American Surgeon最新文献

Artificial intelligence (AI) has transformative potential in postoperative wound care through precise, automated, and timely wound assessment, yet specific applications to surgical wounds remain relatively unexplored compared to chronic wound care. This integrative review critically assesses the state-of-the-art in AI-driven postoperative wound monitoring, highlighting significant advancements, existing limitations, and opportunities for future development. Following an extensive literature search of PubMed, Google Scholar, and Medline, we identified 118 relevant articles meeting stringent inclusion criteria. Our analysis underscores the critical need for large-scale, standardized datasets, explainable AI frameworks, and robust clinical validation studies. By evaluating AI technologies-such as deep learning, wearable biosensors, mobile applications, and natural language processing-we propose a roadmap for integrating advanced AI methods into surgical practice, aiming ultimately to enhance clinical outcomes and patient care.

Background: Morel-Lavallee lesions (MLLs) are rare closed soft tissue degloving injuries caused by shearing forces that separate skin and subcutaneous tissue from underlying fascia. These injuries may be underrecognized in polytrauma patients, increasing the risk of delayed diagnosis, infection, prolonged healing, and long-term morbidity. This scoping review aims to provide a comprehensive summary of clinical presentation, imaging features, and evolving management for MLLs, with the goal of identifying gaps in the literature and guiding clinical decision making.

Methods: We systematically searched PubMed, Scopus, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov between 1992 and 2025 for studies pertaining to adult patients with MLLs. Four independent reviewers screened full texts for inclusion. Data were extracted and summarized using narrative synthesis. Of 633 unique articles, 102 underwent full-text review, and 69 studies met inclusion/exclusion criteria.

Results: MLLs commonly present with fluctuance, ecchymosis, swelling, and skin hypermobility. Diagnosis is clinical, with imaging playing a supportive role. Computed tomography and ultrasound can aid diagnosis in acute trauma settings, while magnetic resonance imaging is best for evaluating composition, chronicity, and extent. Management strategies vary based on size, chronicity, and anatomic locations. Acute lesions may be managed with compression or aspiration. Chronic or recurrent MLLs often require sclerodesis, minimally invasive debridement, or open surgical excision, often with subsequent soft tissue reconstruction.

Conclusions: MLLs remain a diagnostic and therapeutic challenge in trauma. Given the heterogeneity of existing evidence, high-quality prospective studies are needed to establish evidence-based optimal management guidelines and improve long-term outcomes.

In the practice of breast surgery, positive margins are a troublesome pathologic finding associated with an increased risk of local recurrence and the recommendation of re-excision. For this reason, there is an emphasis placed on negative margins for breast surgeries. In this study, we analyze surgical resident involvement in breast cancer operations and associations with margin status.MethodsA retrospective study was completed of adult female patients who underwent a lumpectomy by a single surgeon. The surgeries were categorized by resident involvement in the surgical procedure. Other variables assessed were cancer type, grade, size, neoadjuvant chemotherapy use, and oncoplastic surgery. Variables were evaluated to determine what associated with a positive margin.ResultsWhen comparing cases with and without resident involvement, no statistically significant differences were noted in patient age (65.46 ± 1.76 years vs. 66.14 ± 9.31 years, P = .560), neoadjuvant therapy (11.8% vs. 8.0%, P =.273), and tumor size (12 mm vs. 13 mm, P =.871). The number of positive margins did not differ statistically whether a resident was involved or not (20.3% vs. 16.7%, P =.420). The only variable associated with increased positive margins was adenocarcinoma mixed with ductal carcinoma in situ (DCIS) and pure DCIS, which was associated with the greatest proportions of positive margins.DiscussionUnlike some previous studies, our data reinforces it is safe to involve residents in breast conservation surgery. Specifically, program year did not significantly impact margin status. Thus, surgical training should continue to involve residents in breast surgery without fear of providing suboptimal care.

