Surgery最新文献

{"title":"\"There is a target on you\": Female neurosurgeons' and cardiothoracic surgeons' experiences of overt and covert discrimination in the workplace.","authors":"Leeat Granek, Susan R Durham, Jessica Forcillo, Miranda Too, Sara I McClelland, Amy Sullivan, Deborah L Benzil","doi":"10.1016/j.surg.2026.110581","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110581","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to explore how gender-based discrimination manifests in neurosurgery and cardiothoracic surgery by interviewing women surgeons in these fields about their lived experiences.</p><p><strong>Methods: </strong>Interviews were conducted via videoconference with 22 female surgeons (18 neurosurgeons and 4 cardiothoracic surgeons) practicing in academic and community settings in North America. A thematic analysis based on grounded theory principles was used to code the data for major themes. Results encompass inductively derived themes describing experiences of gender discrimination, professional misrecognition, and discriminatory workplace culture.</p><p><strong>Results: </strong>Three major themes emerged from the analysis. First, participants described overt gender-based mistreatment and institutional discrimination, including sexual harassment, bullying, reproductive discrimination, inequities in compensation, and barriers to leadership opportunities. Second, participants reported professional misrecognition and heightened performance expectations, including being mistaken for nonphysician staff, having their competence constantly questioned, and practicing under intense and increased scrutiny compared with their male colleagues. Third, participants described exclusion rooted in traditionally masculine norms emphasizing competitiveness and tolerance of aggressive behavior, reinforced by informal professional \"boys\" networks that limited access, opportunities, and advancement for female surgeons. These dynamics contributed to persistent barriers to career advancement and workplace inclusion, which participants described as factors that influence retention and long-term participation in these specialties.</p><p><strong>Conclusion: </strong>Female surgeons report persistent gender inequities embedded in workplace culture, institutional structures, and everyday professional interactions. Efforts to improve equity in surgical specialties should extend beyond recruitment and representation to address workplace culture, institutional structures, and accountability mechanisms that influence professional advancement and retention.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110581"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008619","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":"Adoption and outcomes of robotic pancreatectomy in the United States: An instrumental variable analysis.","authors":"Samantha L Savitch, Christina M Fleischer, Cody L Mullens, Jyothi R Thumma, Hari Nathan, Justin B Dimick, Kyle H Sheetz","doi":"10.1016/j.surg.2026.110568","DOIUrl":"10.1016/j.surg.2026.110568","url":null,"abstract":"<p><strong>Background: </strong>The use of minimally invasive surgery approaches has lagged in pancreatic surgery. Single-center studies support using robotic approaches for pancreatectomy, but as pancreatectomy expands outside specialty centers, current data may not reflect all practice settings.</p><p><strong>Methods: </strong>We queried Medicare claims for fee-for-service beneficiaries undergoing distal pancreatectomy or pancreaticoduodenectomy from 2011 to 2023, capturing a varied population across practice settings. We used instrumental variable analysis to compare risk-adjusted 90-day postoperative outcomes between open, laparoscopic, and robotic approaches. The instrumental variable used was hospital referral region-level prior year pancreatectomy robotic use. Hospitals were volume stratified based on the Leapfrog Group's cutoff of 20 operations annually.</p><p><strong>Results: </strong>We identified 55,514 beneficiaries: 43,230 pancreaticoduodenectomy (756 robotic, 753 laparoscopic, and 41,721 open) and 12,284 distal pancreatectomy (1,131 robotic, 981 laparoscopic, and 10,172 open). Laparoscopic pancreatectomy increased after initial adoption between 2014 and 2016 before plateauing. Robotic-assisted pancreaticoduodenectomy and distal pancreatectomy increased 12-fold and 3.6-fold over the study period, respectively, resulting in a 10-percentage point increase in minimally invasive surgery pancreatectomies. Robotic-assisted pancreatectomy was associated with significantly lower rates of serious complications (10.4% vs 16.8%), reoperation (5.7% vs 7.8%), and 90-day mortality (5.2% vs 7.7%) compared with open procedures. Outcomes were similar between robotic and laparoscopic procedures. While outcomes were overall better at high-volume centers, outcomes did not vary by approach within low-volume hospitals. Ninety-day total episode spending was lower for robotic as compared with open operations.