American journal of surgery最新文献

Background: Intra-operative identification of parathyroid glands might be technically challenging and is a major source of hypocalcemia and nerve injury. Artificial-intelligence (AI)-based computer-vision systems have emerged as a potential adjunct.

Methods: A comprehensive search strategy was performed to identify studies using any machine-learning or deep-learning model for intraoperative parathyroid localization or viability assessment in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol on PROSPERO: CRD420251104234.

Results: From 1124 records, 12 studies met inclusion criteria. Among the included studies, nine focused on localization of abnormal glands, while others addressed normal gland identification or perfusion assessment. AI systems utilized various imaging modalities including near infrared autofluorescence, red-blue-green surgical video, and indocyanine green angiography. These models have achieved high diagnostic accuracy, with most systems demonstrating >85% sensitivity and specificity for parathyroid identification.

Conclusions: AI-driven systems demonstrate promising diagnostic performance for intraoperative parathyroid identification across multiple imaging modalities. Although results are encouraging, multicenter datasets, surgeon trust and workflow integration, and trials linking AI guidance to clinical outcomes are essential before routine adoption.

Introduction: Transanal Minimally Invasive Surgery (TAMIS) is frequently used to treat rectal lesions that are not amenable to conventional polypectomy or endoscopic resection. Few studies have reported long-term outcomes of TAMIS. This study aims to assess the long-term outcomes in patients who underwent TAMIS for rectal lesions.

Methods: Patients who underwent TAMIS for rectal neoplasms at a tertiary care center between June 2010 and August 2023 were retrospectively reviewed. The assessment of oncological outcomes, reported separately for benign and malignant lesions, was limited to patients with adenomatous polyps, serrated polyps, or adenocarcinomas as indicated in the postoperative histopathology report. The primary outcomes were long-term oncological outcomes, including local recurrence, distant metastasis, mortality, disease-free and overall survival rates.

Results: The current study included a total of 208 individuals, of whom 74 (35.6 %) were female, with a median age of 64 (19.3) years. Upon postoperative histopathological examination, adenomatous lesions were identified in 109 (52.4 %) patients, serrated adenoma in 7 (3.4 %) patients, negative pathology in 18 (8.7 %) patients, and adenocarcinoma in 74 (35.5 %) patients. The median follow-up duration was 37 months. During the follow-up period, local recurrence occurred in 1 patient (0.8 %) with benign disease, 16 months after TAMIS. Additionally, recurrence occurred in 8 (9.4 %) patients with malignant disease at a median follow-up of 23.5 months. Distant metastasis was observed in 1 patient (0.8 %) who initially had benign disease seven months after experiencing malignant recurrence. Furthermore, distant metastasis was noted in 5 patients (5.9 %) with malignant disease. No disease-related mortality was recorded during the follow-up period for benign lesions. However, 5 (5.9 %) patients with malignant disease experienced mortality associated with rectal adenocarcinoma. The 3-year disease-free and overall survival rates for patients with malignant disease were 91 % and 96.6 % (p = 0.015), respectively.

Conclusion: TAMIS is an effective technique for rectal lesions, offering an acceptable short- and long-term oncological outcome for both benign and malignant lesions.

Background: Since 2019, women comprise the majority of incoming U.S. medical students yet remain underrepresented in surgical specialties.

Methods: This study analyzed gender representation among applicants and residents in General Surgery, Neurosurgery, Orthopedics, Otolaryngology, Plastic Surgery, and Urology from 2019 to 2024. Applicant data was sourced from ERAS and resident data from the ACGME Data Resource Book.

Results: Across all subspecialties, a strong, statistically significant correlation was found between the percentage of female residents and applicants (R = 0.943, p < 0.0001). Subgroup analysis revealed the strongest and most significant association in Urology (R = 1.0, p < 0.0001), followed by General Surgery (R = 0.944, p = 0.016). Other specialties showed varying strengths of correlation, with significance differing by field.

Conclusions: These findings suggest that programs with more female residents may attract more female applicants, emphasizing the role of gender in mentorship and visibility. Enhancing female representation may support greater equity in surgical training and contribute to a more inclusive surgical workforce.

Background: Cigarette smoking significantly increases both lung cancer risk and postoperative pulmonary complications. While smoking cessation before surgery is recommended, the optimal duration remains controversial, particularly for uniportal video-assisted thoracoscopic surgery (VATS). This study aimed to clarify the relationship between smoking cessation duration and postoperative outcomes following uniportal VATS for pulmonary nodules.

Methods: This retrospective observational study examined the relationship between smoking cessation duration and complications in patients receiving uniportal VATS for solitary pulmonary nodules. The cohort included patients treated from January to December 2024. Smokers were divided into short-term (≤4 weeks) and long-term quitters (>4 weeks) based on preoperative cessation period.

Results: Among 473 patients, 92 (19.5 %) experienced complications. No significant differences were found between short-term and long-term quitters in overall complications (20.4 % vs 17.3 %, p = 0.428) or pulmonary complications (19.5 % vs 17.3 %, p = 0.574). Postoperative day 1 assessments showed comparable pulmonary function and 6-MWD between groups. However, long-term quitters reported significantly reduced cough intensity (1.2 ± 0.4 vs 2.1 ± 0.5, p = 0.028), with no differences in sputum characteristics or volume.

Conclusion: In the context of uniportal VATS for solitary pulmonary nodules, our findings indicate that preoperative smoking cessation exceeding four weeks provides limited additional protection against early postoperative dysfunction. Clinical decision-making should balance this evidence against individual oncologic urgency. For patients with solitary lung nodules requiring uniportal VATS, postponing surgery to accommodate a smoking cessation period seemed unnecessary.