BackgroundThoracic outlet syndrome (TOS) is a complex neurovascular condition that remains challenging to diagnose, particularly neurogenic TOS (nTOS), which comprises most cases. While vascular TOS has clear diagnostic criteria, nTOS diagnosis relies on clinical assessments, imaging, and electrophysiologic studies. Scalene and pectoralis minor muscle blocks have been proposed as diagnostic tools, but their accuracy remains uncertain.ObjectiveThis systematic review and meta-analysis assesses the pooled sensitivity, specificity, and diagnostic accuracy of scalene and pectoralis minor blocks for TOS.MethodsA systematic literature search was performed across PubMed, Embase, Scopus, Cochrane Library, Web of Science, and Google Scholar following PRISMA guidelines. Studies evaluating the diagnostic accuracy of these blocks for TOS were included. The QUADAS-2 and Newcastle-Ottawa Scale were used for quality assessment. A meta-analysis using RevMan and STATA assessed pooled sensitivity, specificity, and diagnostic odds ratios (DORs).ResultsOf the 180 reports yielded by the search, 12 studies met inclusion criteria (950 patients). Pooled sensitivity for scalene and pectoralis minor blocks was 87% (95% CI: 83%-90%), while specificity was 34% (95% CI: 26%-43%). The diagnostic odds ratio was 3.98 (95% CI: 2.50-6.34). Substantial heterogeneity was observed (I² = 68%, P < 0.001), attributed to variations in injection protocols, outcome definitions, and patient selection.ConclusionScalene and pectoralis minor blocks have high sensitivity but low specificity for TOS diagnosis. Their use as stand-alone diagnostic tools is limited. However, they may be valuable within a multimodal diagnostic framework integrating clinical evaluation, imaging, and electrophysiologic testing.

BackgroundLaparoscopic inguinal hernia repair is widely adopted for its minimally invasive benefits, but the optimal management of the hernia sac-transection or complete reduction-remains uncertain.MethodsA comprehensive literature search was conducted in both English and Chinese databases to identify randomized controlled trials (RCTs) comparing sac transection with complete sac reduction in laparoscopic inguinal hernia repair. Meta-analysis was performed using RevMan 5.3 software. The quality of evidence for each outcome was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.ResultsA total of 8 RCTs involving 627 patients with inguinal hernia were included. Meta-analysis indicated that, compared to the completely reduced sac (RS) group, the transected sac (TS) group had shorter operation time (MD = -13.95 minutes, 95% CI (-20.56, -7.34), P < .0001) and a lower overall postoperative complication rate (RR = 0.52, 95% CI (0.35, 0.78), P = .001). There were no statistically significant differences between the two groups in terms of postoperative 24-hour VAS pain scores (MD = -0.83, 95% CI (-2.60, 0.94), P = .36), length of hospital stay (MD = -0.39 days, 95% CI (-0.80, 0.01), P = .05), incidence of seroma (RR = 1.41, 95% CI (0.88, 2.26), P = .15), and recurrence rate (RR = 0.67, 95% CI (0.26, 1.71), P = .40).ConclusionThe results of this meta-analysis indicate that sac transection in laparoscopic inguinal hernia repair provides the benefits of shorter operation times and lower rates of overall postoperative complications.

Artificial intelligence (AI) has rapidly emerged as a transformative force in surgical research, driving innovation in preoperative planning, intraoperative guidance, workflow optimization, and academic productivity. Advances in computational power and multimodal data have expanded applications beyond retrospective analytics and predictive modeling to real-time clinical decision support. Current use cases span AI-assisted three-dimensional planning, automated scheduling, and ambient scribe technology. Simultaneously, large language models are increasingly applied to literature synthesis, data analysis, and manuscript development. Yet, this rapid integration raises critical ethical concerns, including algorithmic bias, data privacy, model opacity, and issues of accountability and generalizability. This review synthesizes recent technological advancements and examines these ethical challenges, proposing structured frameworks for responsible implementation. By embedding principles of transparency, equity, and patient safety, the surgical research community can ensure AI innovation translates into meaningful and trustworthy improvements in care.