</p><p><strong>Conclusion: </strong>There has been rapid growth in robotic-assisted pancreatectomy over the past 2 decades, resulting in improved penetration of minimally invasive surgery approaches. The use of robotic-assisted pancreatectomy is not associated with worse outcomes compared with open and laparoscopic procedures, including at low-volume institutions. These findings support the use of the robotic approach for this complex operation.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110568"},"PeriodicalIF":3.2,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171021","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":"Advancing practical skills and improving confidence in high-acuity, low-occurrence operative trauma using high-fidelity operative simulation.","authors":"Nikita Chernetskii, Edward Chao, Michael J Klein, Christopher Decker","doi":"10.1016/j.surg.2026.110535","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110535","url":null,"abstract":"<p><strong>Background: </strong>Advancing endovascular approaches and subspecialty vascular care have significantly diminished general surgery residents' exposure to essential trauma techniques, creating a preparedness gap among graduates managing basic trauma emergencies. The Open Surgical Simulation System is a high-fidelity trauma surgery model enabling skill acquisition through hands-on practice. This study evaluates the outcomes of our curriculum development process and its impact on training outcomes.</p><p><strong>Methods: </strong>A longitudinal analysis of Open Surgical Simulation System simulation training was conducted from 2020 to 2026, encompassing multiple iterations of curriculum refinement based on continuous evaluation and feedback. The curriculum incorporated Kern-guided improvements in instructional design, implementation, and evaluation throughout the study period. Training outcomes were assessed using presimulation and postsimulation surveys with 5-point Likert scales measuring self-assessed knowledge, technical skills, and confidence across 6 procedures: resuscitative thoracotomy, exploratory laparotomy, splenectomy, hepatorrhaphy, small bowel resection, and retroperitoneal exploration. Paired t tests evaluated presimulation to postsimulation improvements across the full development period.</p><p><strong>Results: </strong>A total of 456 training events were conducted during the curriculum development period, of which 364 included complete paired pretraining and post-training assessments for analysis. The Open Surgical Simulation System curriculum consistently demonstrated significant improvements in confidence scores across all evaluated procedures (P < .001). Prior completion of Advanced Trauma Operative Management or Advanced Surgical Skills for Exposure in Trauma courses did not affect baseline confidence levels, and meaningful gains were observed across all trauma procedures.</p><p><strong>Conclusion: </strong>Systematic development of the Open Surgical Simulation System curriculum using Kern's model enabled iterative curriculum refinement and successful geographic expansion while maintaining positive training outcomes. This simulation-based approach improved resident self-reported confidence across trauma procedures and supports the value of iterative curriculum development in addressing documented gaps in trauma surgery training.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110535"},"PeriodicalIF":3.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977959","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 mesh: Rethinking the biology and mechanics of hiatal reconstruction.","authors":"Yalini Vigneswaran","doi":"10.1016/j.surg.2026.110540","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110540","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110540"},"PeriodicalIF":3.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945721","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":"External wrapping of the ascending aorta versus ascending aorta replacement: Systematic review and meta-analysis.","authors":"M Dell'Aquila, N Sherman, K O'Connor, M Baudo, B Tejada, G Falco, I Kola, A Ali, M Vovsha, A Kiridly, S Tohme, J Lester, A M Calafiore, K Katsavrias, S Prapas, F Manetta, A Iribarne, J Newman, N Patel, R Kalimi, S Pupovac, O A Jarral, D R Brinster","doi":"10.1016/j.surg.2026.110538","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110538","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In the treatment of a moderately dilated ascending aorta, external wrapping of the ascending aorta may represent an alternative to the gold standard ascending aorta replacement. Concerns regarding the safety and long-term durability of external wrapping of the ascending aorta have limited its widespread adoption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and meta-analysis comparing external wrapping of the ascending aorta with ascending aorta replacement. The primary outcome was 30-day mortality, defined as 30-day and/or in-hospital mortality, and midterm mortality, as reported by the source studies. Secondary outcomes included intensive care unit and hospital length of stay, cardiopulmonary bypass time, cardiac crossclamp time, reoperation for bleeding, stroke, acute kidney injury, wound infection, concomitant surgeries, and midterm outcomes. Between-group differences were quantified using standardized