Surgery in practice and science最新文献

英文中文

Artificial intelligence for surgical care in war-torn sudan: Feasibility, barriers, and ethical perspectives from a conflict zone 在饱受战争蹂躏的苏丹进行外科护理的人工智能：可行性、障碍和来自冲突地区的伦理观点。

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-06-01 Epub Date: 2026-02-15 DOI: 10.1016/j.sipas.2026.100333

Alsadig Suliman, Lina SeedAhmed, Sara Hussein, Siddig Ali, Sabah Ahmed, Alkhansa Alkhider

Background

Artificial intelligence (AI) offers transformative potential for clinical care, yet its deployment in conflict-affected, low-resource settings remains under-researched. This study evaluates AI awareness, barriers, and readiness among Sudanese surgeons amidst the nation's ongoing armed conflict.

Methods

A sequential explanatory mixed-methods design was employed. An online survey, adapted from validated instruments, assessed AI familiarity, perceived barriers, ethical concerns, and readiness among Sudanese general surgery residents and specialists. From October 2024 to June 2025, 185 completed responses were obtained from a stratified random sample of 195 eligible participants. Follow-up semi-structured interviews were conducted with 20 selected specialists. Quantitative data were analyzed using descriptive statistics, chi-square tests, and the Kruskal-Wallis test with Dunn’s post-hoc comparisons. Qualitative interviews were conducted until thematic saturation was achieved and analyzed thematically, with coding verified through inter-coder reliability.

Results

While AI awareness was moderate (68.7%), practical clinical exposure (9.4%) and advanced literacy (10.3%) were notably low. Surgeons identified AI’s primary utility in training (68.2%) and perioperative decision-making (65.4%). Significant barriers included infrastructure deficits (87.6%), training gaps (79.1%), and financial constraints (72.4%). Conflict-specific challenges were acute, with 92.5% reporting severe technology shortages and 78.3% citing unreliable power/internet. Qualitative themes highlighted AI’s potential for triage and resource allocation, though concerns regarding accountability and ethical governance persisted.

Conclusion

This study provides inaugural evidence on AI feasibility within an African zone. Despite infrastructure collapse, Sudanese surgeons show strong interest in AI for triage and diagnostics. To move forward, development must prioritize offline-compatible, context-adapted tools and robust governance frameworks. These findings provide a blueprint for integrating AI to bolster surgical resilience during humanitarian crises.

背景：人工智能（AI）为临床护理提供了变革性的潜力，但其在受冲突影响的低资源环境中的应用仍未得到充分研究。本研究评估了苏丹外科医生在该国持续的武装冲突中的人工智能意识、障碍和准备情况。方法：采用顺序解释混合方法设计。根据经过验证的仪器进行了一项在线调查，评估了苏丹普外科住院医生和专家对人工智能的熟悉程度、感知障碍、道德问题和准备情况。从2024年10月到2025年6月，从195名合格参与者的分层随机样本中获得185份完整的回复。与20名选定的专家进行了后续半结构化访谈。定量数据分析采用描述性统计、卡方检验、Kruskal-Wallis检验和Dunn事后比较。进行定性访谈，直到主题饱和并进行主题分析，并通过编码者之间的可靠性验证编码。结果：虽然人工智能意识中等（68.7%），但实际临床接触（9.4%）和高级素养（10.3%）明显较低。外科医生认为人工智能的主要用途是训练（68.2%）和围手术期决策（65.4%）。主要障碍包括基础设施不足（87.6%）、培训缺口（79.1%）和财政限制（72.4%）。与冲突相关的挑战也很严峻，92.5%的受访者表示严重的技术短缺，78.3%的受访者表示电力/互联网不可靠。定性主题强调了人工智能在分类和资源分配方面的潜力，尽管对问责制和道德治理的担忧仍然存在。结论：本研究为非洲区域内人工智能的可行性提供了初步证据。尽管基础设施崩溃，苏丹外科医生对人工智能的分类和诊断表现出浓厚的兴趣。为了向前发展，开发必须优先考虑离线兼容、适应环境的工具和健壮的治理框架。这些发现为在人道主义危机期间整合人工智能以增强手术复原力提供了蓝图。

