Surgery最新文献

{"title":"Lymph node metastasis mapping and identification of high-risk stations in pathological T1-2 esophageal squamous cell carcinoma: A retrospective cohort study.","authors":"Kai-Yuan Jiang, Jing Chen, Jin-Zhu Nan, Wen-Long Hu, Heng-Tao Lin, Dai-Yuan Ma, Kai-Di Li, Hai-Ning Zhou, Long-Qi Chen, Dong Tian","doi":"10.1016/j.surg.2025.110024","DOIUrl":"https://doi.org/10.1016/j.surg.2025.110024","url":null,"abstract":"<p><strong>Background: </strong>Lymph node metastasis is a crucial factor in predicting the prognosis of patients with pathologic T1-2 esophageal squamous cell carcinoma, but the optimal extent of lymphadenectomy remains unclear. This study aims to determine the prognostic significance of high-risk lymph node stations and identify risk factors for high-risk lymph node station involvement.</p><p><strong>Methods: </strong>Patients with pathologic T1-2 esophageal squamous cell carcinoma who underwent esophagectomy with lymph node dissection were enrolled between January 2014 and December 2019. The incidence of metastasis at each regional lymph node station was assessed, and the efficacy index was calculated to evaluate the therapeutic value of dissection.</p><p><strong>Results: </strong>In total, 695 patients with T1-2 esophageal squamous cell carcinoma were included. Lymph node stations 2, 7, 8, 16, and 17 were defined as high-risk stations, with metastasis rates of 6.47%, 4.17%, 11.37%, 5.90%, and 7.34%, respectively, which were greater than those of the other stations. Patients with high-risk lymph node station metastasis exhibited elevated efficacy index values (1.67-5.44) and significantly worse overall survival (P < .001). High-risk lymph node station metastasis was an independent prognostic factor (hazard ratio, 1.986; 95% confidence interval, 1.452-2.716, P < .001). Logistic regression identified body mass index, tumor differentiation, tumor size, and tumor location as independent risk factors for high-risk lymph node station involvement.</p><p><strong>Conclusion: </strong>Lymph node stations 2, 7, 8, 16, and 17 were high-risk stations associated with poor prognosis and high therapeutic value. Identification of these high-risk lymph node stations may guide a more tailored lymphadenectomy strategy in patients with T1-2 esophageal squamous cell carcinoma.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110024"},"PeriodicalIF":2.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the no-show: A case study highlighting the hidden scope of barriers to radiotherapy adherence in cancer care","authors":"Camille A. Biggins MHA,&nbsp;Laurie J. Kirstein MD, FACS,&nbsp;Eileen Reilly MSW,&nbsp;Kathryn Swingle MSW, LICSW,&nbsp;Kelly Christensen MSW, LICSW,&nbsp;Laura Marquez MSW, LSWAIC,&nbsp;Mark Daniels BS","doi":"10.1016/j.surg.2026.110087","DOIUrl":"10.1016/j.surg.2026.110087","url":null,"abstract":"<div><h3>Background</h3><div>Despite prevalent systemic barriers to accessing healthcare services, Virginia Mason Medical Center’s Floyd &amp; Delores Jones Cancer Institute has historically taken a piecemeal approach in responding to barriers. To uphold the organization’s mission, they participated in the Commission on Cancer’s “Breaking Barriers” national quality improvement collaborative in 2023 to investigate the predictable and modifiable reasons for radiotherapy nonadherence among their patients with cancer.</div></div><div><h3>Methods</h3><div>From March 1 to December 15, 2023, a multidisciplinary quality improvement team prospectively collected data on patients aged 18–99 years scheduled to receive 14–15 fractions of radiotherapy, excluding palliative care and ultrafractionation regimens. The team employed REDCap for bimonthly reporting and used multiple investigative methods including community assessments, patient chart reviews, patient narratives, and stakeholder input sessions. Environmental and community factors affecting transportation access were systematically evaluated using established quality improvement frameworks. Social work activity data were also collected to quantify institutional resource allocation.</div></div><div><h3>Results</h3><div>Among 104 eligible patients during the initial study period, 85.6% completed all scheduled appointments, 14.4% missed at least 1 appointment, and 3.8% met the no-show threshold of missing at least 3 appointments. By the end of 2023, the total institutional no-show rate was 5.2%, with transportation accounting for only 5.3% of all missed radiotherapy appointments. However, oncology social workers spent 14.8% of their time addressing transportation needs. Transportation-related missed appointments decreased to 3.7% by December 2023, while social work interventions prevented numerous potential no-shows from being recorded.