mean difference. Effect estimates were expressed as odds ratios for binary outcomes, incidence rate ratios for time-dependent mortality, and standardized mean differences for continuous outcomes, each with 95% confidence intervals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight comparative studies comprising 851 patients were identified. A total of 433 patients (50.9%) underwent external wrapping of the ascending aorta, and 418 (49.1%) underwent ascending aorta replacement. The mean follow-up duration was 3.9 years (95% confidence interval, 1.8-8.4 years). No statistically significant differences were observed in 30-day mortality (odds ratio, 0.61; 95% confidence interval, 0.24-1.56), midterm mortality (incidence rate ratio, 0.97; 95% confidence interval, 0.57-1.66), acute kidney injury (odds ratio, 0.66; 95% confidence interval, 0.22-1.96), stroke (odds ratio, 0.67; 95% confidence interval, 0.23-1.93), wound infection (odds ratio, 1.37; 95% confidence interval, 0.41-4.53), concomitant aortic valve replacement (odds ratio, 0.92; 95% confidence interval, 0.42-2.00), coronary artery bypass grafting (odds ratio, 0.86; 95% confidence interval, 0.37-1.99), mitral valve procedures (odds ratio, 0.71; 95% confidence interval, 0.20-2.56), reoperation for bleeding (odds ratio, 0.48; 95% confidence interval, 0.15-1.58), proximal ascending aorta diameter (standardized mean difference, 0.19; 95% confidence interval, -0.21 to 0.59) or midascending aorta diameter at follow-up (standardized mean difference, -0.53; 95% confidence interval, -1.67 to 0.60). External wrapping of the ascending aorta was associated with shorter cardiopulmonary bypass time (unweighted mean absolute difference, 42.4 minutes; standardized mean difference, -2.46; 95% confidence interval, -3.49 to -1.43), crossclamp time (unweighted mean absolute difference, 30.6 minutes; standardized mean difference, -2.12; 95% confidence interval, -3.18 to -1.07), intensive care unit length of stay (unweighted mean absolute difference, 22.6 hours; standardized","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110538"},"PeriodicalIF":3.2,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017510","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":"Invited commentary on \"Economic reporting and conflicts of interest in randomized trials comparing robot assisted with laparoscopic colorectal surgery: A meta-epidemiological systematic review\".","authors":"Sameh Hany Emile","doi":"10.1016/j.surg.2026.110529","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110529","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110529"},"PeriodicalIF":3.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888417","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":"Economic reporting and conflicts of interest in randomized trials comparing robot-assisted with laparoscopic colorectal surgery: A metaepidemiological systematic review.","authors":"Sang-Ji Choi, Gibong Chae","doi":"10.1016/j.surg.2026.110509","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110509","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted colorectal surgery carries a substantial cost premium, yet how consistently randomized trials of these platforms report economic outcomes-and whether reporting relates to industry funding or conflicts of interest-is unclear.</p><p><strong>Methods: </strong>We conducted a metaepidemiological systematic review (PROSPERO: CRD420261411610), searching PubMed, Embase, and Cochrane CENTRAL for randomized controlled trials comparing robot-assisted with conventional laparoscopic colorectal surgery. Reports were classified by cost-reporting tier (tier 1, none; tier 2, cost data without a formal economic evaluation; and tier 3, formal economic evaluation with an incremental cost-effectiveness ratio or quality-adjusted life-years); registries and protocols were checked for prespecified economic outcomes. The trial was the primary unit; proportions were estimated with exact 95% confidence intervals, and funding-reporting relationships were described.</p><p><strong>Results: </strong>Twenty-three reports of 15 trials were included. Any cost data were reported by 7 of 15 trials (46.7%; 95% confidence interval, 21.3-73.4) and a formal economic evaluation by 2 of 15 (13.3%); neither cited the Consolidated Health Economic Evaluation Reporting Standards. Four trials had a registered or protocol-documented economic outcome (2 reported, 2 deferred); most reporting no cost had not planned one. Robotic surgery was costlier in every trial reporting cost, although the scope and evidentiary strength of these comparisons varied substantially; the 2 formal evaluations reached opposite conclusions. Two trials were manufacturer funded, and 4 trials had author conflicts of interest; associations were too imprecise for inference.</p><p><strong>Conclusion: </strong>Within these platform trials, economic outcomes were reported inconsistently. When an economic evaluation is intended, prespecifying a cost outcome and following a standard such as Consolidated Health Economic Evaluation Reporting Standards would improve its usefulness for decision-makers.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110509"},"PeriodicalIF":3.