JAMA surgery最新文献

{"title":"Open Anterior Mesh Repair vs Modified Open Anterior Mesh Repair for Groin Hernia in Women: A Randomized Clinical Trial.","authors":"Alphonsus Matovu,Pär Nordin,Andreas Wladis,Gabriel Sandblom,Moses Elaju,Fredrik Lindmark,Olof Bladin,Jenny Löfgren","doi":"10.1001/jamasurg.2025.2244","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2244","url":null,"abstract":"ImportanceMost women in low- and middle-income countries lack access to laparoscopic methods for groin hernia repair; therefore, an open technique through which both inguinal and femoral hernias can be treated is needed. This could be an option in the absence or inability to use laparoscopic methods.ObjectiveTo determine the safety and effectiveness of open anterior mesh (OAM) repair compared with modified open anterior mesh (MOAM) repair, which includes opening the transversalis fascia and covering the femoral canal with a mesh flap.Design, Setting, and ParticipantsThis was a parallel, 2-arm, double-blind, randomized clinical trial conducted in Northern Uganda, in East Africa, at 2 public hospitals between October 2019 and February 2023. Included in the study were adult women 18 years and older with a primary groin hernia, American Society of Anesthesiologists (ASA) class I or II, and the ability to give informed consent.InterventionsOAM in the control arm and MOAM in the intervention arm.Main Outcomes and MeasuresThe primary outcome was groin hernia recurrence 1 year postoperatively.ResultsA total of 200 participants (mean [SD] age, 52.7 [14.0] years) were included in the study; 99 (49.5%) were allocated to OAM repair, and 101 (50.5%) were allocated to MOAM repair. Nearly 45% of the participants (89 of 200) had a femoral hernia; therefore, 35 of 99 participants (35.4%) in the control arm received the intervention procedure. One year postoperatively, the overall recurrence was 5.6% (11 of 195 participants), and the intention-to-treat analysis showed that 4 of 97 participants (4.1%) in the control arm and 7 of 98 participants (7.1%) in the intervention arm had recurrence (absolute difference = -3.0 percentage points; 95% CI, -9.5 to 3.4; P = .36).Conclusions and RelevanceResults of this randomized clinical trial demonstrate that the MOAM repair was a good option for groin hernia repair in women in low-resource settings. Femoral hernias were very common in the study population, and exposure of the femoral canal was essential to detect these hernias.Trial RegistrationISRCTN Identifier: ISRCTN10330683.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"12 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locating Parathyroid Glands in Thyroid Surgery-Eye of the Beholder.","authors":"Martin Almquist","doi":"10.1001/jamasurg.2025.2222","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2222","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"104 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repairing Groin Hernias in Women-Another Reason to Democratize Laparoscopy.","authors":"Thomas G Weiser","doi":"10.1001/jamasurg.2025.2223","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2223","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"10 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Large Language Models for Surgical Case Length Prediction.","authors":"Adhitya Ramamurthi,Bhabishya Neupane,Priya Deshpande,Ryan Hanson,Srujan Vegesna,Deborah Cray,Bradley H Crotty,Melek Somai,Kellie R Brown,Sachin S Pawar,Bradley Taylor,Anai N Kothari","doi":"10.1001/jamasurg.2025.2154","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2154","url":null,"abstract":"ImportanceAccurate prediction of surgical case duration is critical for operating room (OR) management, as inefficient scheduling can lead to reduced patient and surgeon satisfaction while incurring considerable financial costs.ObjectiveTo evaluate the feasibility and accuracy of large language models (LLMs) in predicting surgical case length using unstructured clinical data compared to existing estimation methods.Design, Setting, and ParticipantsThis was a retrospective study analyzing elective surgical cases performed between January 2017 and December 2023 at a single academic medical center and affiliated community hospital ORs. Analysis included 125 493 eligible surgical cases, with 1950 used for LLM fine-tuning and 2500 for evaluation. An additional 500 cases from a community site were used for external validation. Cases were randomly sampled using strata to ensure representation across surgical specialties.ExposuresEleven LLMs, including base models (GPT-4, GPT-3.5, Mistral, Llama-3, Phi-3) and 2 fine-tuned variants (GPT-4 fine-tuned, GPT-3.5 fine-tuned), were used to predict surgical case length based on clinical notes.Main Outcomes