Surgery最新文献_第2页

The surgeon advocate's role in shaping state and federal policy 外科医生倡导者在制定州和联邦政策中的作用

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-01-16 DOI: 10.1016/j.surg.2025.110068

Ross F. Goldberg MD

Although most surgeons dedicate their careers to clinical excellence, education, and research, many overlook a critical fourth pillar of the profession, advocacy. Surgeons already advocate daily, whether guiding patients through care plans, performing technically complex operations, or navigating insurance barriers. However, few recognize their potential to influence broader health policies that directly affect their surgical practices. This article emphasizes the urgent need for surgeons to engage in both legislative and regulatory processes. Policy decisions, ranging from scope of practice laws to Medicare reimbursement rates, have profound and often immediate impacts on how surgeons deliver care. Although surgeons may be familiar with legislative processes, many underestimate the influence of regulatory bodies such as the Centers for Medicare & Medicaid Services, Food and Drug Administration, and state health departments. These agencies interpret and implement laws, often through unilateral decisions, without direct votes and with minimal physician input. Surgeons are often absent from critical discussions at both state and federal levels, allowing other stakeholders such as the insurers, hospitals, and device manufacturers to shape the narrative and outcome. To counteract this, surgeons must proactively engage with legislators, build long-term relationships, support political action efforts, and participate in organized medicine. These steps do not require holding office or mastering policy intricacies but just consistent, informed involvement. Advocacy is a professional responsibility, an extension of surgical leadership that goes beyond the operating room. By becoming more engaged, surgeons can protect the integrity of their practice, ensure patients maintain access to high-quality surgical care, and shape a health care system that values expertise and evidence-based care. The call to action is clear; if surgeons want a seat at the decision-making table, they must claim it. The scalpel may heal patients, but the pen shapes the system, and both are needed to lead the future of surgery.

尽管大多数外科医生将他们的职业生涯奉献给了临床卓越、教育和研究，但许多人忽视了这个职业的第四个关键支柱——倡导。外科医生每天都在倡导，无论是指导病人完成护理计划，执行技术复杂的手术，还是克服保险障碍。然而，很少有人认识到他们影响直接影响其手术实践的更广泛的卫生政策的潜力。这篇文章强调外科医生迫切需要参与立法和监管程序。政策决定，从执业法律范围到医疗保险报销率，对外科医生如何提供护理有着深远的、往往是直接的影响。尽管外科医生可能熟悉立法程序，但许多人低估了监管机构的影响，如医疗保险和医疗补助服务中心、食品和药物管理局以及州卫生部门。这些机构往往通过单方面决定来解释和实施法律，没有直接投票，医生的投入也很少。外科医生经常缺席州和联邦层面的关键讨论，允许其他利益相关者，如保险公司、医院和设备制造商来塑造叙述和结果。为了应对这种情况，外科医生必须主动与立法者接触，建立长期关系，支持政治行动努力，并参与有组织的医学。这些步骤不需要掌权或掌握错综复杂的政策，只需要始终如一、知情地参与。倡导是一种职业责任，是外科领导的延伸，超越了手术室。通过更多地参与，外科医生可以保护其执业的完整性，确保患者能够获得高质量的外科护理，并塑造一个重视专业知识和循证护理的卫生保健系统。行动的呼吁是明确的；如果外科医生想要在决策桌上占有一席之地，他们必须提出要求。手术刀可以治愈病人，但笔塑造了系统，这两者都需要引领外科手术的未来。

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引用次数: 0

Tabular foundation models as a new portable standard in local surgical risk prediction 表格基础模型作为局部手术风险预测的便携式新标准。

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-02-09 DOI: 10.1016/j.surg.2025.110078

Chris Varghese MBChB, BMedSc(Hons) , Elizabeth Habermann PhD , Kristine Hanson MPH , Ashok Choudhary PhD , Hojjat Salehinejad PhD , Cornelius Thiels DO, MBA

Introduction

Surgical risk is locality-specific, and database infrastructure to support accurate preoperative risk stratification is limited globally. Recently, foundation models for risk prediction trained on large corpus of synthetic data that are ready for domain-specific applications have emerged. We aimed to evaluate the role of a tabular foundation model in widening access to high-accuracy local risk stratification in emergency surgery.

Methods

We applied a transformer-based tabular pretrained foundation model with comparison to logistic regression and gradient boosting methods in our institutional data from the American College of Surgeons National Surgical Quality Improvement Program database of patients undergoing emergency surgery. We first compared performance overall, then at individual sites (n = 5), followed by comparison of the tabular prior-data fitted network model trained on site-level data against logistic regression and XGBoost models trained on all available multisite data not used for testing. Outcomes of interest were 30-day mortality and morbidity.