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引用次数: 0

The impact of body mass index on predicting postoperative pancreatic fistula in relation to pancreatic texture and main pancreatic duct diameter after pancreaticoduodenectomy 体重指数与胰十二指肠切除术后胰腺质地和主胰管直径的关系对预测胰瘘的影响

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-06-01 Epub Date: 2026-02-16 DOI: 10.1016/j.sipas.2026.100334

Oleksandr Kvasivka, Ruslan Pareniuk, Andrii Moiseienko, Illia Pepenin, Kostiantyn Kopchak

Introduction

Pancreaticoduodenectomy (PD) remains the primary radical treatment for malignant periampullary tumors. Clinically relevant postoperative pancreatic fistula (POPF) develops in 15–20% of patients. Body mass index (BMI) may influence the risk of this complication. The aim of our study was to assess the impact of BMI, pancreatic texture, and main pancreatic duct diameter on the risk of POPF after PD.

Methods

A retrospective cohort study included 106 patients who underwent PD for malignant periampullary tumors between 2018 and 2024, performed by a single surgical team at a major center in Ukraine. Patients were grouped according to a classification proposed by the International Study Group for Pancreatic Surgery (ISGPS) based on pancreatic texture and duct diameter: Group A: not-soft texture, duct > 3 mm. Group B: not-soft texture, duct ≤ 3 mm. Group C: soft texture, duct > 3 mm. Group D: soft texture, duct ≤ 3 mm.

Results

Group A included 63 patients, Group B 9, Group C 8, and Group D 26. No significant association between BMI and POPF was found in Groups A, B, and C. However, in Group D, patients with BMI ≥ 25 had a significantly higher rate of POPF compared to those with BMI < 25.

Conclusion

Increased BMI was significantly associated with a higher risk of POPF only in patients with a soft pancreatic texture and a main pancreatic duct diameter ≤ 3 mm.

胰十二指肠切除术（PD）仍然是壶腹周围恶性肿瘤的主要根治性治疗方法。临床相关的术后胰瘘（POPF）在15-20%的患者中发生。身体质量指数（BMI）可能影响这种并发症的风险。本研究的目的是评估BMI、胰腺质地和主胰管直径对PD后POPF风险的影响。方法一项回顾性队列研究纳入了106例2018年至2024年间因壶腹周围恶性肿瘤接受PD治疗的患者，由乌克兰一家主要中心的一个外科团队进行。根据国际胰腺外科研究小组（ISGPS）提出的胰腺质地和胰管直径的分类对患者进行分组：a组：质地不软，胰管3mm。B组：质地不软，风管≤3mm。C组：质地柔软，风管3mm。结果A组63例，B组9例，C组8例，D组26例。A、B、c组BMI与POPF无显著相关性，但D组BMI≥25的患者POPF发生率明显高于BMI≥25的患者。结论仅在胰腺质地柔软且主胰管直径≤3mm的患者中，BMI升高与POPF发生风险增高有显著相关性。

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引用次数: 0

Commentary on “Predictors of post-operative complications following thyroid surgery at a tertiary hospital in Tanzania”: Clarifying mechanisms and clinical implications 对“坦桑尼亚一家三级医院甲状腺手术后并发症的预测因素”的评论：澄清机制和临床意义

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-06-01 Epub Date: 2026-02-26 DOI: 10.1016/j.sipas.2026.100336

Vaishali Rahuldeep Khobragade

引用次数: 0

Predictors of post-operative complications following thyroid surgeries at a tertiary hospital in Tanzania 坦桑尼亚一家三级医院甲状腺手术后并发症的预测因素

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-03-01 Epub Date: 2025-12-08 DOI: 10.1016/j.sipas.2025.100323

Albert Lazaro , Mungeni Misidai , Daniel Kitua , Abdulrahaman Amin , Charles Komba , Ally Mwanga , Larry Akoko , Nashivai Kivuyo

Background

Thyroid disorders pose a substantial burden in low- and middle-income countries (LMICs), where late presentation and limited access to specialized care often result in advanced disease at surgery. Despite thyroidectomy being the definitive treatment for many thyroid conditions, data on surgical outcomes and complication rates from sub-Saharan Africa remain scarce. This study aimed to describe the clinical characteristics, surgical approaches, and in-hospital postoperative outcomes of patients undergoing thyroidectomy at a tertiary hospital in Tanzania, and to identify factors associated with postoperative complications.

