Updates in Surgery最新文献

Background: Minimally invasive distal pancreatectomy (MIDP) has become more common in recent years, offering shorter recovery times and fewer perioperative complications compared to open surgery. However, postoperative pancreatic fistula (POPF) remains a major concern, driving the search for effective stump management strategies to minimize complications and healthcare costs.

Methods: Between February and March 2025, a 25-item Google Forms questionnaire was emailed to the lead surgeons of all 44 IGOMIPS centers. One response per center was requested. The questionnaire covered a wide range of topics, including the preferred surgical platform (laparoscopic vs robotic), types of transection devices (motorized or non-motorized staplers, energy-based tools), use of staple-line reinforcement, pre-firing compression durations, and postoperative drain-management practices. Descriptive analyses were performed and correlated with existing literature.

Results: A total of 36 invited centers, each utilizing minimally invasive surgical techniques for distal pancreatectomy, completed the survey (response rate: 81.8%, 36/44). The adopted surgical platform was robotic in 14 centers (38.9%), laparoscopic in 11 (30.6%) and mixed in 11 (30.6%). Parenchymal transection relied on motorised staplers in 24 centers (66.7%), conventional staplers in 8 (22.2%) and energy-based devices in 2 (5.6%); two centers (5.5%) tailored the device to gland thickness. Pre-firing compression lasted < 1 min in 6 centers (16.7%), 1-3 min in 16 (44.4%) and > 3 min in 6 (16.7%), while 7 centers (19.4%) had no fixed interval. Staple-line reinforcement was never used in 14 centers (38.9%), always used in 6 (16.7%) and applied selectively in the remainder. Routine prophylactic drainage was practised by 32 centers (88.9%); drains were removed < POD 5 in 14 (38.9%).

Conclusion: The marked heterogeneity in stump-management techniques in MIDP highlights the absence of robust, standardized guidelines, reflecting persistent controversies in the literature. Respondents expressed strong interest in future multicenter trials to establish evidence-based protocols, emphasizing that collaborative, large-scale research is crucial for improving patient outcomes and reducing the risk of POPF.

Indocyanine Green (ICG) fluorescence imaging is increasingly used in emergency bowel surgery to assess intestinal perfusion. While literature reports high technical efficacy, intraoperative interpretation remains variable. This systematic review explores how cognitive and systemic human factors influence ICG's perceived effectiveness, compared to reported quantitative outcomes. A systematic search of PubMed and Embase identified 31 original studies from 266 screened articles. Qualitative synthesis was guided by ENTREQ principles. Bias identification followed a thematic approach using cognitive bias categories based on established clinical decision-making frameworks. ICG was reported to influence surgical decision-making in 302 of 308 cases. However, discrepancies between fluorescence findings and clinical actions occurred in 38.3% of cases. Common cognitive patterns included confirmation and anchoring bias, overconfidence in fluorescence interpretation, and reliance on ICG to support pre-established surgical decisions. Systemic limitations included lack of interdisciplinary input, case-report bias, and absence of standardized interpretation protocols. These were analyzed across a full article-by-article bias matrix and summarized by domain and sentiment. ICG is not solely a diagnostic tool, but a cognitive interface shaped by time pressure, decision momentum, and human interpretation. Rather than providing objective certainty, ICG often reinforces existing clinical judgments. Addressing bias-awareness and integrating interdisciplinary frameworks may enhance interpretive consistency and improve patient outcomes. These findings call for greater cognitive standardization in the intraoperative use of ICG during emergency surgery.

Introduction: It is not clear if the acquisition of robotic simulation skills can be affected by external factors during the simulation.

Methods: A cohort of medical students performed five times a basic simulation exercise. Performance indexes were collected to build up individual "learning curves". The participants were randomly divided into five groups and Groups 2 to 5 were "disturbed" by classic music, heavy metal, radio podcast, irregular noises, respectively, whereas participants of Group 1 were not distracted.

Results: In the whole series, there was a progressive improvement of all the simulation parameters and the variability among the participants reduced with time. Group 5 do not reach the higher standards of the other four groups.

Conclusions: Our study demonstrated that simulation could standardize the skills of the trainees at the top level despite different starting points. Irregular noises during the training can delay the acquisition of robotic skills.

