American Surgeon最新文献

This perspective examines recent legislation in multiple U.S. states that allows foreign-trained physicians (FTPs) to obtain medical licensure without completing an ACGME-accredited residency or fellowship. While these laws aim to address physician shortages, they raise important concerns for surgical education and patient care. The article outlines how current licensure pathways lack mechanisms to verify equivalence of international training and may disrupt residency and fellowship training. Moreover, although the policies are framed as rural workforce solutions, most provisional license placements occur in urban academic centers, with no mandate for rural service. Further, the article highlights risks to informed consent, noting that patients may unknowingly receive surgical care from providers who did not complete U.S.-based training, a fact not currently subject to mandatory disclosure. Ultimately, the article calls for greater oversight, transparency, and alignment of these policies with educational and ethical standards to ensure they do not compromise the quality of surgical care.

BackgroundComponent separation technique (CST) has emerged as a novel surgical strategy in the management of large and complex hernia defects. Although prior work has associated CST with decreased hernia recurrence and improved clinical outcomes, the impact of hospital-level variation in component separation utilization remains understudied.MethodsThis retrospective cohort study investigated the impact of operative volume on outcomes in patients undergoing CST. All adult (≥18 years) records for elective CST procedures were tabulated using the 2016-2021 Nationwide Readmissions Database. Hospitals ranked in the top quartile of annual CST volume were defined as high-volume hospitals (HVH; others LVH, MVH, and MHVH). Multivariable regression models were developed to characterize the association between HVH status and outcomes of interest.ResultsOf an estimated 12 720 patients undergoing component separation, 3359 (26.3%) underwent treatment at HVH. Although CST utilization increased significantly over the study period, the total number of high-volume centers remained relatively stable. Additionally, Medicaid recipient status, lowest income quartile, and treatment at rural hospitals were all associated with lower odds of component separation use. Following comprehensive risk adjustment, HVH status was associated with decreased odds of major adverse events (AOR [adjusted odds ratio] 0.75, 95% CI [0.61, 0.91], P = 0.003). However, the HVH cohort had similar resource utilization compared to their LVH, MVH, and MHVH counterparts.DiscussionHigher CST hospital volume was linked with improved clinical outcomes without increased resource utilization. Persistent disparities in component separation utilization highlight the need for protocol standardization and expanded access to specialized surgical care nationally.

Background: Primary surgery in metastatic breast cancer (MBC) has been a subject of debate in part due to the heterogeneity of the results of individual studies. We synthesized evidence from the existing randomized clinical trials (RCTs) to evaluate the effect of primary surgery on health-related quality of life (HRQoL) in MBC. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and ClinicalTrials.gov and gray literature till January 2025. Included were RCTs among patients with MBC for whom outcome data on HRQOL was reported. Results: Of the 1019 records screened, four RCTs (961 patients) were included. The risk of bias was high in one RCT and moderate in three. Four HRQoL tools were deployed. Three moderate-quality RCTs measured HRQoL specifically at 18 months: One was in favor of surgery (BR23 18.7 vs. 10.0, P = 0.009), one showed no difference (BR23 10.4 vs. 12.0, P = 0.45), and one was in favor of avoiding surgery (FACT-B 74.2 vs. 68.0, P = 0.005). Two moderate-quality RCTs measured HRQoL generically at 18 months: None showed any difference (C30 64.7 vs. 60.0, P = 0.3 and C30 63.5 vs 68.7, P = 0.2). One low-quality RCT measured HRQoL generically at 36 months: It showed no difference (SF-12 40.8 vs. 43.4, P = 0.34). Primary surgery improved specific HRQoL at 18 months in one study and deteriorated in another, compared to non-surgical treatment, among moderate-quality trials. Conclusion: The pros and cons of surgery as a palliative option should be considered in shared decision-making for improving life quality among individual patients.

