Surgical Innovation最新文献

Background: In recent years, robot-assisted surgery has been a major advancement in surgery and has gradually become the preferred approach. The precise operation, minimal invasiveness, and the ability to perform the preoperative planning are its characteristics. Due to the continuous improvements in plastic surgery technology over the past few decades, more researchers are trying to integrate robotic technology into plastic surgery. Purpose: This bibliometric study aims to quantatitively evaluate the published literature on the topic of robot-assisted plastic surgery indexed in the Web of Science Core Collection and provide a unique insight for subsequent researches in this field.Research Design and Sample: This time of bibliomteric analysis utilized data obtained fron the online database mentioned above and subsequent data analysis and visulization was abcieved by the R software. Totally 208 publications were enrolled after screening.Data Collection and Analysis: Further analysis on authors, sources, affiliations, trend topics, co-citation, keywords and thematic map was conducted on the bibliometric package.Results: The analysis mentioned above elucidates that the application of robot-assisted surgery in plastic surgery is prospering with a potential direction of "flap" and "breast reconstrction". Conclusion: Thedevelopment robot-assisted surgery encountered a continous surge in roughly a decade ago and will iterating with a promising future.

BackgroundMicroaggressions are subtle verbal or behavioral insults (intentional or unintentional) that typically convey negative or hostile attitudes towards marginalized groups. We aim to study microaggressions and workplace culture amongst European otolaryngologist -head and neck surgeons (E-OTOHNS). The perception of "differential treatment" based on individual traits was used as a proxy for microaggressions.MethodsEuropean members of Young-Otolaryngologists of International Federation of Otorhinolaryngological Societies (IFOS) and Confederation of European Otorhinolaryngological Societies were surveyed regarding observed and personal experiences of microaggressions in the workplace as related to individual factors that comprise one's identity; These factors included biological sex; disability; gender identity; language proficiency; citizenship; ethnicity; political belief; sexual orientation and socioeconomic status.ResultsA total of 230 E-OTOHNS completed the survey (17%), including 113 Women (49%) and 117 men (51%), respectively. The most common daily-to-monthly observed microaggressions were related to age (n = 177, 50.1%), biological sex (n = 105, 45.7%), and language proficiency (n = 67, 29.1%), respectively. Personal experiences of microaggression were related to professional rank (n = 80; 35.3%), age (n = 75; 32.6%), and biological sex (n = 63; 27.5%). Women self-reported significant higher proportions of personal experiences of microaggression related to ageage (40.7% vs 24.8%; P = 0.003), biological sex (41.6% vs 13.8%; P = 0.001), and professional rank (42.0% vs 28.7%; P = 0.049) compared to men. Similarly, Women self-reported higher rates of personal feeling of exclusion from their colleagues at the institution (P = 0.036) than men and were more likely mistaken for another role in the hospital (P = 0.004).ConclusionsWoman European otolaryngologists, particularly those early in their careers, self-report higher proportions of observed or experienced microaggressions related to age, biological sex, and professional rank compared with male otolaryngologists. More efforts are needed in European academic Otolaryngology to reduce microaggressions, discriminations, and exclusions as more woman surgeons enter the medical workforce.

BackgroundThe objective of this study was to investigate whether the advantages of uterine manipulators in laparoscopic hysterectomy could also be applied to abdominal hysterectomy. In the present study, we introduce a novel surgical technique that employs a uterine manipulator during open surgery and analyze the outcomes of this approach.MethodsA prospective, single-center, randomized controlled trial was conducted at a tertiary research hospital with patients who underwent hysterectomy for benign gynecological indications between October 2023 and March 2024. Patients were randomly assigned to either conventional abdominal hysterectomy or manipulator-assisted abdominal hysterectomy. Primary outcomes included operative time, with secondary outcomes including Visual Analog Scale (VAS) pain scores, intraoperative and postoperative complications, and length of hospital stay.ResultsAmong the 142 participants, the manipulator group exhibited a mean operative time of 92.2 ± 11.1 minutes compared to 107.6 ± 14.4 minutes in the control group (P < .001). Length of hospital stay was also significantly shorter in the manipulator group (42.3 ± 14.7 hours vs 47.4 ± 15.8 hours; P = .046). No significant differences were observed in postoperative complications or pain scores between groups. The mean postoperative hemoglobin decrease was significantly lower in the manipulator group (0.74 ± 0.28 g/dL) compared to the control group (1.52 ± 0.33 g/dL) (P < .001).ConclusionThe incorporation of a uterine manipulator in abdominal hysterectomy significantly reduces operative time, colpotomy time, and hospital stay while maintaining a comparable safety profile to conventional techniques. These findings suggest that uterine manipulators may enhance surgical efficiency and could be beneficial in clinical practice.