BackgroundCannabis use has increased in recent years, often perceived as therapeutic for psychiatric symptoms including those of posttraumatic stress disorder (PTSD). However, the relationship between pre-trauma tetrahydrocannabinol (THC) use and development of PTSD symptoms after injury remains poorly defined. The purpose of this study was to determine the association between THC use and positive screening for posttraumatic stress symptoms using the Posttraumatic Adjustment Scale (PAS) in trauma patients.MethodsThis retrospective cohort study used data from a Level 1 trauma center between January 2023 and December 2024. Adult trauma patients who completed inpatient PAS screening were included. Patients were stratified into PAS-positive and PAS-negative groups. THC use was identified via urine drug screen on admission. Multivariable logistic regression was used to evaluate independent predictors of a positive PAS screen, adjusting for age, sex, injury severity, assault mechanism, polysubstance use, ICU admission, and in-hospital complications.ResultsAmong 1960 patients, 437 (22.3%) screened positive on PAS. Tetrahydrocannabinol use was more common in PAS-positive patients (19.6% vs 13.2%, P = 0.001) and remained independently associated with a positive PAS screen after adjustment (OR 1.66, 95% CI 1.23-2.24, P = 0.001). Other independent predictors included polysubstance use, younger age, assault-related injury, and longer hospital stay. Male sex was associated with lower odds of a positive PAS screen.ConclusionsRecent THC use is independently associated with positive PAS screening in trauma patients, suggesting that baseline cannabis use may signal heightened vulnerability to psychological distress following trauma. These findings raise concern about the role of THC as self-medication and highlight the need for targeted screening and intervention.

BackgroundVascular injury is a feared complication of minimally invasive median arcuate ligament (MAL) release. The identified elements of variant anatomy that predispose to injury.MethodsBetween August 2018 and March 2025, 64 patients underwent laparoscopic (51) or robotic (13) median arcuate ligament release operation. Surgical anatomy was prospectively recorded with respect to variants of vascular and visceral anatomy.ResultsOnly 17 cases (27%) had no observed anatomical variant. Visceral arterial variants occurred in 15 cases (23%), and included: Accessory left hepatic artery in 8 (requiring division in 6); common hepatic artery (CHA) variants were observed in 2 cases and included replaced CHA and early origin CHA; 5 left gastric artery (LGA) variants included early origin (N = 3) or duplicated LGA (N = 2). One or both IPA originated from the celiac artery in 32 cases (50%), of which anterior origin off the celiac was seen in 20 cases (31%). Both IPA originated separately from the anterior celiac in 2 cases, and from a common trunk in 9 cases (14%). One IPA arising from the anterior celiac was observed in 8 cases (13%). The coronary vein (CV) inserted into the portal vein superior to the CHA in 6 cases (9%), and coursed parallel to the CHA in 16 cases (25%). A high riding pancreas necessitating retraction was seen in 9 cases (14%).ConclusionMost patients undergoing median arcuate ligament release have elements of complexity that increase the difficulty of operation or increase operative risk.

Introduction: The risk of ovarian malignancy is increasing in patients with a history of breast cancer. Thus, well-defined predictors of ovarian malignancy should be identified to determine surgical or conservative management of adnexal masses in women with breast cancer. This study aimed to clarify the predictors of malignant ovarian tumors in patients with breast cancer with an isolated adnexal mass. Methods: Breast cancer patients diagnosed with an adnexal mass who underwent surgery between 2010 and 2021 at a tertiary cancer center were included in the study. Patients with suspected extra ovarian metastases were excluded. Results: A total of 40 breast cancer patients who underwent surgery for ovarian masses were identified. 23 (57.5%) women had benign ovarian tumors and 17 (42.5%) had malignant ovarian tumors. Among the malignant ovarian tumors, there were three (17.6%) metastatic breast cancers in the ovary and 14 (82.4%) primary ovarian cancers. In univariate analyses, the risk of malignant ovarian tumors increased in women with age >52 years (P = .012), postmenopausal status (P = .023), CA 125 ≥ 35 IU/ml (P = .001), CA 15-3 ≥ 32 IU/ml (P = .002), and complex ovarian masses (P < .001). Ovarian malignancies were observed in 82.4% of patients who had complex ovarian masses. Conclusion: Ovarian malignancies were diagnosed in 82.4% of the breast cancers who had complex ovarian mass on USG examination. Therefore, surgery is recommended in women with complex ovarian masses. Postmenopausal status, age >52 years, CA 125 ≥ 35 IU/ml, and CA 15-3 ≥ 32 were other risk factors for ovarian malignancy.