Surgery最新文献

{"title":"Factors associated with the feasibility and margin quality of sublobar resection for peripheral small-sized non–small cell lung cancer","authors":"Shusheng Zhu MM ,&nbsp;Zhihua Li MM ,&nbsp;Wenzheng Xu MD ,&nbsp;Zhicheng He MD ,&nbsp;Liang Chen MD ,&nbsp;Weibing Wu MD","doi":"10.1016/j.surg.2025.110080","DOIUrl":"10.1016/j.surg.2025.110080","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to identify factors associated with the feasibility and margin quality of sublobar resection for peripheral small-sized non–small cell lung cancer (NSCLC).</div></div><div><h3>Methods</h3><div>Patients with peripheral small-sized non–small cell lung cancer (≤2 cm) who underwent sublobar resection or lobectomy between 2020 and 2023 were screened. Surgical procedures were determined through discussion under the guidance of 3-dimensional computed tomography bronchography and angiography. A surgical margin equal to or larger than the maximum tumor diameter was considered sufficient. Logistic regression analyses were used to screen factors associated with the feasibility and margin quality of sublobar resection. Predictive nomograms were developed for segmentectomy and wedge based on independent factors, respectively.</div></div><div><h3>Results</h3><div>There were 383 (51.3%), 286 (38.3%), and 78 patients (10.4%) undergoing wedge resection, segmentectomy, and lobectomy, respectively. The likelihood of achieving sufficient margins was 90.9% for segmentectomy and 74.4% for wedge resection. Overall, 545 of 747 patients (73.0%) received sublobar resection with sufficient margins. The multivariable logistic regression analysis (segmentectomy with insufficient margins or lobectomy = 1, segmentectomy with sufficient margins = 0) showed that tumor size, radiologic types, located lobes, tumor-to-segmental bronchus distance, and subsegmental attribution were significantly associated with the feasibility and margin quality of segmentectomy. For wedge resection, tumor size and Lewis types were significantly associated with its feasibility or margin quality. The predictive models exhibited good performance, with an area under the curve of 0.821 for segmentectomy and 0.765 for wedge resection.</div></div><div><h3>Conclusion</h3><div>Tumor size, radiologic types, located lobe, tumor-to-segmental bronchus distance, Lewis types, and subsegmental attribution types were associated with the feasibility and margin quality of sublobar resection.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110080"},"PeriodicalIF":2.7,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047059","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":"External validation of prognostic multivariable risk models for surgical site infections after open lower extremity revascularization for peripheral arterial disease","authors":"Eden Singh BA ,&nbsp;Hana Shafique BS, BA ,&nbsp;Anish Karpurapu BS ,&nbsp;Christina Cui MD ,&nbsp;Young Kim MD ,&nbsp;Leila Mureebe MD, MPH ,&nbsp;Adam Johnson MD, MPH","doi":"10.1016/j.surg.2025.110077","DOIUrl":"10.1016/j.surg.2025.110077","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical site infections are common after open lower extremity revascularization for peripheral arterial disease, increasing morbidity, limb loss, mortality, and costs. Although universal bundles reduce surgical site infection rates, some prophylactic measures carry risks and costs, making targeted use in high-risk patients essential. Several multivariable prognostic models for surgical site infections after lower extremity revascularization exist, but few have undergone external validation.</div></div><div><h3>Methods</h3><div>We assessed 10 published surgical site infection risk models using 2 national registries: National Surgical Quality Improvement Program and Vascular Quality Initiative. Discrimination was evaluated with area under the receiver operating characteristic curve, and calibration with visual plots and expected calibration error, applying 200-fold bootstrapping for 95% confidence intervals. Sensitivity analyses examined severe surgical site infections and subgroup calibration.