The American Surgeon, as the official journal of the Southeastern Surgical Congress (SESC), serves as a central component of the society's educational mission to support the development of surgeons, trainees, and clinical educators across the southeastern United States. Historically, manuscripts originating from annual meeting presentations were reviewed by publication committees rather than through formal peer review. As the journal matured and its citation record and Impact Factor grew in importance, The American Surgeon adopted a uniform policy requiring that all submissions-whether meeting-derived or independently submitted-undergo full anonymized peer review. This transition heightened expectations for scholarly rigor and placed new demands on trainees and clinical faculty whose primary responsibilities often center on education and patient care rather than research.To meet this challenge while preserving the society's educational ethos, the journal introduced a structured Pre-Peer Review (Pre-PR) process grounded in four evaluative elements: Suitability Assessment, Editorial Domain Alignment, Readability and Language Assessment, and Positioning, Contextualization, and Currency. Together, these components provide a pedagogically oriented framework that improves manuscript clarity, coherence, and relevance prior to peer review. Authors receive a concrete revision plan and a concise coaching note that identifies actionable steps for strengthening their work. This approach transforms what might otherwise be a discouraging editorial barrier into a formative experience that enhances the quality of submissions and fosters scholarly growth. By integrating structured coaching with transparent editorial standards, The American Surgeon advances both its mission as a peer-reviewed journal and its longstanding commitment to the educational objectives of the SESC.

BackgroundPulmonary benign metastasizing leiomyoma (PBML), characterized by histologically benign lung metastases from uterine leiomyomas, represents a rare hormone-dependent entity with enigmatic pathogenesis. The aim of the study was to define the clinical-radiological features and therapeutic management of pulmonary benign metastasizing leiomyoma.MethodsA total of 115 cases of PBML in women were reviewed, including 105 cases selected from PubMed and 10 cases treated at our institution from 2014 to 2025. Data encompassed clinical history, imaging findings, pathological diagnosis, treatments, and follow-up outcomes. A comprehensive literature review was undertaken. No prospective interventions were performed.ResultsA systematic review identified 105 published PBML cases. Combined with our institutional cohort (n = 10), analysis of 115 patients revealed a median age of 46 years, with bilateral pulmonary nodules present in 68.7% of cases and a history of uterine surgery in 92.1%. Immunohistochemistry consistently showed positivity for smooth muscle markers (90%), estrogen receptor (86.3%), and progesterone receptor (88.2%). Surgical resection of pulmonary lesions was performed in 42.6% (49/115) of patients and was associated with a favorable prognosis, with 85.2% (41/48) of surgically managed patients achieving disease-free status during follow-up.ConclusionPulmonary benign metastasizing leiomyoma is a rare hormone-dependent neoplasm linked to uterine leiomyoma. Pathological verification remains essential for diagnosis. Surgical resection may correlate with favorable outcomes, necessitating long-term recurrence surveillance.

Objectiveto compare the safety and efficacy of robotic surgery and traditional open surgery in living donor liver hepatectomy.MethodsThis meta-analysis included 9 retrospective studies involving a total of 3379 patients, evaluating the primary and secondary outcomes of robotic surgery versus open surgery in donors and recipients. Binary variables were analyzed using odds ratios (ORs) and 95% confidence intervals (CIs), while continuous variables were analyzed using standardized mean differences (SMDs) and 95% CI.ResultsRobotic donor hepatectomy demonstrated significantly longer operative time (SMD = 1.26, 95% CI 0.75-1.76, I² = 90.1%) and warm ischemia time (SMD = 2.24, 95% CI 0.94-3.53, I² = 97.4%) compared to open surgery, both with moderate certainty. Conversely, no significant differences were observed in intraoperative blood loss (SMD = -0.61, 95% CI -1.29 to -0.07), postoperative hospital stay (SMD = -0.36, 95% CI -0.78 to 0.07), overall Clavien-Dindo grades 1-2 complications (OR = 0.68, 95% CI 0.40-1.15), grades 3-4 complications (OR = 1.33, 95% CI 0.44-3.99), or bile leakage incidence (OR = 0.83, 95% CI 0.28-2.47) for donors. For recipients, robotic surgery significantly reduced both grades 1-2 (OR = 0.70, 95% CI 0.53-0.94) and grades 3-4 complications (OR = 0.65, 95% CI 0.50-0.84), while showing comparable perioperative mortality (OR = 1.36, 95% CI 0.84-2.19), hepatic artery thrombosis (OR = 1.19, 95% CI 0.64-2.21), and biliary complications (OR = 1.01, 95% CI 0.52-1.97).ConclusionRobotic living donor right hepatectomy demonstrates comparable donor safety and superior effectiveness in reducing recipient complications.