</div></div><div><h3>Conclusion</h3><div>This project reveals an “iceberg problem” where transportation insecurity’s true magnitude remains hidden beneath outcome-oriented no-show metrics. The substantial discrepancy between low rates of transportation-related missed appointments (5.3%) and high social work time allocation (14.8%) demonstrates that no-show rates mask significant institutional workload required to maintain treatment adherence. Social work time emerges as a more sensitive, novel indicator of barrier vulnerability that reframes the problem from patient-centric failure to system-level resource demands. Health care organizations should implement proactive, data-driven barrier management systems that account for hidden workloads while developing sustainable, multilevel interventions to ensure equitable cancer care access.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110087"},"PeriodicalIF":2.7,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative midterm ramifications of one anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy: A retrospective cohort study of 6,234 patients","authors":"Adi Vinograd MD, MPH ,&nbsp;Lital Keinan Boker MD, PhD ,&nbsp;Rita Dichtiar MPH ,&nbsp;Alina Rosenberg PhD ,&nbsp;Orly Romano-Zelekha PhD ,&nbsp;Inbal Globus PhD","doi":"10.1016/j.surg.2026.110083","DOIUrl":"10.1016/j.surg.2026.110083","url":null,"abstract":"<div><h3>Background</h3><div>One-anastomosis gastric bypass is a commonly performed metabolic bariatric surgery, yet comprehensive comparisons of its midterm outcomes with Roux-en-Y gastric bypass and sleeve gastrectomy remain limited. The study aimed to assess midterm outcomes, including weight loss and 3-year post–metabolic bariatric surgery complications, in a nationwide cohort.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients aged ≥18 years who underwent one-anastomosis gastric bypass, Roux-en-Y gastric bypass, or sleeve gastrectomy between 2016 and 2019, using data from the National Metabolic Bariatric Surgery Registry and Maccabi Health Services, the second largest health provider. Adjusted odds ratios for study outcomes were estimated using multivariable logistic regressions and propensity score matching.</div></div><div><h3>Results</h3><div>The study comprised 2,249 one-anastomosis gastric bypass (36.1%), 447 Roux-en-Y gastric bypass (7.2%), and 3,538 sleeve gastrectomy (56.8%) patients. Preoperative mean body mass index values were 41.3 ± 4.9, 40.4 ± 4.7, and 41.6 ± 4.9 kg/m² for one-anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy, respectively. One-anastomosis gastric bypass achieved the greatest weight-loss efficacy of 30.9% at 3 years of follow-up (<em>P</em> &lt; .001). One-anastomosis gastric bypass was associated with higher odds of anal fissure (adjusted odds ratio, 1.85; 95% confidence interval, 1.38–2.49) alongside lower odds of constipation (adjusted odds ratio, 0.62; 95% confidence interval, 0.49–0.79), compared with sleeve gastrectomy. Both one-anastomosis gastric bypass and Roux-en-Y gastric bypass were associated with a higher likelihood of abdominal pain, diarrhea, and stomach ulcers compared with sleeve gastrectomy, after adjustment for potential confounders.</div></div><div><h3>Conclusion</h3><div>One-anastomosis gastric bypass demonstrated a greater magnitude of weight loss compared with sleeve gastrectomy but was associated with a higher incidence of specific gastrointestinal complications. These findings suggest additional considerations when selecting the optimal metabolic bariatric surgery approach, alongside tailored postoperative surveillance.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110083"},"PeriodicalIF":2.7,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing costs versus savings using fluorescence angiography with indocyanine green for colorectal surgery in the United States: Multifaceted meta-analysis and cost analysis","authors":"Patrick Goldhawk-White BSc ,&nbsp;Kevin White MD, PhD ,&nbsp;Manish Chand MBA, PhD ,&nbsp;Danny A. Sherwinter MD ,&nbsp;Steven Wexner MD, PhD(Hon)","doi":"10.1016/j.surg.2025.110072","DOIUrl":"10.1016/j.surg.2025.110072","url":null,"abstract":"<div><h3>Background</h3><div>Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography.</div></div><div><h3>Methods</h3><div>Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021–2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography–associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration.</div></div><div><h3>Results</h3><div>Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million.</div></div><div><h3>Conclusion</h3><div>For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110072"},"PeriodicalIF":2.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term parietal complications following surgery for inflammatory colitis: An underestimated issue","authors":"Océane Lelièvre MD ,&nbsp;Solafah Abdalla MD, PhD ,&nbsp;Aurélien Amiot MD, PhD ,&nbsp;Antoine Meyer MD, PhD ,&nbsp;Franck Carbonnel MD, PhD ,&nbsp;Christophe Penna MD, PhD ,&nbsp;Stéphane Benoist MD, PhD ,&nbsp;Antoine Brouquet MD, PhD","doi":"10.1016/j.surg.2026.110082","DOIUrl":"10.1016/j.surg.2026.110082","url":null,"abstract":"<div><h3>Background</h3><div>Surgical management of inflammatory colitis often requires a staged approach with multiple procedures. Data on incidence, risk factors, and management of parietal complications remain limited.</div></div><div><h3>Methods</h3><div>All adult patients who underwent surgery for inflammatory colitis between March 2010 and May 2024 were included. The primary endpoint was the incidence of incisional hernia, parastomal hernia, or stoma prolapse after complete surgical treatment. Risk factors were assessed, with age, body mass index ≥25 kg/m², and permanent stoma retained for multivariate analysis.</div></div><div><h3>Results</h3><div>One hundred nine patients underwent surgery for refractory colitis (<em>n</em> = 32; 29%), severe acute colitis (<em>n</em> = 58; 54%), and dysplasia (<em>n</em> = 19; 17%). Single or staged procedures resulted in 73 ileal pouch-anal anastomoses (67%), 23 ileorectal anastomoses (21%), and 13 nonrestorative proctocolectomies with end ileostomy (12%). Eighty-four patients (77%) had temporary stomas, and 19 (17%) had permanent stomas. The median follow-up was 44 (interquartile range: 21–91) months. Twenty-five patients (23%) developed parietal complications after a median of 25 (interquartile range: 11–35) months: 22 (20%) incisional hernia, 4 (3.6%) parastomal hernia, and 3 (2.8%) stoma prolapse. None of the 4 patients with prophylactic biological mesh placement during stoma closure developed complications. Twenty patients underwent abdominal wall repair, with 6 (30%) recurrences and 3 (15%) redo surgeries. Permanent stoma was the only independent risk factor (odds ratio = 4.35, 95% confidence interval: 1.24–15.7; <em>P</em> = .022).</div></div><div><h3>Conclusion</h3><div>Nearly one-quarter of patients with inflammatory colitis develop parietal complications after surgery, with high recurrence after repair. Prophylactic mesh placement during stoma closure should be studied.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110082"},"PeriodicalIF":2.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A missed opportunity to discuss treatment costs? A qualitative analysis of preoperative conversations about thyroid cancer treatment","authors":"Emily V. Crowley MS ,&nbsp;Catherine B. Jensen MD, MSc ,&nbsp;Elizabeth M. Bacon MPH ,&nbsp;Benjamin C. James MD, MS ,&nbsp;Susan C. Pitt MD, MPHS","doi":"10.1016/j.surg.2025.110075","DOIUrl":"10.1016/j.surg.2025.110075","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110075"},"PeriodicalIF":2.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of spatiotemporal features into machine learning assessment of open surgical skills","authors":"Armin Alipour MS ,&nbsp;Jeffrey Balian BS ,&nbsp;Kevin Tabibian BS ,&nbsp;Oh Jin Kwon MD ,&nbsp;Nguyen Le MS ,&nbsp;Areti Tillou MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.surg.2025.110079","DOIUrl":"10.1016/j.surg.2025.110079","url":null,"abstract":"<div><h3>Introduction</h3><div>Accurate and objective assessment of operative skills is essential for improving training paradigms, patient safety, and quality of surgery. Advances in machine learning have facilitated automated assessment of minimally invasive and robotic operations. This study aims to develop a novel machine learning model for evaluation of open surgical proficiency.</div></div><div><h3>Methods</h3><div>This study used the AIxSuture data set. A global rating score was assigned for each video, categorizing individuals into novice (<em>n</em> = 119), intermediate (<em>n</em> = 79), and proficient (<em>n</em> = 116) classes. Hybrid convolutional neural network and long-short-term-memory networks were employed to train the video classifier model. ResNet50, an image classification model, served as a spatial feature extractor to perform nonlinear transformations. Long-short-term-memory networks selectively retained and discarded both significant and insignificant changes in frame sets that capture the subject's movements. The class-wise F1 score was measured to assess harmonic performance.