</div></div><div><h3>Results</h3><div>Ten models published between 2012 and 2024 were identified: 4 from single institutions, 5 from national registries, and 1 from an international prospective study. In the National Surgical Quality Improvement Program, 8.5% of 61,586 patients developed surgical site infections; in the Vascular Quality Initiative, 11.2% of 75,193 patients developed surgical site infections. Across all models and datasets, the area under the receiver operating characteristic curve ranged from 0.50 to 0.60, indicating poor discrimination. Wiseman, Eslami, and Gwilym models performed best for discrimination, whereas Wiseman, Xu, and Gwilym showed relatively better calibration by expected calibration error. Visual inspection revealed poor calibration overall, with most models underestimating risk in low-risk patients and overestimating risk in high-risk patients.</div></div><div><h3>Conclusion</h3><div>Existing surgical site infection risk models demonstrate inadequate discrimination and calibration on external validation, limiting clinical utility. Poor performance likely reflects differences in cohorts, outcome definitions, and missing variables. Transparent, interpretable reporting and rigorous, independent external validation are essential before clinical implementation.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110077"},"PeriodicalIF":2.7,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038968","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":"Operating room communication and teamwork: An observational pilot study comparing objective and perceived collaboration","authors":"Valerie L. Armstrong MD ,&nbsp;Patricia G. Lu MD ,&nbsp;Eleanor R. Johnson MD, MPH ,&nbsp;Richard D. Butterfield MA ,&nbsp;Anagha Deshpande MD ,&nbsp;Vikram S. Gill MD ,&nbsp;Yihuai Qu BS ,&nbsp;Sayi P. Boddu MS ,&nbsp;Dawn E. Peters MSW ,&nbsp;Julia A. Files MD ,&nbsp;Chee-Chee H. Stucky MD","doi":"10.1016/j.surg.2025.109719","DOIUrl":"10.1016/j.surg.2025.109719","url":null,"abstract":"<div><h3>Background</h3><div>Patient safety in the operating room requires effective teamwork and communication. The purpose of this observational pilot study is to identify trends and potential biases of perceived communication effectiveness and teamwork in the operating room, such that education and interventions can be provided for improved teamwork, patient safety, and workplace satisfaction.</div></div><div><h3>Methods</h3><div>Trained observers attended randomly assigned surgical cases over a 3-month period to analyze effectiveness of teamwork, communication, and leadership skills among surgeon, anesthesia, and circulating/scrub nurse teams and complete objective surveys. Subjective surveys were completed anonymously by every member of the team to gauge perceived teamwork, cooperation, and communication among those present. Results were analyzed using <em>t</em> test and analysis of variance.</div></div><div><h3>Results</h3><div>From 14 cases, 28 objective, and 97 subjective surveys were completed. There were no differences between objective and subjective impressions by respondent age, gender, role, or involvement. However, when the respondent and lead surgeon were the opposite gender, the surgeon was rated less favorably in all categories. Cases longer than 3 hours scored lower on all categories. Circulating/scrub staff scored greatest on completion of checklist items (<em>P</em> &lt; .0001) and communication (<em>P</em> &lt; .001) while surgeons scored highest on teamwork (<em>P</em> &lt; .0001) and leadership (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusion</h3><div>Gender and age were not factors leading to significant differences between subjective and objective evaluations; however, attending surgeon gender specifically and case duration were associated with subjective communication and teamwork scores. These results identify opportunities for education and training to reduce bias in the operating room.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 109719"},"PeriodicalIF":2.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038967","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":"Retrograde intraureteral injections of indocyanine green versus ureteral stents to reduce urinary tract complications during pelvic surgery: Systematic review and meta-analysis","authors":"Patrick E. Goldhawk-White BSc ,&nbsp;Kevin P. White MD, PhD ,&nbsp;Ceana Nezhat MD ,&nbsp;Fernando Dip MD ,&nbsp;Raul J. Rosenthal MD ,&nbsp;Steven D. Wexner MD, PhD","doi":"10.1016/j.surg.2025.110047","DOIUrl":"10.1016/j.surg.2025.110047","url":null,"abstract":"<div><h3>Introduction</h3><div>Failure to successfully delineate ureters during pelvic surgery carries significant risks. The ureters are the most commonly injured retroperitoneal structures, and ureteral injuries are associated with prolonged hospital stays, higher health care costs, and increased morbidity. In this meta-analysis, we compared the retrograde ureteral injection of indocyanine green and ureteral stents to visualize ureters and prevent ureteral injury and other urinary tract complications during pelvic surgery.