This article argues for universal adoption of gender-inclusive language in surgical care as a cornerstone of patient-centered practice. Despite evidence of mental health benefits from gender-affirming care, affirming language remains inconsistent, limited by inadequate training, rushed perioperative encounters, and absent institutional protocols. We present a practical framework for integrating inclusive language, including neutral greetings and de-gendered anatomical terms. These practices reduce misgendering and strengthen patient-provider rapport across all patients. We further call for systemic reforms in residency training, education, and institutional accountability. These changes are critical to upholding standards of equitable surgical practice amid current legislative threats to gender-affirming care.

BackgroundDespite the reported rise in both golf cart (GC) usage and associated trauma in the United States, epidemiologic data describing their neurological impact is scarce. This study aims to describe the incidence, mechanisms, and outcomes of GC-associated head trauma in patients requiring neurosurgical consultation.MethodsPatients at a single institution admitted for GC-related head trauma requiring neurosurgical consultation between November 2013 and August 2023 were retrospectively analyzed and described.ResultsA total of 97 patients were identified. Most patients presented with Glasgow Coma Score (GCS) on admission of 13 to 15 (93.81%) and modified Rankin scale (mRS) score of 0 to 2 (91.75%). The most common reported mechanism of injury was fall or jump from a moving GC (73.20%) and the most common diagnosis was intracranial hemorrhage (ICH) (57.73%). Five total patients (5.15%) required neurosurgical intervention with only one patient (1.03%) expiring secondary to their trauma. 94.85% of patients (n = 92) were discharged with mRS scores ranging from 0 to 2. Univariate linear regression analyses demonstrated that patient age, presenting GCS, admission mRS score of 3-6, alcohol intoxication, presence of intracranial bleed, and LOC were predictors of hospital LOS. Necessitation of neurosurgical intervention was significantly associated only with admission mRS between 3 and 6.DiscussionGC-related neurotrauma poses a serious yet potentially preventable health concern to drivers and bystanders alike. Policies regarding seatbelt usage and safety measures for GCs continue to vary widely state-to-state and require data to inform decisions. This is the largest study to-date evaluating the incidence, mechanisms, and outcomes of GC-associated neurotrauma.

Despite a record number of solid organs transplanted in 2023, ongoing issues with donor shortages leave thousands of people in the United States waiting. Increased utilization of donors after circulatory death (DCD) has been the primary driver of the increase in total transplants. Availability of newer technologies including normothermic machine perfusion (NMP), normothermic regional perfusion (NRP), and hypothermic machine perfusion (HMP) have been shown to attenuate ischemia-reperfusion injury and allow for graft viability assessment prior to implantation. Outcomes across all solid organs, especially in higher risk donors, have improved using machine perfusion to decrease rates of primary non-function and damage related to ischemia-reperfusion injury (IRI). Here, we present an overview of deceased donation practices across all solid organs.

In the rapidly advancing landscape of surgical education, the traditional apprenticeship model is being increasingly complemented by individualized learning, competency-based assessment, and data-driven feedback. Work-hour restrictions, administrative burdens, and limited operative exposure have intensified the need for innovative solutions to supplement faculty-led training. Artificial intelligence (AI) has emerged as a promising adjunct, offering scalable platforms for technical skill acquisition, personalized feedback, and structured progress tracking. Early applications include AI-guided simulation, feedback, natural language processing for resident evaluation, and advanced applicant-screening systems, which hold the potential to streamline holistic review while reducing faculty workload. Despite these advances, significant challenges remain, including bias mitigation, ethical data governance, and the need for rigorous outcome-based validation. The greatest promise lies in hybrid models, where AI augments rather than replaces mentorship, freeing faculty for complex, context-dependent teaching. With careful implementation, AI is poised to meaningfully transform surgical education worldwide.