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819468","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":"Rural advocacy: Meeting the challenge.","authors":"David J Welsh","doi":"10.1016/j.surg.2026.110504","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110504","url":null,"abstract":"<p><p>Rural settings can be challenging with regard to the level of resources and general support of surgery. Effective advocacy is the means to deal with barriers to good surgical care. While advocating for more support for rural health care can appear daunting, it can be accomplished. This article gives concrete examples of tools for rural surgeons to participate in strong advocacy as well as success stories. This article can serve as a primer to begin or amplify a surgeon's advocacy journey.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110504"},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866949","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":"Addressing the need for change in surgical training culture.","authors":"Mackenzie Snyder, Jonathan Dort","doi":"10.1016/j.surg.2026.110505","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110505","url":null,"abstract":"<p><p>Significant research has occurred over the last 2 decades outlining the disparities that female residents and residents who are underrepresented in medicine face. While there is an increasing number of institutional protocols and initiatives published in the literature attempting to improve these disparities, enrollment and retention of minority residents remain lower than expected. Designing and implementing measures to improve the recruitment, retention, and daily experience of women and underrepresented in medicine residents involves significant challenges because of the complex nature of the disparities that these residents experience. We describe our own experience with The Pregnancy Curriculum, an initiative that created sweeping culture changes and initially disruptive policies in our own institution to support pregnant residents. As we reflect on our own experience, we find that honoring the individuality of residents and their unique goals creates sustainable and effective changes to support residents. Herein, we outline the disparities residents face, current research in institutional protocols, and our own response to the challenges that residents experience.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110505"},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913438","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":"Outcomes following mesh reinforcement and primary suture repair for postoperative fascial dehiscence: A multicenter retrospective cohort study.","authors":"Rudolf van den Berg, Sophie van Streun, Sebastiaan van Steensel, Christel A L de Raaff, Pieter J Tanis, Eva B Deerenberg","doi":"10.1016/j.surg.2026.110500","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110500","url":null,"abstract":"<p><strong>Background: </strong>Fascial dehiscence, or burst abdomen, is a serious postoperative complication associated with high morbidity, prolonged hospitalization, and incisional hernia formation. The optimal repair strategy remains debated.</p><p><strong>Methods: </strong>In this retrospective multicenter comparative cohort study, patients who underwent primary suture or mesh repair for fascial dehiscence within 14 days of their initial abdominal surgery between 2020 and 2023 were included. The composite primary outcome consisted of recurrent fascial dehiscence or incisional hernia within 1 year (re-fascial dehiscence/incisional hernia) and was evaluated using Kaplan-Meier and Cox-regression analyses.</p><p><strong>Results: </strong>Seventy-six patients with fascial dehiscence were included. Fascial dehiscence was repaired with suturing in 34 patients and reinforcement mesh in 42 patients. Median follow-up was 12 months (interquartile range, 4-23). Reoperation for re-fascial dehiscence was more frequent after suture repair (18% vs 2%, P = .022). Combined re-fascial dehiscence/incisional hernia occurred in 61% of sutured repairs versus 31% of mesh repairs (risk reduction by mesh reinforcement: hazard ratio, 0.37; 95% confidence interval, 0.17-0.78; P = .0097). Surgical complications within 1 year occurred in 27% after suture and in 5% after mesh repair (P = .009), with significant differences in Clavien-Dindo ≥IIIb events (12% vs 0%, P = .018). Fistula formation rates were 9% and 2% in the suture and mesh groups, respectively, with mesh-related infection occurring in 2% of cases. Hospital length of stay was median 22 days (interquartile range, 12-33) and 22 days (interquartile range, 13-31) in the suture and mesh groups, respectively (P = .836).</p><p><strong>Conclusion: </strong>In this multicenter comparative cohort study, fascial dehiscence repair using mesh reinforcement was associated with a significantly lower risk of recurrent fascial dehiscence and incisional hernia development, and fewer complications.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110500"},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930760","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}