Surgery最新文献

{"title":"Impact of surgical approach on gastric cancer surgery based on textbook outcome: Open, laparoscopic, and robotic surgery-A retrospective cohort study.","authors":"Elisenda Garsot Savall, Arantxa Clavell, Sebastià Videla, Natalia Pallarès, Cinta Hierro, Cristina Bugés, Sergio Alonso, Marta Viciano","doi":"10.1016/j.surg.2026.110205","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110205","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer surgery is evolving toward minimally invasive techniques such as laparoscopic and robotic gastrectomy. This study assesses surgical quality through the textbook outcome, a composite measure reflecting optimal perioperative results. We compared textbook outcome achievement across open gastrectomy, laparoscopic gastrectomy, and robotic gastrectomy, and its association with 1-year mortality.</p><p><strong>Methods: </strong>A retrospective cohort of patients with gastric or esophagogastric junction cancer undergoing curative gastrectomy between 2014 and 2023 at a tertiary center was analyzed. Surgical approaches included open gastrectomy, laparoscopic gastrectomy, and robotic gastrectomy. Textbook outcome was used to evaluate surgical quality. Inverse probability weighting balanced baseline characteristics across groups. Multivariable logistic regression and weighted Cox models explored associations between surgical approach, textbook outcome, and 1-year mortality.</p><p><strong>Results: </strong>Two hundred patients were included: 53 open gastrectomy, 103 laparoscopic gastrectomy, and 44 robotic gastrectomy. After inverse probability weighting adjustment, minimally invasive approaches showed superior outcomes. Textbook outcome was achieved in 31.4% (95% confidence interval: 15.2%-53.9%) of open gastrectomy, 56.8% (95% confidence interval: 46.5%-66.6%) of laparoscopic gastrectomy, and 68.6% (95% confidence interval: 51.5%-81.8%) of robotic gastrectomy patients, mainly due to higher R0 resection rates and adequate lymphadenectomy (≥15 nodes). Hospital stay was shorter in laparoscopic gastrectomy and robotic gastrectomy. Achieving textbook outcome was independently associated with higher 1-year survival across all approaches.</p><p><strong>Conclusion: </strong>This is the first Western study evaluating surgical quality using textbook outcome across gastrectomy approaches. Both laparoscopic gastrectomy and robotic gastrectomy achieved higher textbook outcome rates than open gastrectomy, with robotic gastrectomy showing the best outcomes, largely driven by improved oncological resection. Textbook outcome achievement correlated with significantly improved 1-year overall survival.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110205"},"PeriodicalIF":2.7,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Questioning adjuvant therapy and surveillance in octogenarians after right hemicolectomy","authors":"Giovanni Taffurelli MD, PhD ,&nbsp;Isacco Montroni MD, PhD ,&nbsp;Federico Ghignone MD ,&nbsp;Francesca Sivieri MD ,&nbsp;Davide Zattoni MD ,&nbsp;Giacomo Frascaroli MD ,&nbsp;Federico Mazzotti MD ,&nbsp;Giampaolo Ugolini MD, PhD","doi":"10.1016/j.surg.2025.110053","DOIUrl":"10.1016/j.surg.2025.110053","url":null,"abstract":"<div><h3>Background</h3><div>As the population ages, more octogenarians are diagnosed with colorectal cancer. Their high comorbidity and mortality risk complicate decisions on adjuvant therapy and surveillance. This study compared outcomes of right hemicolectomy in older versus younger patients and identified predictors of noncancer mortality.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 400 patients undergoing elective laparoscopic right hemicolectomy for stage I–III right-sided colon cancer at a tertiary center (2017–2024). Patients were stratified by age (&lt;80 vs ≥80 years); those aged ≥70 years were screened for frailty. Outcomes included short-term morbidity, disease-free survival, overall survival, and noncancer mortality. Fine-Gray regression identified predictors of noncancer death.