and MeasuresThe primary outcome was average error between predicted and actual surgical case length (wheels-in to wheels-out time). The secondary outcome was prediction accuracy, defined as predicted length within 20% of actual duration.ResultsFine-tuned GPT-4 achieved the best performance with a mean absolute error (MAE) of 47.64 minutes (95% CI, 45.71-49.56) and R2 of 0.61, matching the performance of current OR scheduling (MAE, 49.34 minutes; 95% CI, 47.60-51.09; R2, 0.63; P = .10). Both GPT-4 fine-tuned and GPT-3.5 fine-tuned significantly outperformed current scheduling methods in accuracy (46.12% and 46.08% vs 40.92%, respectively; P < .001). GPT-4 fine-tuned outperformed all other models during external validation with similar performance metrics (MAE, 48.66 minutes; 95% CI, 45.31-52.00; accuracy, 46.0%). Base models demonstrated variable performance, with GPT-4 showing the highest performance among non-fine-tuned models (MAE, 59.20 minutes; 95% CI, 56.88 - 61.52).Conclusion and RelevanceThe findings in this study suggest that fine-tuned LLMs can predict surgical case length with accuracy comparable to or exceeding current institutional scheduling methods. This indicates potential for LLMs to enhance operating room efficiency through improved case length prediction using existing clinical documentation.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"146 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allocation Out of Sequence in Lung Transplant: An Analysis of the UNOS Registry.","authors":"Samantha E Halpern,Ruby Singh,Oliver K Jawitz,Ahmed Gurses,Isaac S Alderete,Jacob A Klapper,Lucy Nam,Matthew G Hartwig,Asishana A Osho,Kunal J Patel","doi":"10.1001/jamasurg.2025.2142","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2142","url":null,"abstract":"ImportanceAllocation out of sequence (AOOS) allows organ procurement organizations (OPOs) to offer organs outside of standard allocation and bypass those atop the match run. AOOS may allow OPOs to successfully place medically complex organs; however, increasing use of AOOS also raises concern for inefficiencies within the allocation process and may exacerbate systemic inequities.ObjectiveTo characterize patterns of lung AOOS among organ procurement organizations and transplant centers and compare lung transplant characteristics and outcomes between in-sequence and AOOS groups.Design, Setting, and ParticipantsIn this retrospective cohort study, the United Network for Organ Sharing registry was queried for lung transplants performed between September 1, 2021, and June 30, 2024. Data were linked to the Potential Transplant Recipient file to identify all offers for included donor lungs. These data were analyzed from October 2024 to February 2025. Participants included adult donors who donated at least 1 lung for transplant and corresponding primary isolated lung transplant recipients. The final cohort included 7914 lung donor-recipient pairs.Exposure(s)Lung AOOS vs in sequence, defined by match-run refusal codes for donor lung offers.Main Outcome(s) and Measure(s)Donor and recipient characteristics, posttransplant outcomes, and OPO-level and transplant center-level rates of lung AOOS.ResultsOverall, 7914 lung transplants were included, of which 558 used AOOS (7.1%). Rates of lung AOOS ranged from 0% to 30% among OPOs and 0% to 50% among transplant centers. Use of lung AOOS increased in the continuous distribution era (10% vs 4%; P < .001). Donors of AOOS lungs were more likely to donate after circulatory death and had lower partial pressure of oxygen/fraction of inspired oxygen ratios, longer ischemic times, and longer travel distances. AOOS recipients were less likely to require pretransplant hospitalization, intensive care, and ventilator or extracorporeal membrane oxygenation support. On multivariable analysis, lung AOOS was associated with lower odds of prolonged intubation and early acute rejection and shorter posttransplant hospital length of stay.ConclusionsAOOS is increasingly used in lung transplant and is associated with transplant of medically complex lungs into lower acuity recipients. Further investigation is needed to understand how AOOS affects lung utilization, especially in the era of continuous distribution.