</div></div><div><h3>Methods</h3><div>Thorough reviews of PubMed, Embase, and Scopus were conducted to identify all studies evaluating the efficacy of retrograde ureteral indocyanine green injections and/or ureteral stents for ureteral injury prevention. Strict inclusion criteria were applied, incorporating a Modified Downs and Black Assessment score. Because no studies comparing these 2 approaches directly were identified, indirect comparisons were performed contrasting rates of successful stent or indocyanine green placement, ureteral injury, and urinary tract complications, including the Pearson χ² or Fisher exact test and odds ratios with 95% confidence intervals.</div></div><div><h3>Results</h3><div>Twenty and 17 studies were eligible for meta-analysis for stents and indocyanine green, encompassing 25,784 and 569 patients, respectively. All 1,009 ureters that were injected with indocyanine green were injected successfully versus the successful insertion of only 99.1% of the 5,202 ureteral stents for which this approach was reported (<em>P</em> = .001). Ureteral injuries and other urinary tract complications occurred in 0.18% and 2.16% of ICG patients versus 1.12% and 11.58% of stent patients (<em>P</em> = .02 and <em>P</em> &lt; .001), respectively.</div></div><div><h3>Conclusion</h3><div>Although direct comparisons remain necessary, evidence suggests that retrograde intraureteral injections of indocyanine green are at least as good at preventing ureteral injury as stents, with a much lower rate of other urinary tract complications.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110047"},"PeriodicalIF":2.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030959","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":"Fluorescence imaging with indocyanine green during breast cancer surgery and postmastectomy breast reconstruction: A double systematic review and cost analysis","authors":"Patrick Goldhawk-White BSc ,&nbsp;Kevin P. White MD, PhD ,&nbsp;Annemiek Doeksen MD, PhD ,&nbsp;Ciara McGoldrick MD ,&nbsp;Peter C. Neligan MD, FRCS(I), FRCSC ,&nbsp;Martin I. Newman MD ,&nbsp;Vassilis Pitsinis MD, FRCS(Eng), FEBS(Breast), PhD ,&nbsp;Rutger M. Schols MD, PhD","doi":"10.1016/j.surg.2025.110052","DOIUrl":"10.1016/j.surg.2025.110052","url":null,"abstract":"<div><h3>Background</h3><div>Level I evidence argues that indocyanine green fluorescence imaging, used alone, is either noninferior or superior to current gold standards of technetium Tc 99m ± blue dye for detecting sentinel lymph nodes during breast cancer surgery. Extensive literature also shows that perfusion assessments using indocyanine green fluorescence angiography reduce the rates of perfusion-related complications, including flap necrosis and necessary reoperations during breast reconstruction after mastectomy. Our objective was to examine the relative costs of using indocyanine green fluorescence imaging for breast cancer resection and breast reconstruction.</div></div><div><h3>Methods</h3><div>A multidisciplinary team performed an extensive review of published literature spanning PubMed, EMBASE, and Scopus. Cost analysis was conducted for studies meeting stringent eligibility criteria that included the need for detailed data on both variable and fixed costs, both of the procedures and potential complications. Study quality was assessed using the modified Downs and Black Quality Assessment tool.</div></div><div><h3>Results</h3><div>Overall, 2,095 and 993 abstracts were screened for sentinel lymph node detection and postmastectomy breast reconstruction, respectively, leading to 5 studies with 1,484 indocyanine green fluorescence imaging patients and 1,697 control patients for sentinel lymph node detection and 5 studies with 1,446 indocyanine green fluorescence angiography patients and 1,339 control patients for breast reconstruction. For sentinel lymph node detection, per-patient savings using indocyanine green fluorescence imaging ranged from US $175 to US $1,241 (mean = US $474). For breast reconstruction, per-patient costs of indocyanine green fluorescence angiography ranged from a mean US $3 loss to US $1,160 savings (mean = US $553 saved).