</div></div><div><h3>Results</h3><div>Of 400 patients, 180 (45%) were aged ≥80 years. Octogenarians had higher comorbidity (Age-Adjusted Charlson Comorbidity Index &gt;6 in 68.3% vs 22.3%, <em>P</em> &lt; .001). Laparoscopic surgery was safe across groups, with similar conversion and leak rates but different 90-day mortality (4.4% vs 0%, <em>P</em> = .002). Disease-free survival was comparable (55.2 vs 54.6 months, <em>P</em> = 1.000), but overall survival was lower in older patients (62 vs 91 months, <em>P</em> &lt; .001). Age ≥80 years (subdistribution hazard ratio 4.55, 95% confidence interval 1.63–12.7) and Age-Adjusted Charlson Comorbidity Index &gt;6 (subdistribution hazard ratio 2.45, 95% confidence interval 1.15–6.0) independently predicted noncancer mortality, which reached 40.4% at 5 years in patients aged ≥80 years with high comorbidity.</div></div><div><h3>Conclusions</h3><div>Laparoscopic right hemicolectomy is safe in octogenarians, with recurrence outcomes comparable to younger patients. However, competing noncancer mortality in those with significant comorbidities limits the benefit of adjuvant therapy and intensive surveillance. Postoperative management should be tailored to comorbidity burden rather than age alone.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110053"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing costs versus savings using fluorescence angiography with indocyanine green for colorectal surgery in the United States: Multifaceted meta-analysis and cost analysis","authors":"Patrick Goldhawk-White BSc ,&nbsp;Kevin White MD, PhD ,&nbsp;Manish Chand MBA, PhD ,&nbsp;Danny A. Sherwinter MD ,&nbsp;Steven Wexner MD, PhD(Hon)","doi":"10.1016/j.surg.2025.110072","DOIUrl":"10.1016/j.surg.2025.110072","url":null,"abstract":"<div><h3>Background</h3><div>Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography.</div></div><div><h3>Methods</h3><div>Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021–2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography–associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration.</div></div><div><h3>Results</h3><div>Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million.</div></div><div><h3>Conclusion</h3><div>For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110072"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term parietal complications following surgery for inflammatory colitis: An underestimated issue","authors":"Océane Lelièvre MD ,&nbsp;Solafah Abdalla MD, PhD ,&nbsp;Aurélien Amiot MD, PhD ,&nbsp;Antoine Meyer MD, PhD ,&nbsp;Franck Carbonnel MD, PhD ,&nbsp;Christophe Penna MD, PhD ,&nbsp;Stéphane Benoist MD, PhD ,&nbsp;Antoine Brouquet MD, PhD","doi":"10.1016/j.surg.2026.110082","DOIUrl":"10.1016/j.surg.2026.110082","url":null,"abstract":"<div><h3>Background</h3><div>Surgical management of inflammatory colitis often requires a staged approach with multiple procedures. Data on incidence, risk factors, and management of parietal complications remain limited.</div></div><div><h3>Methods</h3><div>All adult patients who underwent surgery for inflammatory colitis between March 2010 and May 2024 were included. The primary endpoint was the incidence of incisional hernia, parastomal hernia, or stoma prolapse after complete surgical treatment. Risk factors were assessed, with age, body mass index ≥25 kg/m², and permanent stoma retained for multivariate analysis.</div></div><div><h3>Results</h3><div>One hundred nine patients underwent surgery for refractory colitis (<em>n</em> = 32; 29%), severe acute colitis (<em>n</em> = 58; 54%), and dysplasia (<em>n</em> = 19; 17%). Single or staged procedures resulted in 73 ileal pouch-anal anastomoses (67%), 23 ileorectal anastomoses (21%), and 13 nonrestorative proctocolectomies with end ileostomy (12%). Eighty-four patients (77%) had temporary stomas, and 19 (17%) had permanent stomas. The median follow-up was 44 (interquartile range: 21–91) months. Twenty-five patients (23%) developed parietal complications after a median of 25 (interquartile range: 11–35) months: 22 (20%) incisional hernia, 4 (3.6%) parastomal hernia, and 3 (2.8%) stoma prolapse. None of the 4 patients with prophylactic biological mesh placement during stoma closure developed complications. Twenty patients underwent abdominal wall repair, with 6 (30%) recurrences and 3 (15%) redo surgeries. Permanent stoma was the only independent risk factor (odds ratio = 4.35, 95% confidence interval: 1.24–15.7; <em>P</em> = .022).</div></div><div><h3>Conclusion</h3><div>Nearly one-quarter of patients with inflammatory colitis develop parietal complications after surgery, with high recurrence after repair. Prophylactic mesh placement during stoma closure should be studied.