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"21 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supervised Exercise Therapy in Patients With Claudication Undergoing Endovascular Peripheral Vascular Intervention.","authors":"Chen Dun,Terrence C Tsou,Andrew Wu,Midori White,Katherine M McDermott,Corey A Kalbaugh,Jesse A Columbo,Maya Salameh,Caitlin W Hicks","doi":"10.1001/jamasurg.2025.2136","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2136","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"3 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I Can See (Myelin) Clearly Now.","authors":"Rachel B Atkinson,Eric G Sheu","doi":"10.1001/jamasurg.2025.1979","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1979","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"648 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Shared Decision-Making and Patient-Reported Outcomes.","authors":"George Q Zhang,Orly N Farber,Elizabeth J Lilley,Felix O Akinbami,Jennifer E Fanning,Jill Steinberg,Ronald Bleday,Andrea L Pusic,Jason B Liu","doi":"10.1001/jamasurg.2025.2059","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2059","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"304 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rizedisben in Minimally Invasive Surgery: A Nonrandomized Clinical Trial.","authors":"Samuel A Gold,Maria M Pere,Melissa Assel,Alexander D Doudt,Trey D Durdin,Andrew W Silagy,Lucas W Dean,Pedro Recabal,Erica Levine,Alan Burke,Govind Ragupathi,Mohammad R Marzabadi,Zhong-Ke Yao,Guangbin Yang,Guangli Yang,Ouathek Ouerfelli,Melissa McCarter,Xi Chen,Efstathia Tzatha,Jonathan A Coleman,Alvin C Goh,Robert C Smith,Behfar Ehdaie,Andrew J Vickers,Peter T Scardino,James A Eastham,Vincent P Laudone,Timothy F Donahue","doi":"10.1001/jamasurg.2025.1987","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1987","url":null,"abstract":"ImportanceFluorescence-guided surgery aims to improve intraoperative identification of vital structures. Rizedisben is a myelin-binding fluorophore that fluoresces in the blue light (370-425 nm) spectrum to improve intraoperative nerve identification.ObjectiveTo determine the optimal safe and clinically effective dose of rizedisben for sustained intraoperative fluorescence of nerve structures.Design, Setting, and ParticipantsA single-arm, open-label, phase 1 study was conducted in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) at an urban academic cancer center in New York City between January 2023 and October 2024. Using a dose escalation design, increasing doses of rizedisben were administered after safety was assessed at each level until a clinically effective dose was determined. The obturator nerve served as the reference nerve for measuring fluorescence intensity. Eligible patients were 18 years old and older, diagnosed with prostate cancer, and scheduled for RALP. Patients were recruited in preoperative clinic visits once deemed eligible for the study. Those with prior pelvic surgery or radiation, known central or peripheral nervous system disease, current use of neurotoxic medications, recent exposure to phototoxic drugs, or serious kidney or liver dysfunction were excluded.InterventionsRizedisben was intravenously administered intraoperatively 30 minutes prior to visualization of the obturator nerve.Main Outcomes and MeasuresSafety was assessed through 45 postoperative days. Fluorescence was measured via subjective intraoperative scoring and by post hoc objective image analysis. Clinically effective dose was defined as achieving sustained fluorescence of the obturator nerve in 3 or more of 5 patients in 2 consecutive cohorts, provided fewer than 20% of patients experienced grade 2 or greater toxicity. Sustained fluorescence was defined as moderate or better fluorescence for 90 minutes or longer. At the clinically effective dose, fluorescence assessments of the neurovascular bundles were included.ResultsThirty-eight patients (median [IQR] age, 61.5 [57.8-66.3] years) enrolled in and completed the trial. Dosing was escalated from 0.25 to 3.0 mg/kg. There was 1 grade 2 adverse event (rash) possibly attributable to rizedisben. Sustained fluorescence of the obturator nerve was achieved in all patients at 3.0 mg/kg. Prostate neurovascular bundles demonstrated evidence of fluorescence in 8 of 9 (89%) patients at 3.0 mg/kg.Conclusions and RelevanceIn this phase 1 trial of rizedisben, the 3.0-mg/kg dose was shown to be generally well tolerated and clinically effective. At this dose, there was excellent sustained fluorescence of the obturator nerves, and the neurovascular bundles were visualized in 8 of 9 patients. Based on these data, we are designing phase 2 studies with rizedisben for additional indications.Trial RegistrationClinicalTrials.gov Identifier: NCT04983862.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"46 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Local Therapy for Rectal Cancer in the Era of Precision Oncology-When Less Is More.","authors":"Aron Bercz, Philip S Bauer, J Joshua Smith","doi":"10.1001/jamasurg.2025.1377","DOIUrl":"10.1001/jamasurg.2025.1377","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"793-794"},"PeriodicalIF":15.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}