Results

Among 7,281 emergency surgery patients (4.8% mortality, 30.2% morbidity), tabular prior-data fitted network achieved the highest area under the receiver operating characteristic curve (0.82, 95% confidence interval 0.81–0.83, for morbidity; 0.89, 95% confidence interval 0.89–0.90, for mortality) and under the precision-recall curve (0.68, 95% confidence interval 0.66–0.7, for morbidity; 0.35, 95% confidence interval 0.29–0.39, for mortality), and best calibration (Brier score 0.15 for morbidity and 0.04 for mortality) compared with logistic regression and XGBoost models. The tabular prior-data fitted network's excellent performance persisted in smaller site-specific cohorts. A tabular prior-data fitted network model trained only on a single site's data performed comparable to logistic regression and XGBoost models trained on all available multisite data (P < .4).

Conclusions

Access to high-performance surgical risk stratification can be improved through a tabular foundation model. This portable approach offers flexibility to missing data, and strong comparative performance in smaller data sets.

手术风险是局部特异性的，支持准确术前风险分层的数据库基础设施在全球范围内是有限的。最近，针对特定领域应用的大型合成数据语料库进行风险预测训练的基础模型已经出现。我们的目的是评估表格基础模型在急诊手术中扩大获得高精度局部风险分层的作用。方法：我们采用基于变压器的表格预训练基础模型，并对来自美国外科医师学会国家外科质量改进计划数据库的急诊手术患者的机构数据进行了逻辑回归和梯度增强方法的比较。我们首先比较了整体性能，然后在单个站点（n = 5）进行了比较，然后比较了在站点级数据上训练的表格先验数据拟合网络模型与逻辑回归和在所有可用的未用于测试的多站点数据上训练的XGBoost模型。感兴趣的结局是30天死亡率和发病率。结果：在7281例急诊手术患者（死亡率4.8%，发病率30.2%）中，表格式先验数据拟合网络在患者工作特征曲线下（发病率0.82,95%置信区间0.81-0.83；死亡率0.89,95%置信区间0.89-0.90）和精确召回曲线下（发病率0.68,95%置信区间0.66-0.7；死亡率0.89,95%置信区间0.89-0.90）的面积最大。0.35, 95%置信区间0.29-0.39，死亡率)，与logistic回归和XGBoost模型相比，最佳校准（发病率Brier评分0.15，死亡率0.04）。表格先验数据拟合网络的优异性能在较小的特定地点队列中持续存在。仅在单个站点数据上训练的表格式先验数据拟合网络模型的表现与在所有可用的多站点数据上训练的逻辑回归和XGBoost模型相当（P < .4）。结论：通过表格式基础模型可以提高手术风险分层的可及性。这种可移植的方法为丢失数据提供了灵活性，并且在较小的数据集中具有很强的比较性能。

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引用次数: 0

The impact of frailty on postoperative outcomes of veterans with stage I non–small cell lung cancer 虚弱对I期非小细胞肺癌退伍军人术后预后的影响。

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-02-11 DOI: 10.1016/j.surg.2026.110089

Nahom Seyoum MD , Steven Tohmasi MD, MPHS , Daniel B. Eaton Jr. MPH , Tullis Liu BS , Nikki E. Rossetti MD, MPHS, MSc , Martin W. Schoen MD, MPH , Theodore S. Thomas MD, MPHS , Su-Hsin Chang PhD, SM , Yan Yan MD, PhD , Mayank R. Patel MD , Ana A. Baumann PhD , Whitney S. Brandt MD , Daniel Kreisel MD , Bryan F. Meyers MD, MPH , Benjamin D. Kozower MD, MPH , Brendan T. Heiden MD, MPHS , Varun Puri MD, MSCI

Background

Although surgical resection is the standard of care for early-stage non–small cell lung cancer, frailty influences treatment decisions. We evaluated the prognostic utility of the Veterans Affairs Frailty Index, a claims-based assessment tool, among veterans undergoing resection for stage I non–small cell lung cancer.

Methods

We conducted a retrospective cohort study of veterans who underwent curative-intent surgery for stage I non–small cell lung cancer in the Veterans Health Administration from 2006 to 2020. Using the Veterans Affairs Frailty Index, frailty was categorized as follows: nonfrail (≤0.1), prefrail (0.1–0.2), mildly frail (0.2–0.3), moderately frail (0.3–0.4), and severely frail (>0.4). The primary outcome was overall survival, assessed using multivariable Cox regression. Secondary outcomes included major complications, prolonged hospitalization, 30-day readmission, 90-day mortality, and recurrence.

