOALS and OSATS tests in pre and post-test, which implies comparability between the training methods. Also, the Pillai's Trace statistical test for the MANOVA (0.95, F(12, 54) = 4.0988, P < 0.05) and (0.66, F(2, 31) = 30.18, P < 0.05) indicates that the educational level of the participant does have a statistically significant association with the results obtained in the pre- and post-test.ConclusionsEducation and development of laparoscopic surgery skills using cadavers preserved with the presented formaldehyde-free solution is comparable to other simulation models for the acquisition of skills in minimally invasive surgery. Also, this tool improves the learning curve in subjects with no prior experience.

BackgroundCustomizable positioning devices for endocrine surgery are scarce, and existing solutions often rely on improvised supports. This technical report introduces 3 patented 3D-printed devices developed to enhance precision, ergonomics, and safety during endocrine procedures.Methodology and Device DescriptionThe required devices were designed using available software and printed via Fused Deposition Modeling with ABS filament. Post-processing involved acetone smoothing and the addition of an EVA lining for enhanced patient comfort. Specifically, a 3D-printed neck pillow and arm sling were applied during thyroidectomy, while a 3D-printed prone mattress was utilized for adrenalectomy. These devices incorporated modular cushions and magnetic fasteners to facilitate rapid assembly.Preliminary ResultsThe thyroid surgery yielded optimal neck extension, a 73-minute operative time, and 50 mL blood loss without complication. Adrenal surgery was completed with a 105-minute operative time and 50 mL of blood loss, followed by an uneventful recovery. Both patients were discharged on postoperative day 2. The surgical devices allowed stable intraoperative positioning in the reported cases, without observed positioning-related adverse events.Current StatusThese lightweight, modular 3D-printed devices were designed to support ergonomic and stable positioning in endocrine procedures. Despite their preliminary success, broader adoption will require addressing challenges related to cost, regulation, and process integration.

BackgroundHow clinicians conceptualize artificial intelligence reveals underlying assumptions about professional authority and decision-making. This study examined whether surgical and medical specialties frame AI differently in research and if such differences reflect divergent professional norms.Methods1561 AI-related research abstracts published between January 1, 2019, and March 27, 2025, in 30 high-impact journals. Abstracts were identified through a structured PubMed query and analyzed using a large language model (DeepSeek Reasoner) trained to classify along three dimensions: the human-AI relationship, the impact on professional autonomy, and the locus of decision control. A stratified validation sample was independently coded by a human rater. Chi-square testing and logistic regression were used to assess differences by specialty and publication year.ResultsSurgical abstracts more frequently framed AI as assistive (69.8% vs 54.9%; P < .001), explicitly addressed professional autonomy (73.5% vs 61.3%; P < .001), and specified decision control (69.3% vs 58.6%; P < .001) compared to medical abstracts. These differences persisted across the 7-year period. In multivariable logistic regression, assistive framing (OR, 2.43; 95% CI, 1.82-3.23) and explicit autonomy discussion (OR, 1.46; 95% CI, 1.11-1.92) were independently associated with surgical specialty.ConclusionsSurgical and medical specialties exhibit distinct patterns in how they conceptualize AI, reflecting established perspectives on authority, expertise, and the human-machine relationship. These framings have implications for AI tool design, clinical implementation, and healthcare governance. Recognizing conceptual differences on AI is critical as healthcare transitions toward algorithmically mediated decision-making, as they may shape the future culture of clinical care.

BackgroundSurgery is a central component of healthcare but involves significant risks, with complications occurring in 16.4% patients, accounting for 7.7% of worldwide fatalities. "Surgery 4.0" or digitisation of surgery, has introduced extended reality (XR) technology, offering opportunities to enhance peri-operative care. This study explored the current uses of XR to improve outcomes for general surgery patients.MethodA systematic search of MEDLINE, EMBASE, and Cochrane databases was performed in August 2024 to include studies using XR for pre-operative planning, navigation or patient experience for adult patients undergoing general surgery. Data on pre-operative planning, post-operative complications, patient experience, image segmentation and study reporting were presented using a narrative approach.ResultsThe search returned 966 articles. 26 studies were included featuring 1142 patients. The most investigated procedure was liver resection (n = 11, 42%), with XR interventions showing significant reductions in length of stay, blood loss, operative time and complication rates. Improved outcomes were only seen for patients undergoing liver resection. For patient experience (n = 5, 19%), XR systems were shown to significantly improve anxiety, pain and mood scores. Most studies (n = 11, 73%%) utilised manual methods for image segmentation, costing up to €650 and taking 3-6 hours per model. Reporting of the XR technology, assessment and future development was variable.ConclusionThe benefits of XR technology to improve patient outcomes in liver surgery are emerging but are yet to materialise in other general surgical procedures. Future research should focus on automatic image segmentation to improve workflow efficiency and innovation frameworks to generate robust evidence.