AimAnal Intraepithelial Neoplasia has been a hot topic in colorectal surgery and many Scientific Societies have produced guidelines for their diagnosis and treatment. This study aims to appraise the quality of the existing guidelines in this field.MethodsA systematic review of the Literature was conducted in PubMed, EMBASE and Scholar Google databases. Seven authors independently valued the quality of guidelines using the AGREE II instrument.ResultsThis study identified and included 9 guidelines of varying quality. The highest scoring guidelines were different considering each domain. NYSDOH ones gained the higher scoring in 2 domains. However, there was considerable variability across the studies and the various domains. The highest scoring domains were domain VI: Editorial Independence (median = 89% across all studies); IV: Clarity of Presentation (median = 61% across all studies) and domain I: Scope & Purpose (median = 59% across all studies). The lowest scores were observed in domain V: Applicability (22%) and domain III: Rigour of Development (29%). Only 2 of the 9 gained unanimous support for their use, whilst 5 guidelines were unanimously declared unsuitable for clinical use. The last 2 guidelines were considered beneficial only for limited purposes.Conclusions4 out of the 9 guidelines examined obtained moderate/good scores in various domains of the AGREE II tool. The review of the guidelines highlighted poor attention to stakeholder involvement and scarce care, mainly in the Rigour of development and Applicability of the guidelines. The AGREE II instrument could improve the drafting of new guidelines or help update published ones.

ObjectivesThis study seeks to compare a newly developed portable flexible nasopharyngoscope (ENLYT^®) to the standard of care (SOC) flexible nasopharyngoscope.MethodsSubjects were consented to undergo a nasopharyngeal scope exam using ENLYT^® after SOC nasopharyngoscope examination. Data collection included a physician feedback survey consisting of questions regarding ease of use, video quality and perceived patient pain. Additionally, subjects provided a comparison of discomfort between the two scopes.ResultsThe following results were compiled from nine examiners completing ENLYT^® exams on 50 patients. The nine examiners consisted of five attendings, three residents, and 1 physician assistant. The attendings performed 31 exams (62%) and the others performed 19 exams (38%). 72% of the exam surveys reported the ENLYT^® flexible nasopharyngoscope was the same or easier to use than the SOC nasopharyngoscope. 88% of exams reported the ENLYT^® video quality was "the same" to "better". 94% of exams reported the perceived patient pain with the ENLYT^® flexible nasopharyngoscope was the same or less than the SOC nasopharyngoscope. Subjects reported that 88% of the exams were the same or less discomfort with the ENLYT^® scope compared to the SOC scope.ConclusionThe portable ENLYT^® flexible nasopharyngoscope was able to provide comparable exam results when compared to the SOC nasopharyngoscope.

BackgroundThe daily implementation of robotic programmes for general surgery has allowed for the diffusion of the robotic approach in clinical practice in many centres with relatively little experience in laparoscopic liver resection.MethodsThis study describes our preliminary experience with robotic liver resection (RLR) using the da Vinci Xi Surgical System^®, beginning with assistance provided by an expert robotic colorectal team. Between 2022 and 2024, data on 61 consecutive minor RLRs performed by a single hepatobiliary team were retrospectively analysed. Intraoperative blood loss and operative time were used to construct learning curves.ResultsIn the first phase of the learning curve (competency; cases 1-20), surgeons focused on acquiring basic surgical skills. Most cases involved non-anatomical wedge resections of superficial liver lesions with a low IWATE score. From the 14th case onwards, a significant improvement in operative time and a reduction in blood loss were observed. During the second phase of the learning curve (proficiency; cases 21-50), the surgical cases became more complex. The cumulative operative time increased progressively, reaching a plateau around the forty-first case. Blood loss initially increased but then gradually stabilised below 400 mL. During the early mastery phase of the learning curve (cases 51-61), the IWATE score continued to increase (mean 8), whereas the cumulative operative time and blood loss were stable.ConclusionsWe believe that the success of our initial robotic programme is due not only to technological advancement, but also to the continuous development and effective collaboration of the multidisciplinary colorectal and liver team.