Results

Among 12,271 veterans, 7.7% were severely frail. Compared with nonfrail patients, severely frail patients were older (mean age 70.3 years vs 64.7 years; P < .001) and were more likely to undergo minimally invasive surgery (57.7% vs 37.8%) and sublobar resection (41.2% vs 22.3%) (all P < .001). Severe frailty was independently associated with higher risk of major complications (adjusted odds ratio 2.85, 95% confidence interval 2.18–3.71), prolonged hospitalization (adjusted odds ratio 2.67), 30-day readmission (adjusted odds ratio 1.76), 90-day mortality (adjusted odds ratio 2.87), and worse overall survival (adjusted hazard ratio 2.20, 95% confidence interval 1.97–2.46; all P < .001). Recurrence was not significantly associated with frailty (adjusted hazard ratio 0.87; P = .410).

Conclusion

Frailty, as measured by the Veterans Affairs Frailty Index, independently predicts adverse postoperative and survival outcomes following resection for stage I non–small cell lung cancer. Preoperative frailty assessment may improve risk stratification and guide surgical decision making.

背景：虽然手术切除是早期非小细胞肺癌的标准治疗方法，但虚弱会影响治疗决策。我们评估了退伍军人事务衰弱指数（一种基于索赔的评估工具）在接受I期非小细胞肺癌切除术的退伍军人中的预后效用。方法：我们对2006年至2020年在退伍军人健康管理局接受I期非小细胞肺癌治疗目的手术的退伍军人进行了回顾性队列研究。根据退伍军人事务衰弱指数，将衰弱分为：非衰弱（≤0.1）、预衰弱（0.1-0.2）、轻度衰弱（0.2-0.3）、中度衰弱（0.3-0.4）和重度衰弱（>0.4）。主要终点是总生存率，采用多变量Cox回归进行评估。次要结局包括主要并发症、延长住院时间、30天再入院、90天死亡率和复发。结果：12271名退伍军人中，重度虚弱者占7.7%。与非虚弱患者相比，严重虚弱患者年龄更大（平均年龄70.3岁比64.7岁，P < 0.001），更容易接受微创手术（57.7%比37.8%）和叶下切除术（41.2%比22.3%）（均P < 0.001）。严重虚弱与较高的主要并发症风险（校正优势比2.85,95%可信区间2.18-3.71）、住院时间延长（校正优势比2.67）、30天再入院（校正优势比1.76）、90天死亡率（校正优势比2.87）和较差的总生存率（校正风险比2.20,95%可信区间1.97-2.46，均P < 0.001）独立相关。复发与虚弱无显著相关性（校正风险比0.87;P = 0.410）。结论：虚弱，由退伍军人事务虚弱指数衡量，独立预测I期非小细胞肺癌切除术后的不良术后和生存结果。术前虚弱评估可以改善风险分层和指导手术决策。

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引用次数: 0

Clinical outcomes of completing total pancreatectomy for isolated recurrence of pancreatic ductal adenocarcinoma in the remnant pancreas after initial pancreatectomy 首次胰腺切除术后残余胰腺孤立性胰管腺癌复发的全胰切除术的临床结果。

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-02-11 DOI: 10.1016/j.surg.2026.110088

Yejong Park MD, PhD , Dae Wook Hwang MD, PhD , Jae Hoon Lee MD, PhD , Ki Byung Song MD, PhD , Eunsung Jun MD, PhD , Woohyung Lee MD, PhD , Song Cheol Kim MD, PhD

Background

This study evaluated the clinical features of patients with isolated recurrence of pancreatic ductal adenocarcinoma in the remnant pancreas after initial pancreatectomy. It specifically analyzed the postoperative and oncologic outcomes of patients who underwent completion total pancreatectomy to identify prognostic factors associated with 5-year survival.

Methods

A retrospective review was conducted on 93 patients with isolated recurrence of pancreatic ductal adenocarcinoma in the remnant pancreas after initial pancreatectomy between 2009 and 2020. Of these, 59 patients underwent completion total pancreatectomy, and 34 did not undergo completion total pancreatectomy. Clinicopathologic factors and overall survival were analyzed based on completion total pancreatectomy status.

Results

The 5-year overall survival after initial pancreatectomy for pancreatic ductal adenocarcinoma was 22.3% in the patients who did not undergo completion total pancreatectomy, with a median survival of 32.8 months. In contrast, patients who underwent completion total pancreatectomy exhibited a 5-year overall survival of 61.7% and a median survival of 91.2 months (P < .001). Among patients with early recurrence, those who underwent completion total pancreatectomy exhibited a median survival of 33.5 months. In contrast, patients with late recurrence showed a median survival of 104.2 months. Early recurrence after pancreatectomy was identified as a significant poor prognostic factor for survival (hazard ratio 6.684, 95% confidence interval 2.474–18.062, P < .001), along with tumor size >4 cm and elevated carcinoembryonic antigen levels.