</div></div><div><h3>Conclusion</h3><div>Although further studies remain necessary, using indocyanine green fluorescence imaging during breast cancer surgery and breast reconstruction appears to appreciably lower costs, both by eliminating the need for technetium Tc 99m and by reducing perfusion-related complications.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110052"},"PeriodicalIF":2.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030902","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":"Cancer-specific mortality ratio: A new survival metric to assess the survival impact of colorectal cancer","authors":"Sameh Hany Emile MBBCh, MSc, MD, FACS ,&nbsp;Steven D. Wexner MD, PhD (Hon)","doi":"10.1016/j.surg.2025.110073","DOIUrl":"10.1016/j.surg.2025.110073","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110073"},"PeriodicalIF":2.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030937","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":"Associations between state gun policies and firearm-related deaths in the United States: A mixed-effects analysis from 2003 to 2022.","authors":"Melissa A Kendall, Emily A Grimsley, Rachel L Wolansky, Joseph Sujka, Paul C Kuo","doi":"10.1016/j.surg.2025.109911","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109911","url":null,"abstract":"<p><strong>Background: </strong>Firearm-related deaths are prevalent in the United States, with the second greatest total recorded in 2022. Data associating handgun policies with firearm-related crude death rates by all intentions and crude suicide rates remain inconclusive. We aimed to identify associations between handgun policies and crude death rates and crude suicide rates over time.</p><p><strong>Methods: </strong>We queried the Centers for Disease Control and Prevention database for adult crude death rates and crude suicide rates in the United States and the Research and Development Firearm Database to identify state-specific handgun policies. We analyzed data from 2003 to 2022 using 2 mixed-effects models: crude death rates and crude suicide rates. Linear and quadratic interaction terms captured changes in policy effectiveness over time. Robust standard errors accounted for heteroscedasticity, improving estimate reliability.</p><p><strong>Results: </strong>Safety training requirements reduced crude death rates by 29.0% (P < .01), followed by possession restrictions (12.2%; P < .01), registration requirements (8.9%; P < .05), and tracing requirements (6.1%; P < .05). Permit requirements reduced crude suicide rates by 15.9% (P < .05), followed by extreme risk protection orders (6.7%; P < .001), untraceable firearms restrictions 5.9%; P < .05), tracing requirements (4.3%; P < .05), and trafficking policies (4.2%; P < .05). Preemption of local policies increased crude suicide rates by 9.8% (P < .01). The effect of tracing requirements increased from 2003-2022 for both crude death rates (6.1% to 30.6%; P < .01) and crude suicide rates (4.3% to 22.5%; P < .05). The effect of preemption of select local policies initially weakened from 2003-2012, (+12.2% to +9.7%), then strengthened to +15.3% in 2022 (P < .01).</p><p><strong>Conclusion: </strong>Safety training, possession requirements, handgun registration, and tracing policies are associated with lower crude death rates. Permit requirements, extreme risk protection orders, untraceable firearm restrictions, tracing, and trafficking policies are associated with lower crude suicide rates. Implementation of these policies nationwide may reduce crude death rates and crude suicide rates.