Postoperative pancreatic fistula (POPF) complicates 9.9-28.5% of pancreatic surgeries. This protocol describes a preclinical study in a large animal model comparing endoluminal radiofrequency ablation (ERFA) and glue occlusion of the main pancreatic duct (MPD), both performed four weeks prior to surgery to induce pancreatic atrophy and potentially reduce the risk of POPF. In this randomized study, healthy pigs were allocated to either the ERFA or the glue occlusion groups. The protocol comprises three sequential procedures: (1) MPD occlusion via a hybrid laparoscopic or robotic approach, (2) minimally invasive pancreatic transection at four weeks, and (3) necropsy 15 days post-transection. This study addresses the technical challenges of manipulating pancreatic ducts in large animals and provides a standardized approach for evaluating MPD occlusion techniques. The methodology enables a robust comparison between ERFA and glue occlusion while accounting for anatomical variations between porcine and human models to support future clinical applications.

The integration of molecular diagnostics into surgical oncology is redefining the management of colorectal cancer (CRC). Microsatellite instability (MSI) testing and mismatch repair (MMR) analysis have moved from purely prognostic tools to key determinants of therapeutic strategy. In MSI-high (MSI-H) and MMR-deficient (dMMR) tumours, immune checkpoint inhibitors have shown unprecedented pathological response rates, leading to a paradigm shift in non-metastatic CRC. Recently published trials suggest that immunotherapy may alter the timing and extent of resection, while raising new questions about patient selection, surgical planning, and long-term oncological safety. Conversely, microsatellite-stable (MSS) disease remains a therapeutic frontier, with ongoing studies exploring combined immunotherapy regimens. This evolving landscape demands that surgeons develop a deeper understanding of tumour biology and participate actively in translational research. The future of CRC surgery will rely not only on technical excellence but on the ability to integrate molecular knowledge into precise, multidisciplinary treatment algorithms.

Anastomotic leakage is a serious complication after surgery for rectal cancer. The prevention of anastomotic leakage is important, and prevention methods include temporary ileostomy and transanal drainage tubes. In clinical practice, a TDT is often used in combination with a temporary ileostomy. Many studies have compared ileostomy and TDT; however, there are few reports on the additive effects of TDT in patients with temporary ileostomy. We included patients who underwent laparoscopic surgery for rectal cancer (cT1-2/N0/M0) located within 5 cm of the anal verge at 47 specialized centers in Japan between 2014 and 2017. Gastrointestinal anastomosis was performed in the patients, and a temporary ileostomy was created. Eligible patients were matched 1:1 based on propensity scores for the presence or absence of TDT. Postoperative outcomes and complications were compared between TDT and non-TDT groups. Of 299 cases collected, 252 were eligible for inclusion. After propensity score matching, 166 patients (83 per group) were included. In the TDT group, there was a significant delay in urinary catheter removal (4.3 ± 0.3 vs. 3.5 ± 0.3 days, P = 0.028) and prolonged hospital stay (20.2 ± 1.1 vs. 17.5 ± 1.1 days, P = 0.027). However, there were no significant differences in the number of anastomotic leakages (grade I, 1 vs. 1; grade II, 2 vs. 1; and grade III, 2 vs. 2; P = 1.000) or other postoperative complications between the groups. In patients in which a temporary ileostomy is created during lower rectal cancer surgery, the need for TDT is considered insignificant.

Gasless transaxillary endoscopic thyroidectomy (GTET) offers an extracervical approach with cosmetic benefits, yet spatial orientation around critical structures can be challenging for learners. We aimed to standardize and illustrate a stepwise GTET workflow with clearly annotated intraoperative landmarks. This single-center descriptive study presents a unified, stepwise technique for GTET. High-resolution intraoperative images were annotated in-figure (arrows and labels) to identify constant landmarks and "risk zones," including the recurrent laryngeal nerve (RLN; trunk/entry), inferior parathyroid and feeding vessels, Berry ligament, tracheal plane, external branch of the superior laryngeal nerve (EBSLN) corridor, upper-pole dissection plane, and central compartment boundaries. For each step, concise tips and pitfalls are provided to support reproducibility and teaching. An atlas-style, annotated workflow is presented that links exposure, landmark identification, and safe dissection planes. The figures and legends prioritize consistent orientation cues and highlight commonly hazardous areas (e.g., Berry ligament region, RLN entry, inferior parathyroid pedicle), aiming to reduce ambiguity for less-experienced surgeons. This annotated, stepwise description of GTET may facilitate surgical orientation, communication, and training. The framework is intended to be adaptable across learning environments; future prospective studies should evaluate learning curves and clinical outcomes using standardized endpoints.