Conclusion

In the remnant pancreas, completion total pancreatectomy for isolated recurrence of pancreatic ductal adenocarcinoma may offer favorable oncologic outcomes in carefully selected patients—particularly patients with recurrence after 1 year, tumor size <4 cm, and stable tumor marker levels.

背景：本研究评估残胰腺初始切除术后孤立性胰腺导管腺癌复发患者的临床特征。该研究特别分析了完成全胰腺切除术患者的术后和肿瘤预后，以确定与5年生存率相关的预后因素。方法：回顾性分析2009年至2020年93例首次胰腺切除术后残余胰腺孤立性胰腺导管腺癌复发的病例。其中59例患者行完全全胰切除术，34例未行完全全胰切除术。根据全胰切除术的完成情况，分析临床病理因素和总生存率。结果：未行完全全胰切除术的胰管腺癌患者初始胰切除术后的5年总生存率为22.3%，中位生存期为32.8个月。相比之下，完成全胰腺切除术的患者的5年总生存率为61.7%，中位生存期为91.2个月（P < 0.001）。在早期复发的患者中，完成全胰腺切除术的患者中位生存期为33.5个月。而晚期复发患者的中位生存期为104.2个月。胰腺切除术后早期复发被认为是影响生存的重要不良因素（风险比6.684,95%可信区间2.474-18.062,P < 0.001），肿瘤大小bbbb4 cm和癌胚抗原水平升高也是影响生存的重要因素。结论：在残胰腺中，完全全胰腺切除术治疗孤立性胰腺导管腺癌复发可能对精心挑选的患者有良好的肿瘤预后，特别是1年后复发的患者，肿瘤大小

{"title":"Clinical outcomes of completing total pancreatectomy for isolated recurrence of pancreatic ductal adenocarcinoma in the remnant pancreas after initial pancreatectomy","authors":"Yejong Park MD, PhD , Dae Wook Hwang MD, PhD , Jae Hoon Lee MD, PhD , Ki Byung Song MD, PhD , Eunsung Jun MD, PhD , Woohyung Lee MD, PhD , Song Cheol Kim MD, PhD","doi":"10.1016/j.surg.2026.110088","DOIUrl":"10.1016/j.surg.2026.110088","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated the clinical features of patients with isolated recurrence of pancreatic ductal adenocarcinoma in the remnant pancreas after initial pancreatectomy. It specifically analyzed the postoperative and oncologic outcomes of patients who underwent completion total pancreatectomy to identify prognostic factors associated with 5-year survival.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 93 patients with isolated recurrence of pancreatic ductal adenocarcinoma in the remnant pancreas after initial pancreatectomy between 2009 and 2020. Of these, 59 patients underwent completion total pancreatectomy, and 34 did not undergo completion total pancreatectomy. Clinicopathologic factors and overall survival were analyzed based on completion total pancreatectomy status.</div></div><div><h3>Results</h3><div>The 5-year overall survival after initial pancreatectomy for pancreatic ductal adenocarcinoma was 22.3% in the patients who did not undergo completion total pancreatectomy, with a median survival of 32.8 months. In contrast, patients who underwent completion total pancreatectomy exhibited a 5-year overall survival of 61.7% and a median survival of 91.2 months (<em>P</em> < .001). Among patients with early recurrence, those who underwent completion total pancreatectomy exhibited a median survival of 33.5 months. In contrast, patients with late recurrence showed a median survival of 104.2 months. Early recurrence after pancreatectomy was identified as a significant poor prognostic factor for survival (hazard ratio 6.684, 95% confidence interval 2.474–18.062, <em>P</em> < .001), along with tumor size >4 cm and elevated carcinoembryonic antigen levels.</div></div><div><h3>Conclusion</h3><div>In the remnant pancreas, completion total pancreatectomy for isolated recurrence of pancreatic ductal adenocarcinoma may offer favorable oncologic outcomes in carefully selected patients—particularly patients with recurrence after 1 year, tumor size <4 cm, and stable tumor marker levels.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110088"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182463","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}

引用次数: 0

A missed opportunity to discuss treatment costs? A qualitative analysis of preoperative conversations about thyroid cancer treatment 错过了讨论治疗费用的机会？甲状腺癌治疗术前对话的定性分析

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-01-29 DOI: 10.1016/j.surg.2025.110075

Emily V. Crowley MS , Catherine B. Jensen MD, MSc , Elizabeth M. Bacon MPH , Benjamin C. James MD, MS , Susan C. Pitt MD, MPHS

引用次数: 0

Integration of spatiotemporal features into machine learning assessment of open surgical skills 将时空特征整合到开放手术技能的机器学习评估中

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-01-28 DOI: 10.1016/j.surg.2025.110079

Armin Alipour MS , Jeffrey Balian BS , Kevin Tabibian BS , Oh Jin Kwon MD , Nguyen Le MS , Areti Tillou MD , Peyman Benharash MD

Introduction

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.