</div></div><div><h3>Results</h3><div>Our assessment achieved a mean F1 score of 80.1% in determining the performance level of each subject, outperforming previous models. Additionally, the model classified performance with 90.1% accuracy for the novice group, 65.7% for the intermediate group, and 86.3% for the proficient group. Despite lower accuracy in the intermediate class, this metric outperformed other models in this group by nearly 10%. The present model classified each video into appropriate skill levels at an estimated 10.2 ± 0.4 seconds.</div></div><div><h3>Conclusions</h3><div>Our machine learning model provides a robust framework for skill assessment in open surgery. The application of machine learning in clinical practice should be considered to evaluate surgeons' skills and help improve training and outcomes.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110079"},"PeriodicalIF":2.7,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cost comparison analysis of environmentally sustainable interventions in colorectal surgery","authors":"Rabiya Aseem MBBS, MSc, MRCS ,&nbsp;Siya Lodhia MBBS, MRCS ,&nbsp;Timothy Rockall MBBS, MD, FRCS ,&nbsp;Daniel Jackson BSc, MSc, PhD","doi":"10.1016/j.surg.2025.110054","DOIUrl":"10.1016/j.surg.2025.110054","url":null,"abstract":"<div><h3>Background</h3><div>Operating theaters are significant contributors to hospital carbon emissions, with colorectal surgery offering substantial opportunities for sustainable transformations. Financial assessments are critical to aid sustainable implementation within health care organizations. We conducted a cost comparison analysis of substituting disposable surgical items with their reusable counterparts in colorectal surgeries.</div></div><div><h3>Methods</h3><div>This was a prospective cost comparison study across 65 consecutive elective laparoscopic colorectal resections at a single UK center. Interventions included reusable laparoscopic ports/trocars, a reusable harmonic device, and reusable textiles (gowns, drapes, and slide sheets). Costs were analyzed using a per-case unit (capital amortized over expected lifetime + per-use sterilization/laundering). We also conducted a two-way sensitivity analysis and a threshold (break-even) analysis with 6% discounting over a 5-year life span.</div></div><div><h3>Results</h3><div>The total observed savings across 65 cases were £14,239.03. The reusable harmonic device remained cost-saving in all two-way combinations, with savings of £24.7k–£28.5k over 65 cases (baseline of £26.6k). Reusable textiles were consistently cheaper than disposables across modeled volumes. Reusable ports did not demonstrate cost savings at observed volumes and prices and did not reach parity on threshold analysis. Findings were driven by processing costs, capital price, and utilization.</div></div><div><h3>Conclusion</h3><div>Selectively adopted reusables can deliver measurable financial savings, particularly the harmonic device and theatre textiles, whereas other items may remain cost-increasing at current volumes and prices. The per-case, two-way sensitivity framework is transferable and can be populated with local inputs to inform implementation decisions aligned with sustainability aims.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110054"},"PeriodicalIF":2.7,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcium and vitamin D reduce hypoparathyroidism and hospital stay after thyroidectomy: A randomized controlled trial","authors":"Vasileios Gkanis MD, MSc ,&nbsp;Konstantinos Nastos MD, PhD ,&nbsp;Konstantinos Ntalaperas MD ,&nbsp;Evangelia Agianni MD ,&nbsp;Spyridon Lainas MD ,&nbsp;Panagiota Raikou MD ,&nbsp;Nikolaos Dafnios MD, PhD ,&nbsp;Ioannis Papakonstantinou MD, PhD ,&nbsp;Sophocles Lanitis MD, PhD","doi":"10.1016/j.surg.2025.110071","DOIUrl":"10.1016/j.surg.2025.110071","url":null,"abstract":"<div><h3>Background</h3><div>Transient hypoparathyroidism is a common complication after total thyroidectomy, prolonging hospitalization and necessitating calcium and/or vitamin D replacement. Evidence from prospective randomized trials on preventive supplementation remains limited. This study aimed to evaluate whether prophylactic calcium and vitamin D supplementation reduces transient hypoparathyroidism and shortens hospital stay after total thyroidectomy.