Materials and Methods

This was a hospital-based retrospective cohort study involving patients who underwent thyroid surgery between January 2018 and December 2023. Data were retrieved from case notes and surgical records in the hospital’s medical records department. Sociodemographic and clinical characteristics were analyzed as predictor variables, while postoperative in-hospital complications were the primary outcomes. Multivariable logistic regression was performed to identify independent predictors of complications.

Results

A total of 405 patients underwent thyroidectomy during the study period, with a female predominance (89.6%) and a mean age of 48 ± 13 years. The majority presented with anterior neck swelling (98.5%), and 24% had retrosternal extension. Benign pathology accounted for 77% of cases. The overall complication rate was 15.3%, with hypocalcemia (4%) and superior laryngeal nerve injury (3%) being the most common. The mortality rate was 0.5%. Independent predictors of in-hospital complications included total thyroidectomy (aOR: 3.12; 95% CI: 1.08–9.02) and symptom duration exceeding 10 years (aOR: 4.12; 95% CI: 1.60–10.58).

Conclusion

Postoperative morbidity following thyroidectomy in this setting was primarily driven by delayed presentation and the extent of surgery. Targeted interventions to promote early diagnosis and optimize perioperative care are essential to improve patient outcomes.

在低收入和中等收入国家（LMICs），甲状腺疾病是一个沉重的负担，在这些国家，姗姗来迟和获得专业护理的机会有限往往导致手术时疾病进展。尽管甲状腺切除术是许多甲状腺疾病的最终治疗方法，但撒哈拉以南非洲地区关于手术结果和并发症发生率的数据仍然很少。本研究旨在描述坦桑尼亚一家三级医院甲状腺切除术患者的临床特征、手术方式和住院术后结果，并确定与术后并发症相关的因素。材料和方法这是一项基于医院的回顾性队列研究，涉及2018年1月至2023年12月期间接受甲状腺手术的患者。数据从医院病历部门的病例记录和手术记录中检索。社会人口学和临床特征作为预测变量进行分析，而术后院内并发症是主要结局。采用多变量逻辑回归来确定并发症的独立预测因素。结果研究期间共行甲状腺切除术405例，女性占89.6%，平均年龄48±13岁。大多数患者表现为颈前肿胀（98.5%），24%为胸骨后伸展。良性病理占77%。总并发症发生率为15.3%，其中以低钙血症（4%）和喉上神经损伤（3%）最为常见。死亡率为0.5%。院内并发症的独立预测因子包括全甲状腺切除术（aOR: 3.12; 95% CI: 1.08-9.02）和症状持续时间超过10年（aOR: 4.12; 95% CI: 1.60-10.58）。结论本组甲状腺切除术后的术后发病率主要由延迟出现和手术范围引起。有针对性的干预措施促进早期诊断和优化围手术期护理对改善患者预后至关重要。

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引用次数: 0

The textbook outcome of pancreaticoduodenectomy for adenocarcinoma of the pancreas in a high-volume centre 教科书结果胰十二指肠切除术胰腺腺癌在高容积中心

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-03-01 Epub Date: 2026-02-02 DOI: 10.1016/j.sipas.2026.100330

Muhammad Anas Bin Akhtar, Sibgha Aimon, Syed Tatheer Abbas, Aamir Ali Syed, Fatima Tu Zahara, Shahid Khattak, Shahzaib Asif, Sana Hussain, Taha Ahmad, Sayed Moosa Kazim

Background

Pancreatic adenocarcinoma remains a leading cause of cancer-related mortality, with only 15–20% of patients eligible for resection at diagnosis. Pancreaticoduodenectomy (PD) is the standard surgical treatment, yet achieving optimal outcomes is challenging. Textbook Outcome (TO), a composite measure of quality, has emerged as a superior indicator of surgical success compared to individual parameters. This study evaluates TO in PD for pancreatic adenocarcinoma at a high-volume center and its impact on survival.

Methods

This was a retrospective analysis conducted at a tertiary cancer center. TO was defined by negative resection margins, ≥12 lymph nodes retrieved, ICU stay <72 h, hospital stay ≤14 days, no readmission within 30 days, no major complications (Clavien-Dindo grade ≥3), and no postoperative pancreatic fistula grade B or C. Patients who underwent pancreaticoduodenectomy for adenocarcinoma pancreas were included. Patients with incomplete data for TO were excluded.