BackgroundCommercially available large language models (LLMs) have demonstrated impressive capabilities in processing vast datasets and generating coherent narratives. However, their lack of domain-specific knowledge limits their reliability in clinical applications. This study aimed to develop and evaluate BariatricSurgeryGPT, a fine-tuned LLM specifically tailored for bariatric surgery to provide more accurate and clinically relevant responses to bariatric surgery-related questions.MethodsWe obtained 8764 bariatric surgery research abstracts published between January 1, 2020, and January 1, 2024, from PubMed. These abstracts were preprocessed and tokenized to fine-tune a pre-trained GPT-2 model using PyTorch and HuggingFace frameworks. The model's performance was evaluated using BLEU, METEOR, and ROUGE-1 scores on 20 clinically relevant bariatric surgery questions, each tested across nine temperature settings (0.1-0.9) for both the fine-tuned and baseline GPT-2 models, yielding 360 total evaluation instances.ResultsBariatricSurgeryGPT demonstrated consistent improvements over the baseline GPT-2 model across all metrics. The fine-tuned model achieved a BLEU score of 0.165 (vs 0.147 for baseline, 12.8% improvement), a METEOR score of 0.633 (vs 0.585, 8.2% improvement), and a ROUGE-1 score of 0.267 (vs 0.243, 9.7% improvement). These improvements indicate enhanced precision, recall, and semantic relevance in generating bariatric surgery-specific content.ConclusionBariatricSurgeryGPT represents the first domain-specific LLM for bariatric surgery and demonstrates the feasibility of developing specialty-specific AI tools with improved accuracy for clinical applications. The specialty-specific models could enhance surgical education through interactive learning tools, improve patient communication via personalized educational materials, and support clinical decision-making by providing evidence-based information synthesis.

BackgroundAccurate intraoperative blood loss estimation is crucial, particularly for pediatric and adolescent patients. Traditional methods (visual, gravimetric, formula-based) are often imprecise and unreliable, highlighting a need for objective and efficient approaches.MethodsThis study proposes a novel machine learning (ML) approach to predict blood loss from surgical sponges via a pixel-counting rate system. We utilized image preprocessing, including edge detection, and evaluated various ML algorithms with hyperparameter tuning. Details include deployment on commodity smartphones, a deterministic preprocessing pipeline, and app-level measures to mitigate folding, lighting, and motion blur. Model accuracy was assessed using RMSE and R². A lightweight CNN baseline on raw images was also evaluated, positioning our system as a low-cost, mobile alternative to proprietary solutions.ResultsThe ML-based method significantly reduced reliance on subjective visual estimation. Gradient Boosting (GB) and Artificial Neural Networks (ANN) achieved a minimum RMSE of 0.91 and a maximum R² of 0.93, outperforming traditional methods. The system demonstrates strong potential for integration into mobile phone applications for practical clinical use.ConclusionsOur machine learning-based pixel-counting approach offers a more accurate and efficient alternative for intraoperative blood loss estimation. Future research will expand the dataset, refine ML algorithms, and adapt the system for specialized equipment. While a CNN baseline approached GB performance, GB remained superior at the current data scale. A prospective paired-data plan is outlined for future benchmarking. Clinically, the per-sponge RMSE (∼0.9 cc) aligns with an acceptable error margin (0.5-1.0 cc) for decision support, noting that pediatric transfusion decisions rely on cumulative loss and multimodal monitoring.

BackgroundRobotic procedures are still increasing in abdominal surgery. Yet, little is known about the postoperative Quality of Life (pQoL) after these procedures. The aim of this study was to determine the pQoL of patients who underwent robotic-assisted abdominal surgery.MethodsAs a cross-sectional, retrospective study, several validated questionnaires were used to evaluate the pQoL. After confirmed consent patients who underwent robotic upper gastrointestinal tract (UGI), hepatopancreatobiliary (HPB), and colorectal (CR) procedures between 03/2020 and 03/2023 were enrolled. Subgroup analysis referred to oncologic and non-oncologic indications, postoperative time periods and age >70 years. Scoring was adjusted to a scale of 0 to 100 (as the best QoL) for comparability.ResultsA total of 197 patients were included (n = 111 for oncological indications, n = 86 for functional, non-oncological indications). Organ-related subgroup analyses showed an overall score of >70 for each group (oncologic: UGI: 75.6 ± 16.6; HPB: 85.6 ± 15.7; CR: 81.9 ± 18.5 and non-oncologic: UGI: 76.0 ± 14.8; HPB: 78.9 ± 13.2; CR: 82.4 ± 6.6). A decline in pQoL was observed during the second year after surgery, evident in both oncologic (<1 year: 80.7 ± 16.2 vs 1-2 years: 73.1 ± 19.7 vs 2-3 years: 88.4 ± 11.2, p = .005) and non-oncologic patients (<1 year: 80.7 ± 10.1 vs 1-2 years: 69.7 ± 18.9 vs 2-3 years: 75.6 ± 12.5, p = .033). PQoL was similar for patients under and above 70 years.ConclusionThe overall pQoL for abdominal surgery was good regardless of the indication or the organ system. A decline in the pQoL was noted during the second year after surgery. Due to the retrospective design and small subgroups, further longitudinal studies are required to determine the long-term QoL and influencing factors.