</div></div><div><h3>Methods</h3><div>In this single-center, prospective, randomized, controlled, open-label trial, 600 patients undergoing total thyroidectomy without central neck dissection were randomized to receive prophylactic oral calcium carbonate/gluconate and alfacalcidol (group A, <em>n</em> = 300) or standard postoperative care (group B, <em>n</em> = 300). Primary outcomes were biochemical and symptomatic hypocalcemia and the need for intravenous calcium. Secondary outcomes included postoperative serum calcium levels and length of hospital stay. Statistical analyses used χ², Student’s <em>t</em> test, Mann-Whitney <em>U</em> test, and odds ratio and 95% confidence interval.</div></div><div><h3>Results</h3><div>Laboratory hypocalcemia (serum calcium &lt;8.5 mg/dL) occurred significantly less often in group A (16.9% vs 39.9%; odds ratio 0.305, 95% confidence interval 0.207–0.451, <em>P</em> &lt; .001). Symptomatic hypocalcemia was also reduced (5.6% vs 12.3%; odds ratio 0.427, 95% confidence interval 0.232–0.785, <em>P</em> &lt; .005), as was the need for intravenous calcium (1.8% vs 9.3%; odds ratio 0.175, 95% confidence interval 0.070–0.441, <em>P</em> &lt; .001). Group A demonstrated higher mean serum calcium levels on postoperative days 1 and 2 (<em>P</em> &lt; .001) and a shorter hospital stay (1.25 days vs 1.7 days, <em>P</em> &lt; .001). Supplementation benefits were consistent across subgroups stratified by malignancy status and preoperative vitamin D levels.</div></div><div><h3>Conclusion</h3><div>Routine calcium and vitamin D supplementation after total thyroidectomy significantly reduces transient hypoparathyroidism and shortens hospitalization. These findings support its use as a standard postoperative strategy to enhance recovery and reduce health care resource utilization.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110071"},"PeriodicalIF":2.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a robotic pancreatoduodenectomy program: Navigating the learning curve with a liberal patient selection and conversion strategy","authors":"Zhi Ven Fong MD, MPH, DrPH ,&nbsp;Chee-Chee Stucky MD ,&nbsp;Po Hong Tan MBBS ,&nbsp;Dillon Cheung MD ,&nbsp;Stephanie Yu MD ,&nbsp;Anita M. Moyer RN, OCN ,&nbsp;Julie L. Hildebrand PA-C, MS ,&nbsp;Hoe Yan Hor MBBS ,&nbsp;Melody Tu MBBS ,&nbsp;Rick Bold MD, MBA ,&nbsp;Yu-Hui Chang MS, PhD ,&nbsp;Nabil Wasif MD, MPH","doi":"10.1016/j.surg.2025.110070","DOIUrl":"10.1016/j.surg.2025.110070","url":null,"abstract":"<div><h3>Background</h3><div>The robotic platform is being increasingly utilized to perform pancreatoduodenectomy, but implementation can be associated with a steep learning curve, and large number of cases is required to surmount it. We detail an approach for implementation of a robotic pancreatoduodenectomy program that incorporates a liberal patient selection and conversion strategy to achieve proficiency while maintaining outcomes.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing pancreatoduodenectomy from January 2018 to June 2025 were identified. A robotic pancreatoduodenectomy program was implemented in October 2023. Difference-in-difference models with patients identified in the National Surgical Quality Improvement Program during the same period as a control cohort were used.</div></div><div><h3>Results</h3><div>A total of 205 patients underwent pancreatoduodenectomy, 127 in the preimplementation period and 78 in the postimplementation period. Of the 78 pancreatoduodenectomies performed in the postimplementation period, 62 (79.5%) were performed robotically with a conversion rate of 19.4%. Compared with the preimplementation cohort, the postimplementation cohort had similar complication and mortality rates but shorter median length of stay (5 days vs 8 days, <em>P</em> &lt; .0001). On difference-in-difference analyses, the institutional cohort was associated with an increase in robotic use after program implementation (+74.8%, <em>P</em> &lt; .001) compared with the National Surgical Quality Improvement Program control cohort. The institutional cohort was also associated with fewer pancreatic fistulas (−12.3%, <em>P</em> = .02), shorter length of stay (−2.0 days, <em>P</em> &lt; .001), and similar 30-day major morbidity (−9.3%, <em>P</em> = .14) and readmission (+7.3%, <em>P</em> = .13), as well as mortality rates (−1.7%, <em>P</em> = .45) after program implementation.</div></div><div><h3>Conclusion</h3><div>A robotic pancreatoduodenectomy program with a liberal patient selection and conversion strategy can be safely implemented while preserving overall outcomes compared with National Surgical Quality Improvement Program benchmarks.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110070"},"PeriodicalIF":2.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}