Results

A total of 269 patients were included. Complete TO was achieved in 56.9% of patients. Most achieve outcome was negative margins (R0) in 94.8%, and ≥12 lymph nodes were retrieved in 92.6%. Least achieved outcome was hospital stays >14 days in 85%. Overall Survival in patients achieving TO vs those who did not achieved TO was 49 ± 1 month vs 40 ± 2 months respectively. (p = 0.004).

Conclusion

Our tertiary cancer center demonstrated better TO rates compared to international published literature, reinforcing the importance of structured quality metrics in pancreatic surgery. TO serves as a robust predictor of long-term survival and should be integrated into surgical audits to enhance patient-centered care.

背景：胰腺腺癌仍然是癌症相关死亡的主要原因，只有15-20%的患者在诊断时符合切除条件。胰十二指肠切除术（PD）是标准的外科治疗方法，但达到最佳结果是具有挑战性的。教科书结果（TO）是一种质量的综合测量，与单个参数相比，已成为手术成功的优越指标。本研究在大容量中心评估PD患者的TO及其对生存的影响。方法在某三级肿瘤中心进行回顾性分析。TO的定义为切除边缘阴性，淋巴结≥12个，ICU住院时间≥72 h，住院时间≤14天，30天内无再入院，无重大并发症（Clavien-Dindo分级≥3），术后无胰瘘B级或c级。排除了TO数据不完整的患者。结果共纳入269例患者。56.9%的患者达到完全TO。94.8%的患者获得阴性边缘（R0）， 92.6%的患者获得≥12个淋巴结。85%的患者住院时间最少，为14天。达到TO的患者与未达到TO的患者的总生存期分别为49±1个月和40±2个月。（p = 0.004）。结论与国际上发表的文献相比，我们的三级肿瘤中心显示出更好的TO率，这加强了结构化质量指标在胰腺手术中的重要性。TO作为长期生存的可靠预测指标，应纳入手术审计，以加强以患者为中心的护理。

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引用次数: 0

Acknowledgement of reviewers in 2025 for Surgery in Practice and Science 2025年《外科实践与科学》审稿人致谢

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI: 10.1016/j.sipas.2026.100328

Artur Rebelo, Jörg Kleeff

引用次数: 0

Pressure trends and diagnosis of acute compartment syndrome 压力趋势与急性筋膜室综合征的诊断

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-03-01 Epub Date: 2026-01-18 DOI: 10.1016/j.sipas.2026.100327

Yasser Bouklouch , Justin Matta , William T Obremskey , Ross Leighton , Mitchell Bernstein , Edward J Harvey

Objectives

Acute compartment syndrome (ACS) is a serious condition resulting from increased intracompartmental pressure (ICP) within a closed muscle compartment. There is a lack of understanding of continuous pressure trends despite being an accepted method for tracking disease. It was hypothesized that trends in pressure would determine risk of ACS.

Methods

This is a retrospective review of collected data from two prospective cohort trials. Anonymized ICP pressures from 147 trauma patients with extremity fractures were gathered. Patient data from multicenter level one trauma academic hospitals was analyzed. Data was taken from trauma patients that received a continuous real-time pressure device. Statistical and observational analysis were carried out to examine trends in patients with and without resultant acute compartment syndrome.

Results

Patients that developed ACS did not always have significantly higher absolute ICPs that exceed the theoretical critical 30 mmHg threshold for fasciotomy. Patients with ACS showed a consistent upward trend over time (average increase of 0.674 mmHg per hour). In contrast, non-ACS patients, even those that exceeded the previous postulated 30mmHg threshold, exhibit a natural and gradual decline in ICP over time (average decline of 0.285 mmHg per hour).

Conclusions

This research highlights the limitations of single-point pressure measurements and underscores the benefits of continuous ICP monitoring for timely ACS diagnosis. Continuous pressure data enables better clinical decision-making, reducing the risk of both unnecessary and delayed fasciotomies. This study emphasizes the need for integrating continuous pressure monitoring into standard practice to improve the management and outcomes of patients at risk for ACS.