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110082"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National trends in conduit selection for redo coronary arterial bypass grafting","authors":"Bennet S. Cho MD ,&nbsp;Nguyen K. Le MD, MS ,&nbsp;Troy Coaston BS ,&nbsp;Esteban Z. Aguayo MD ,&nbsp;Oh Jin Kwon MD ,&nbsp;Saad Mallick MD ,&nbsp;Giselle Porter BS ,&nbsp;Peyman Benharash MD, MS","doi":"10.1016/j.surg.2025.110043","DOIUrl":"10.1016/j.surg.2025.110043","url":null,"abstract":"<div><h3>Background</h3><div>Redo coronary arterial bypass grafting is a high-risk operation associated with significant morbidities. Although conduit selection remains a critical factor influencing post–coronary arterial bypass grafting outcomes, the trends in vessel utilization in redo operations remain poorly characterized. We used a nationally representative database to examine contemporary trends in conduit selection in redo versus first-time coronary arterial bypass grafting and risk factors of mortality among patients with repeat bypasses.</div></div><div><h3>Methods</h3><div>Using the 2016–2021 Nationwide Readmissions Database, we identified adult patients undergoing isolated coronary arterial bypass grafting, stratified into <em>F</em><em>irst-time</em> and <em>R</em><em>edo</em> cohorts. The primary outcome was in-hospital mortality; secondary outcomes included perioperative complications, postoperative length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmissions. Temporal trends in conduit use (internal mammary artery, radial artery, and saphenous vein) were assessed.</div></div><div><h3>Results</h3><div>Among 928,925 patients, 5.3% underwent redo coronary arterial bypass grafting. From 2016 to 2021, the use of the internal mammary artery, radial artery, and saphenous vein increased in both cohorts (<em>P</em> &lt; .001). Redo status was associated with higher likelihood of developing complications, longer length of stay (β + 6.2 days), and increased costs (β + $11,100), but lower odds of in-hospital mortality (adjusted odds ratio: 0.75). Internal mammary artery use was independently associated with reduced odds of mortality (adjusted odds ratio: 0.57).</div></div><div><h3>Conclusion</h3><div>Redo coronary arterial bypass grafting is modestly increasing nationwide and remains associated with greater morbidity and resource use, compared with first-time coronary arterial bypass grafting. Nonetheless, adjusted mortality is lower in redo coronary arterial bypass grafting, potentially reflecting careful patient selection and intensive perioperative care. Arterial conduit use, especially internal mammary artery, may confer survival benefits and warrants further study in the redo setting.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110043"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcium and vitamin D reduce hypoparathyroidism and hospital stay after thyroidectomy: A randomized controlled trial","authors":"Vasileios Gkanis MD, MSc ,&nbsp;Konstantinos Nastos MD, PhD ,&nbsp;Konstantinos Ntalaperas MD ,&nbsp;Evangelia Agianni MD ,&nbsp;Spyridon Lainas MD ,&nbsp;Panagiota Raikou MD ,&nbsp;Nikolaos Dafnios MD, PhD ,&nbsp;Ioannis Papakonstantinou MD, PhD ,&nbsp;Sophocles Lanitis MD, PhD","doi":"10.1016/j.surg.2025.110071","DOIUrl":"10.1016/j.surg.2025.110071","url":null,"abstract":"<div><h3>Background</h3><div>Transient hypoparathyroidism is a common complication after total thyroidectomy, prolonging hospitalization and necessitating calcium and/or vitamin D replacement. Evidence from prospective randomized trials on preventive supplementation remains limited. This study aimed to evaluate whether prophylactic calcium and vitamin D supplementation reduces transient hypoparathyroidism and shortens hospital stay after total thyroidectomy.</div></div><div><h3>Methods</h3><div>In this single-center, prospective, randomized, controlled, open-label trial, 600 patients undergoing total thyroidectomy without central neck dissection were randomized to receive prophylactic oral calcium carbonate/gluconate and alfacalcidol (group A, <em>n</em> = 300) or standard postoperative care (group B, <em>n</em> = 300). Primary outcomes were biochemical and symptomatic hypocalcemia and the need for intravenous calcium. Secondary outcomes included postoperative serum calcium levels and length of hospital stay. Statistical analyses used χ², Student’s <em>t</em> test, Mann-Whitney <em>U</em> test, and odds ratio and 95% confidence interval.