Methods

This study used the AIxSuture data set. A global rating score was assigned for each video, categorizing individuals into novice (n = 119), intermediate (n = 79), and proficient (n = 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.

Results

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.

Conclusions

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.

准确和客观的手术技能评估对于改善培训模式、患者安全和手术质量至关重要。机器学习的进步促进了微创手术和机器人手术的自动评估。本研究旨在开发一种新的机器学习模型来评估开放手术的熟练程度。方法本研究采用AIxSuture数据集。为每个视频分配一个全局评分，将个人分为新手（n = 119），中级（n = 79）和精通（n = 116）班。采用混合卷积神经网络和长短期记忆网络对视频分类器模型进行训练。利用图像分类模型ResNet50作为空间特征提取器进行非线性变换。长短期记忆网络选择性地保留和丢弃捕捉受试者运动的帧集中的重要和不重要的变化。测量班级一级F1分数以评估和声性能。结果我们的评估在确定每个受试者的表现水平方面的平均F1得分为80.1%，优于以往的模型。此外，该模型对新手组的分类准确率为90.1%，中级组为65.7%，熟练组为86.3%。尽管在中级类别中准确率较低，但该指标在该组中比其他模型高出近10%。目前的模型在10.2±0.4秒内将每个视频分类为适当的技能水平。结论我们的机器学习模型为开放性手术的技能评估提供了可靠的框架。应该考虑在临床实践中应用机器学习来评估外科医生的技能，并帮助改善培训和结果。

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引用次数: 0

Retrograde intraureteral injections of indocyanine green versus ureteral stents to reduce urinary tract complications during pelvic surgery: Systematic review and meta-analysis 盆腔手术中逆行静脉注射吲哚菁绿与输尿管支架减少尿路并发症：系统回顾和荟萃分析

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-01-21 DOI: 10.1016/j.surg.2025.110047

Patrick E. Goldhawk-White BSc , Kevin P. White MD, PhD , Ceana Nezhat MD , Fernando Dip MD , Raul J. Rosenthal MD , Steven D. Wexner MD, PhD

Introduction

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.

Methods

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.

Results

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 (P = .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 (P = .02 and P < .001), respectively.

Conclusion

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.

导读：盆腔手术中输尿管的描绘失败会带来很大的风险。输尿管是最常见的腹膜后结构损伤，输尿管损伤与住院时间延长、医疗费用增加和发病率增加有关。在这项荟萃分析中，我们比较了输尿管逆行输尿管注射吲哚菁绿和输尿管支架在盆腔手术中观察输尿管并预防输尿管损伤和其他尿路并发症。方法：对PubMed、Embase和Scopus进行了全面的回顾，以确定所有评估逆行输尿管吲哚青绿注射和/或输尿管支架预防输尿管损伤疗效的研究。采用了严格的纳入标准，包括修改的Downs和Black评估分数。由于没有直接比较这两种方法的研究，因此进行了间接比较，比较支架或吲哚菁绿放置成功率、输尿管损伤和尿路并发症，包括Pearson χ2或Fisher精确检验和95%置信区间的优势比。结果：20项和17项研究符合支架和吲哚菁绿的荟萃分析，分别包括25,784例和569例患者。所有1009条输尿管注射吲哚菁绿均成功，而采用该方法的5202条输尿管支架中，只有99.1%的输尿管支架置入成功（P = 0.001）。ICG组输尿管损伤及其他尿路并发症发生率分别为0.18%和2.16%，支架组为1.12%和11.58% （P = 0.02和P < 0.001）。结论：虽然直接比较仍然是必要的，但有证据表明，逆行静脉注射吲哚菁绿在预防输尿管损伤方面至少与支架一样好，而且其他尿路并发症的发生率要低得多。

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引用次数: 0

Preperitoneal enhanced-view totally extraperitoneal (PeTEP) technique in midline and lateral incisional hernia repair: Early multicenter outcomes 腹膜前全腹膜外增强（PeTEP）技术在中线和外侧切口疝修补中的早期多中心结果

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-01-08 DOI: 10.1016/j.surg.2025.110041