目的急性筋膜室综合征（ACS）是由于闭合性肌室腔内压力（ICP）升高而引起的一种严重疾病。尽管连续压力趋势是一种公认的追踪疾病的方法，但缺乏对其的了解。假设血压的变化趋势会决定ACS的风险。方法对两项前瞻性队列试验收集的数据进行回顾性分析。收集147例四肢骨折创伤患者的匿名颅内压。对来自多中心一级创伤专科医院的患者资料进行分析。数据取自接受连续实时压力装置的创伤患者。统计和观察分析进行了检查趋势的患者有和没有由此产生的急性筋膜间室综合征。结果发生ACS的患者的绝对icp并不总是明显高于筋膜切开术的理论临界阈值30 mmHg。ACS患者呈持续上升趋势（平均每小时增加0.674 mmHg）。相比之下，非acs患者，即使超过了先前假设的30mmHg阈值，随着时间的推移，ICP也会自然逐渐下降（平均每小时下降0.285 mmHg）。结论：本研究强调了单点压力测量的局限性，并强调了持续ICP监测对ACS及时诊断的好处。持续的压力数据有助于更好的临床决策，减少不必要和延迟的筋膜切开术的风险。本研究强调需要将持续压力监测纳入标准实践，以改善ACS风险患者的管理和预后。

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引用次数: 0

Comment on “Improving consenting practice in trauma and orthopaedics: A single centre original mixed methods study” 对“改进创伤骨科的同意实践：单中心原创混合方法研究”的评论

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.sipas.2025.100325

Ankit Batra , Prashant Kokiwar , Priyanka Aher , Indu Singh

引用次数: 0

Comment on “Predictors of post-operative complications following thyroid surgeries at a tertiary hospital in Tanzania” 对“坦桑尼亚一家三级医院甲状腺手术后并发症预测因素”的评论

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-03-01 Epub Date: 2026-02-03 DOI: 10.1016/j.sipas.2026.100331

Chandana Maji, Hariharan Srinivasan, Aishwarya Biradar, Reenoo Jauhari

引用次数: 0

The role of artificial intelligence in advancing urologic care: From diagnostics to therapeutics 人工智能在推进泌尿科护理中的作用：从诊断到治疗

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2026-03-01 Epub Date: 2025-11-29 DOI: 10.1016/j.sipas.2025.100322

Sina Samenezhad , Dorna Rafighi

Artificial intelligence (AI) is gradually altering urology by improving diagnostic precision, prognostic evaluation, and therapy decisions in a broad spectrum of urologic diseases. Utilizing machine learning, deep learning, and radiomics, applications of AI have exhibited promise in enhancing cancer identification, stratification, and therapy response prediction, especially in prostate, bladder, and kidney cancers. Beyond cancer therapy, AI enables individually tailored care for benign diseases like benign prostatic hyperplasia, urolithiasis, Functional Urology even in pediatrics by enhancing diagnostic ability and outcome prediction. Heterogeneity of data, model explainability, ethical issues, and lack of prospective validation constrain incorporation into everyday practice. This review summarizes current applications and discusses methodological and ethical limitation, and defines future directions toward enhancing multidisciplinary interaction, standardization across datasets, and prudent implementation. Eventually, AI provides large-scale opportunity to transform urologic care by facilitating individually tailored, expedient, and equitable patient care.

人工智能（AI）通过提高广泛泌尿系统疾病的诊断精度、预后评估和治疗决策，正在逐渐改变泌尿外科。利用机器学习、深度学习和放射组学，人工智能的应用在增强癌症识别、分层和治疗反应预测方面表现出了希望，特别是在前列腺癌、膀胱癌和肾癌方面。除了癌症治疗，人工智能还可以通过提高诊断能力和结果预测，为良性疾病（如良性前列腺增生、尿石症、功能泌尿科甚至儿科）提供个性化护理。数据的异质性、模型的可解释性、伦理问题和缺乏前瞻性验证限制了将其纳入日常实践。这篇综述总结了目前的应用，讨论了方法和伦理限制，并定义了未来的方向，以加强多学科的互动，跨数据集的标准化和谨慎的实施。最终，人工智能通过促进个体化、权宜之计和公平的患者护理，为改变泌尿科护理提供了大规模的机会。

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