</div></div><div><h3>Results</h3><div>Laboratory hypocalcemia (serum calcium &lt;8.5 mg/dL) occurred significantly less often in group A (16.9% vs 39.9%; odds ratio 0.305, 95% confidence interval 0.207–0.451, <em>P</em> &lt; .001). Symptomatic hypocalcemia was also reduced (5.6% vs 12.3%; odds ratio 0.427, 95% confidence interval 0.232–0.785, <em>P</em> &lt; .005), as was the need for intravenous calcium (1.8% vs 9.3%; odds ratio 0.175, 95% confidence interval 0.070–0.441, <em>P</em> &lt; .001). Group A demonstrated higher mean serum calcium levels on postoperative days 1 and 2 (<em>P</em> &lt; .001) and a shorter hospital stay (1.25 days vs 1.7 days, <em>P</em> &lt; .001). Supplementation benefits were consistent across subgroups stratified by malignancy status and preoperative vitamin D levels.</div></div><div><h3>Conclusion</h3><div>Routine calcium and vitamin D supplementation after total thyroidectomy significantly reduces transient hypoparathyroidism and shortens hospitalization. These findings support its use as a standard postoperative strategy to enhance recovery and reduce health care resource utilization.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110071"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the no-show: A case study highlighting the hidden scope of barriers to radiotherapy adherence in cancer care","authors":"Camille A. Biggins MHA,&nbsp;Laurie J. Kirstein MD, FACS,&nbsp;Eileen Reilly MSW,&nbsp;Kathryn Swingle MSW, LICSW,&nbsp;Kelly Christensen MSW, LICSW,&nbsp;Laura Marquez MSW, LSWAIC,&nbsp;Mark Daniels BS","doi":"10.1016/j.surg.2026.110087","DOIUrl":"10.1016/j.surg.2026.110087","url":null,"abstract":"<div><h3>Background</h3><div>Despite prevalent systemic barriers to accessing healthcare services, Virginia Mason Medical Center’s Floyd &amp; Delores Jones Cancer Institute has historically taken a piecemeal approach in responding to barriers. To uphold the organization’s mission, they participated in the Commission on Cancer’s “Breaking Barriers” national quality improvement collaborative in 2023 to investigate the predictable and modifiable reasons for radiotherapy nonadherence among their patients with cancer.</div></div><div><h3>Methods</h3><div>From March 1 to December 15, 2023, a multidisciplinary quality improvement team prospectively collected data on patients aged 18–99 years scheduled to receive 14–15 fractions of radiotherapy, excluding palliative care and ultrafractionation regimens. The team employed REDCap for bimonthly reporting and used multiple investigative methods including community assessments, patient chart reviews, patient narratives, and stakeholder input sessions. Environmental and community factors affecting transportation access were systematically evaluated using established quality improvement frameworks. Social work activity data were also collected to quantify institutional resource allocation.</div></div><div><h3>Results</h3><div>Among 104 eligible patients during the initial study period, 85.6% completed all scheduled appointments, 14.4% missed at least 1 appointment, and 3.8% met the no-show threshold of missing at least 3 appointments. By the end of 2023, the total institutional no-show rate was 5.2%, with transportation accounting for only 5.3% of all missed radiotherapy appointments. However, oncology social workers spent 14.8% of their time addressing transportation needs. Transportation-related missed appointments decreased to 3.7% by December 2023, while social work interventions prevented numerous potential no-shows from being recorded.</div></div><div><h3>Conclusion</h3><div>This project reveals an “iceberg problem” where transportation insecurity’s true magnitude remains hidden beneath outcome-oriented no-show metrics. The substantial discrepancy between low rates of transportation-related missed appointments (5.3%) and high social work time allocation (14.8%) demonstrates that no-show rates mask significant institutional workload required to maintain treatment adherence. Social work time emerges as a more sensitive, novel indicator of barrier vulnerability that reframes the problem from patient-centric failure to system-level resource demands. Health care organizations should implement proactive, data-driven barrier management systems that account for hidden workloads while developing sustainable, multilevel interventions to ensure equitable cancer care access.