Joaquín M. Munoz-Rodriguez MD, PhD, FACS , Laura Román García de León MD , Álvaro Robin Valle De Lersundi MD, PhD , Luis A. Blazquez-Hernando MD, PhD , Manuel Medina Pedrique MD , Celia Fidalgo Martínez MD , Marcello De Luca MD , José Luis Lucena de la Poza MD, PhD , Miguel A. Garcia-Urena MD, PhD, FACS , Javier Lopez-Monclus MD, PhD, FACS

Background

Minimally invasive options for incisional hernia repair have expanded, yet data on preperitoneal enhanced-view totally extraperitoneal approaches for incisional hernias are limited. We aimed to evaluate safety, feasibility, and early outcomes of the preperitoneal enhanced-view totally extraperitoneal approach via cranial, caudal, and midline access in midline and lateral incisional hernias.

Methods

We performed a multicenter retrospective cohort study across 2 university hospitals (January 2024–June 2025). Patients with midline or lateral incisional hernias undergoing a preperitoneal enhanced-view totally extraperitoneal approach were included; primary hernias and loss-of-domain cases were excluded. Perioperative management was standardized. The primary end point was recurrence; secondary end points included surgical site occurrences, surgical site occurrences requiring procedural intervention, mesh infection, bulging, chronic pain, operative time, and length of stay.

Results

We analyzed 60 incisional hernia repairs (58.3% men; age 65.1 ± 12.2 years; body mass index 28.7 ± 4.2 kg/m²; obesity 35%). Defects were midline in 81.7% and lateral in 18.3%; most were European Hernia Society W2 classification. Access was cranial in 76.7%, midline 13.3%, and caudal in 10.0%. Three procedures required intraoperative conversion to enhanced-view totally extraperitoneal approach due to peritoneal fragility; no conversions to open surgery occurred. Fascial closure was achieved in all cases; a tailored preperitoneal mesh (mean area 544.6 ± 272 cm²) was placed without fixation. Mean operative time was 163 ± 66 minutes; length of stay was 1.28 ± 0.7 days. Surgical site occurrence rate was 6.6% (2 superficial hematomas, 2 asymptomatic seromas), with no surgical site infections or surgical site occurrences requiring procedural interventions. At 8.12 ± 3.92 months' follow-up, there were no recurrences, mesh infections, chronic seromas, or chronic pain.

Conclusions

The preperitoneal enhanced-view totally extraperitoneal approach appears to be a feasible and safe minimally invasive option for midline and lateral incisional hernia repair, enabling broad anatomic applicability with low short-term morbidity and no early recurrences. Prospective studies with long-term follow-up are needed to validate its long-term efficacy.

背景：切口疝修补的微创选择已经扩大，但腹膜前增强视野完全腹膜外入路治疗切口疝的数据有限。我们的目的是评估经颅、尾和中线入路的腹膜前增强视野完全腹膜外入路治疗中线和外侧切口疝的安全性、可行性和早期结果。方法我们在两所大学医院（2024年1月- 2025年6月）进行了一项多中心回顾性队列研究。中线或外侧切口疝患者接受腹膜前增强视野完全腹膜外入路；排除原发性疝和区域丧失病例。围手术期管理规范化。主要终点为复发；次要终点包括手术部位发生、需要手术干预的手术部位发生、补片感染、肿胀、慢性疼痛、手术时间和住院时间。结果分析60例切口疝修补手术，男性58.3%，年龄65.1±12.2岁，体重指数28.7±4.2 kg/m2，肥胖35%。中线缺损占81.7%，外侧缺损占18.3%；多数为欧洲疝学会W2分类。颅内通路占76.7%，中线通路占13.3%，尾侧通路占10.0%。由于腹膜脆弱，有3例手术需要术中转为全腹膜外透视入路；未发生转开手术。所有病例均实现筋膜闭合；量身定制的腹膜前补片（平均面积544.6±272 cm2）不固定放置。平均手术时间163±66分钟；住院时间为1.28±0.7 d。手术部位发生率为6.6%（2例浅表血肿，2例无症状血清肿），无手术部位感染或手术部位发生需要手术干预。随访8.12±3.92个月，无复发、网状物感染、慢性血清肿、慢性疼痛。结论腹膜前增强视野全腹膜外入路是中线和外侧切口疝修补的一种安全可行的微创方法，解剖适用性广，短期发病率低，无早期复发。需要长期随访的前瞻性研究来验证其长期疗效。