IntroductionIn living donor kidney transplantation, recipient surgery is often performed concurrently with donor nephrectomy, limiting preoperative understanding of graft anatomy before graft arrival. This study evaluated the feasibility, safety, and perceived usefulness of intraoperative application of sterilized three-dimensional (3D) printed donor kidney models for surgical planning.MethodsPatient-specific 3D kidney models were created from preoperative contrast-enhanced computed tomography using SYNAPSE VINCENT software, printed with a Cara Print 4.0 Pro, and gas sterilized for intraoperative use. Ten consecutive transplants using 3D models (June 2024-July 2025) were compared with the most recent 10 without models (June 2022-May 2024). Surgical outcomes were analyzed, and eight surgeons completed a 5-point Likert scale questionnaire on accuracy, handling, and usefulness.ResultsThe models reproduced donor kidney anatomy with reasonable accuracy. Surgeons reported benefits for graft orientation, anastomosis, and graft bed preparation, especially for less-experienced surgeons. Handling was satisfactory, although vessel rigidity was noted. No intraoperative complications, graft damage, or contamination events were attributable to model use, and overall surgical outcomes were comparable between groups.ConclusionsIntraoperative use of sterilized 3D-printed donor kidney models is feasible, safe, and cost-effective. These models may serve as practical adjuncts for surgical planning, anatomical visualization, and education in living donor kidney transplantation. Further multicenter studies are warranted to validate their broader clinical and educational impact.

Background/NeedUncontained power morcellation during laparoscopic gynecologic surgery risks intra-abdominal dissemination of benign or malignant tissue, a significant safety concern highlighted by FDA warnings. This has created a critical need for robust and reliable tissue containment systems that can be easily integrated into surgical workflows to mitigate this risk.Methodology and device descriptionThe LapBox Power Tissue Containment System is a single-use device featuring a dual-walled inflatable chamber designed to create a secure environment for morcellation. We conducted a Good Laboratory Practice (GLP)-compliant toxicology study in three female domestic pigs to assess its safety under simulated worst-case conditions. The device was inserted laparoscopically, and the internal dual-walled chamber of the device was inflated to a high pressure (∼160 mmHg) to simulate a localized worst-case compressive scenario, while the overall intra-abdominal insufflation was maintained at a standard 15 mmHg. Postoperative monitoring included clinical observation, bloodwork, and, at day 13, necropsy and histopathology.Preliminary ResultsAll procedures were completed without mortality, morbidity, or device-related complications. The LapBox maintained full structural integrity. Postoperative clinical, hematological, and biochemical parameters showed no adverse effects. Gross necropsy and detailed histopathology confirmed the absence of device-related ischemia, necrosis, thrombosis, or foreign-body reaction.Current statusThis preclinical study demonstrates that the LapBox Power system has an excellent safety profile and biocompatibility, even under extreme conditions. The device is ready for the next stage of evaluation. These findings support its translational potential and warrant further investigation in human clinical studies to confirm its safety and efficacy.

BackgroundThe aim of this study was to summarize the current evidence regarding the role of dorsal genital nerve stimulation (DGNS) in the management of fecal incontinence (FI).Patients and MethodsThis study was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed (Medline, Scopus, CENTRAL, Web of Science, CORE, medRxiv Repository, SciELO, AJOL, and Google Scholar) to identify and retrieve the eligible studies. The last search date was 13/12/2025. The primary endpoint was the pooled complication rate of DGNS in patients with FI. Both prospective and retrospective studies were considered. Quality evaluation was performed via the ROBINS-I tool.ResultsOverall, 6 non-randomized studies and 90 patients were included. The overall complication rate was 1.9% (95% CI: -1.1%, 4.9%; I² = 0%; P = .213). Α post-interventional improvement of the anal resting pressure (MD: 11.6; 95% CI: 6.5, 16.79; I² = 0%; P < .001) and anal squeeze pressure (MD: 35.3; 95% CI: 17.24, 53.33; I² = 0%; P < .001) was confirmed. The application of ROBINS-I tool resulted in all studies being graded as high-risk of bias.ConclusionsWe emphasize the need for prospective randomized controlled trials to determine the exact role of DGNS in the management of FI.