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110087"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of thyroid ultrasound and surgery after glucagon-like peptide-1 receptor agonist prescription","authors":"Lia D. Delaney MD, MS ,&nbsp;Heather Day MS ,&nbsp;Katherine Arnow MS ,&nbsp;Robin M. Cisco MD ,&nbsp;Dan Eisenberg MD, MS ,&nbsp;Manjula Kurella Tamura MD, MPH ,&nbsp;Insoo Suh MD ,&nbsp;Electron Kebebew MD ,&nbsp;Carolyn D. Seib MD, MAS","doi":"10.1016/j.surg.2025.110042","DOIUrl":"10.1016/j.surg.2025.110042","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110042"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a robotic pancreatoduodenectomy program: Navigating the learning curve with a liberal patient selection and conversion strategy","authors":"Zhi Ven Fong MD, MPH, DrPH ,&nbsp;Chee-Chee Stucky MD ,&nbsp;Po Hong Tan MBBS ,&nbsp;Dillon Cheung MD ,&nbsp;Stephanie Yu MD ,&nbsp;Anita M. Moyer RN, OCN ,&nbsp;Julie L. Hildebrand PA-C, MS ,&nbsp;Hoe Yan Hor MBBS ,&nbsp;Melody Tu MBBS ,&nbsp;Rick Bold MD, MBA ,&nbsp;Yu-Hui Chang MS, PhD ,&nbsp;Nabil Wasif MD, MPH","doi":"10.1016/j.surg.2025.110070","DOIUrl":"10.1016/j.surg.2025.110070","url":null,"abstract":"<div><h3>Background</h3><div>The robotic platform is being increasingly utilized to perform pancreatoduodenectomy, but implementation can be associated with a steep learning curve, and large number of cases is required to surmount it. We detail an approach for implementation of a robotic pancreatoduodenectomy program that incorporates a liberal patient selection and conversion strategy to achieve proficiency while maintaining outcomes.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing pancreatoduodenectomy from January 2018 to June 2025 were identified. A robotic pancreatoduodenectomy program was implemented in October 2023. Difference-in-difference models with patients identified in the National Surgical Quality Improvement Program during the same period as a control cohort were used.</div></div><div><h3>Results</h3><div>A total of 205 patients underwent pancreatoduodenectomy, 127 in the preimplementation period and 78 in the postimplementation period. Of the 78 pancreatoduodenectomies performed in the postimplementation period, 62 (79.5%) were performed robotically with a conversion rate of 19.4%. Compared with the preimplementation cohort, the postimplementation cohort had similar complication and mortality rates but shorter median length of stay (5 days vs 8 days, <em>P</em> &lt; .0001). On difference-in-difference analyses, the institutional cohort was associated with an increase in robotic use after program implementation (+74.8%, <em>P</em> &lt; .001) compared with the National Surgical Quality Improvement Program control cohort. The institutional cohort was also associated with fewer pancreatic fistulas (−12.3%, <em>P</em> = .02), shorter length of stay (−2.0 days, <em>P</em> &lt; .001), and similar 30-day major morbidity (−9.3%, <em>P</em> = .14) and readmission (+7.3%, <em>P</em> = .13), as well as mortality rates (−1.7%, <em>P</em> = .45) after program implementation.</div></div><div><h3>Conclusion</h3><div>A robotic pancreatoduodenectomy program with a liberal patient selection and conversion strategy can be safely implemented while preserving overall outcomes compared with National Surgical Quality Improvement Program benchmarks.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110070"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local infiltration of liposomal bupivacaine is associated with reduced postoperative admission in anterior abdominal hernia repair","authors":"Johnathan V. Torikashvili BS,&nbsp;Rachel L. Wolansky MD,&nbsp;Emily A. Grimsley MD,&nbsp;Tyler Zander MD,&nbsp;Joseph Sujka MD,&nbsp;Paul C. Kuo MD, MS, MBA,&nbsp;Melissa A. Kendall MD","doi":"10.1016/j.surg.2025.110069","DOIUrl":"10.1016/j.surg.2025.110069","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110069"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}