{"title":"Preperitoneal enhanced-view totally extraperitoneal (PeTEP) technique in midline and lateral incisional hernia repair: Early multicenter outcomes","authors":"Joaquín M. Munoz-Rodriguez MD, PhD, FACS , Laura Román García de León MD , Álvaro Robin Valle De Lersundi MD, PhD , Luis A. Blazquez-Hernando MD, PhD , Manuel Medina Pedrique MD , Celia Fidalgo Martínez MD , Marcello De Luca MD , José Luis Lucena de la Poza MD, PhD , Miguel A. Garcia-Urena MD, PhD, FACS , Javier Lopez-Monclus MD, PhD, FACS","doi":"10.1016/j.surg.2025.110041","DOIUrl":"10.1016/j.surg.2025.110041","url":null,"abstract":"<div><h3>Background</h3><div>Minimally invasive options for incisional hernia repair have expanded, yet data on preperitoneal enhanced-view totally extraperitoneal approaches for incisional hernias are limited. We aimed to evaluate safety, feasibility, and early outcomes of the preperitoneal enhanced-view totally extraperitoneal approach via cranial, caudal, and midline access in midline and lateral incisional hernias.</div></div><div><h3>Methods</h3><div>We performed a multicenter retrospective cohort study across 2 university hospitals (January 2024–June 2025). Patients with midline or lateral incisional hernias undergoing a preperitoneal enhanced-view totally extraperitoneal approach were included; primary hernias and loss-of-domain cases were excluded. Perioperative management was standardized. The primary end point was recurrence; secondary end points included surgical site occurrences, surgical site occurrences requiring procedural intervention, mesh infection, bulging, chronic pain, operative time, and length of stay.</div></div><div><h3>Results</h3><div>We analyzed 60 incisional hernia repairs (58.3% men; age 65.1 ± 12.2 years; body mass index 28.7 ± 4.2 kg/m<sup>2</sup>; obesity 35%). Defects were midline in 81.7% and lateral in 18.3%; most were European Hernia Society W2 classification. Access was cranial in 76.7%, midline 13.3%, and caudal in 10.0%. Three procedures required intraoperative conversion to enhanced-view totally extraperitoneal approach due to peritoneal fragility; no conversions to open surgery occurred. Fascial closure was achieved in all cases; a tailored preperitoneal mesh (mean area 544.6 ± 272 cm<sup>2</sup>) was placed without fixation. Mean operative time was 163 ± 66 minutes; length of stay was 1.28 ± 0.7 days. Surgical site occurrence rate was 6.6% (2 superficial hematomas, 2 asymptomatic seromas), with no surgical site infections or surgical site occurrences requiring procedural interventions. At 8.12 ± 3.92 months' follow-up, there were no recurrences, mesh infections, chronic seromas, or chronic pain.</div></div><div><h3>Conclusions</h3><div>The preperitoneal enhanced-view totally extraperitoneal approach appears to be a feasible and safe minimally invasive option for midline and lateral incisional hernia repair, enabling broad anatomic applicability with low short-term morbidity and no early recurrences. Prospective studies with long-term follow-up are needed to validate its long-term efficacy.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110041"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941430","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}

引用次数: 0

Drivers and composition of hospitalization costs in patients undergoing laparoscopic tension-free hiatal hernia repair: A quantile regression study 腹腔镜无张力裂孔疝修补术患者住院费用的驱动因素和构成：一项分位数回归研究

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-01-08 DOI: 10.1016/j.surg.2025.110036

Xiaoli Liu MD, Qiuyue Ma PhD, Haiyun Li BS, Minxian Zhao BS, Yingmo Shen MD, Huiqi Yang MD

Background

Laparoscopic tension-free repair has become the standard surgical treatment for hiatal hernia because of its favorable clinical outcomes. However, the associated hospitalization costs vary considerably, driven by both patient complexity and technical factors. This study aimed to analyze the drivers and composition of hospitalization costs in patients undergoing laparoscopic tension-free hiatal hernia repair using a quantile regression approach.

Methods

A retrospective observational study was conducted among patients who underwent laparoscopic tension-free hiatal hernia repair at Beijing Chao-Yang Hospital, Capital Medical University, between 2020 and 2023. Clinical, demographic, and procedural data were extracted from electronic medical records. The primary outcome was total hospitalization cost; secondary outcomes included cost composition (diagnosis, treatment, nursing, medication, materials, and others) and postoperative recurrence. Quantile regression was used to identify factors associated with total hospitalization costs across the 10th–90th percentiles. Recurrence was examined using multivariable logistic regression.

Results

A total of 197 patients were included. Most were female (60.4%) and aged ≥65 years (54.8%). Material costs represented the largest share of total hospitalization expenses in every year (>58%). In quantile regression, mesh fixation with absorbable sutures versus tackers was associated with lower costs across all quantiles (β = –11,671 to –8,372; all P ≤ .003). Length of stay was positively associated with costs from the 10th to the 70th quantile (β = 623–917; all P ≤ .032). Intensive care unit use increased costs predominantly in the lower-mid quantiles (q10–q40; β = 2,577–4,301). Postoperative recurrence occurred in 9 of 197 patients (4.6%) and had no independent predictors on multivariable analysis.