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109911"},"PeriodicalIF":2.7,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019682","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":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109953","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109953","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109953"},"PeriodicalIF":2.7,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019628","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":"Lateral laryngeal ultrasound for vocal cord evaluation in neck surgery: A mutually double-blind comparative study with laryngoscopy","authors":"Jung-Woo Woo MD ,&nbsp;Jun Ho Lee MD, PhD ,&nbsp;Han Shin Lee MD, PhD ,&nbsp;Hyunsuk Suh MD ,&nbsp;Eun Jung Jung MD, PhD","doi":"10.1016/j.surg.2025.110074","DOIUrl":"10.1016/j.surg.2025.110074","url":null,"abstract":"<div><h3>Background</h3><div>Vocal cord dysfunction is a significant complication after thyroid surgery, typically evaluated with invasive laryngoscopy. This study assessed diagnostic accuracy and feasibility of lateral laryngeal ultrasound as a noninvasive alternative.</div></div><div><h3>Methods</h3><div>In a prospective, double-blind study at Gyeongsang National University Changwon Hospital (February 2016 to June 2023), 718 patients underwent preoperative and postoperative vocal cord assessment using laryngoscopy and lateral laryngeal ultrasound. Both patients and assessors were blinded to the counterpart modality. Sensitivity, specificity, and visualization rates were analyzed.</div></div><div><h3>Results</h3><div>Lateral laryngeal ultrasound visualized vocal cords in 99.6% of cases (715/718), with 100% sensitivity and 99.5% specificity for detecting vocal cord paralysis compared with laryngoscopy. No adverse effects were reported.</div></div><div><h3>Conclusions</h3><div>Lateral laryngeal ultrasound is a reliable, noninvasive tool for perioperative vocal cord evaluation, offering a patient-friendly alternative that may reduce the need for laryngoscopy in thyroid surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110074"},"PeriodicalIF":2.7,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019633","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":"AI-driven prediction of completion time and errors in the Advanced Training in Laparoscopic Suturing (ATLAS) needle handling task: One step closer to automated surgical skill assessment","authors":"Huu Phong Nguyen PhD ,&nbsp;Sofia Garces-Palacios MD ,&nbsp;Darian Hoagland MD ,&nbsp;Nicole Wise MD ,&nbsp;Kailen Wong BS ,&nbsp;Sai Abhinav Pydimarry BS ,&nbsp;Sharanya Vunnava BS ,&nbsp;Daniel J. Scott MD ,&nbsp;Dmitry Nepomnayshy MD ,&nbsp;Ganesh Sankaranarayanan PhD","doi":"10.1016/j.surg.2025.110045","DOIUrl":"10.1016/j.surg.2025.110045","url":null,"abstract":"<div><h3>Background</h3><div>The Advanced Training in Laparoscopic Suturing is a proficiency-based curriculum of 6 structured tasks. In the needle handling task, participants maneuver a needle through 6 standardized holes on a circular platform. Performance (completion time and errors) is currently evaluated in person or through manual video review. This study explored the potential of artificial intelligence models to automate the assessment of this task by predicting task duration and detecting needle drop errors.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of Advanced Training in Laparoscopic Suturing needle handling task videos collected from 2 tertiary centers. Two complementary artificial intelligence models were developed. First, videos were annotated across 10 distinct phases. A deep expandable three-dimensional convolutional network combined with hybrid adaptive k-nearest neighbors and smoothed moving average and exponential moving average was trained for phase segmentation and duration prediction. Second, a vision transformer model was trained to detect needle drop errors by classifying frame segments based on needle visibility.</div></div><div><h3>Results</h3><div>Phase segmentation accuracy improved from 82.06% ± 0.84% to 89.67% ± 1.27%, with the highest accuracy reaching 90.56% and an F1-score of 86.90% using the hybrid k-nearest neighbors and smoothed moving average model. The predicted task duration error had a mean error of 0.84%. The vision transformer model achieved a 95.16% classification accuracy on validation frames and detected 66.6% of needle drops &gt;2 seconds and 63.6% of needle drops &gt;5 seconds in test videos.</div></div><div><h3>Conclusion</h3><div>Artificial intelligence–based models exhibited high and moderate accuracy for task duration prediction and needle drop error, respectively, offering scalable solutions for objective surgical assessments.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110045"},"PeriodicalIF":2.7,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980613","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}