Conclusion

Hospitalization costs for laparoscopic tension-free hiatal hernia repair were largely driven by material expenditures. Absorbable suture fixation reduced costs across all quantiles without prolonging operative time, whereas longer length of stay increased costs, and intensive care unit use affected mainly the lower-mid range. Early recurrence was uncommon and had no independent predictors, supporting cost-conscious strategies that prioritize judicious fixation, discharge efficiency, and selective critical-care use, to be confirmed in prospective studies with standardized long-term outcomes.

背景腹腔镜无张力修补术因其良好的临床效果已成为裂孔疝的标准手术治疗方法。然而，由于患者的复杂性和技术因素，相关的住院费用差异很大。本研究旨在采用分位数回归方法分析腹腔镜无张力裂孔疝修补术患者住院费用的驱动因素和组成。方法对2020 - 2023年在首都医科大学附属北京朝阳医院行腹腔镜无张力裂孔疝修补术的患者进行回顾性观察研究。从电子病历中提取临床、人口统计学和手术数据。主要观察指标为总住院费用；次要结局包括费用构成（诊断、治疗、护理、药物、材料等）和术后复发率。分位数回归用于确定与第10 - 90百分位数的总住院费用相关的因素。使用多变量逻辑回归检验复发性。结果共纳入197例患者。多数为女性（60.4%），年龄≥65岁（54.8%）。材料费用占每年住院总费用的最大份额（58%）。在分位数回归中，使用可吸收缝线的网状固定与黏着剂相比，在所有分位数中成本都较低（β = -11,671至-8,372；所有P≤0.003）。从第10到第70分位数，住院时间与费用呈正相关（β = 623-917；所有P≤0.032）。重症监护病房使用增加的费用主要集中在中低分位数（q10-q40; β = 2,577-4,301）。197例患者中有9例（4.6%）出现术后复发，多变量分析无独立预测因素。结论腹腔镜无张力裂孔疝修补术住院费用主要由材料支出驱动。可吸收缝线固定在不延长手术时间的情况下降低了所有分位数的成本，而较长的住院时间增加了成本，重症监护病房的使用主要影响中低范围。早期复发不常见，没有独立的预测因素，支持成本意识策略，优先考虑明智的固定，出院效率和选择性重症监护使用，在标准化长期结果的前瞻性研究中得到证实。

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引用次数: 0

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 人工智能驱动的腹腔镜缝合高级培训（ATLAS）针处理任务完成时间和错误预测：离自动化手术技能评估又近了一步

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-04-01 Epub Date: 2026-01-17 DOI: 10.1016/j.surg.2025.110045

Huu Phong Nguyen PhD , Sofia Garces-Palacios MD , Darian Hoagland MD , Nicole Wise MD , Kailen Wong BS , Sai Abhinav Pydimarry BS , Sharanya Vunnava BS , Daniel J. Scott MD , Dmitry Nepomnayshy MD , Ganesh Sankaranarayanan PhD

Background

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.

Methods

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.

Results

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 >2 seconds and 63.6% of needle drops >5 seconds in test videos.

Conclusion

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.

背景：腹腔镜缝合高级培训是一个基于熟练程度的课程，包含6个结构化任务。在处理针头的任务中，参与者操纵针头穿过圆形平台上的6个标准孔。性能（完成时间和错误）目前是亲自评估或通过手动视频审查。这项研究探索了人工智能模型的潜力，通过预测任务持续时间和检测针头掉落错误来自动评估这项任务。方法回顾性分析2个三级中心收集的《腹腔镜缝合针操作任务高级培训》视频资料。开发了两个互补的人工智能模型。首先，在10个不同的阶段对视频进行注释。结合混合自适应k近邻、平滑移动平均和指数移动平均训练了深度可扩展三维卷积网络，用于相位分割和持续时间预测。其次，训练视觉变换模型，根据针的可见度对帧段进行分类，检测针滴误差；结果混合k近邻-平滑移动平均模型的相位分割准确率由82.06%±0.84%提高到89.67%±1.27%，最高准确率达到90.56%，f1评分为86.90%。预测的任务持续时间误差平均误差为0.84%。视觉变压器模型在验证帧上的分类准确率达到95.16%，在测试视频中检测到66.6%的针滴>；2秒和63.6%的针滴>；5秒。结论基于人工智能的模型在任务持续时间预测和针滴误差方面分别具有较高和中等的准确性，为客观的手术评估提供了可扩展的解决方案。

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引用次数: 0