Surgery最新文献

{"title":"Short-term and long-term outcomes of hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma and gallbladder carcinoma: A systematic review and meta-analysis with meta-regression.","authors":"Shahin Hajibandeh, Shahab Hajibandeh, Syed Soulat Raza, David C Bartlett, Nikolaos Chatzizacharias, Bobby V M Dasari, Keith J Roberts, Ravi Marudanayagam, Robert P Sutcliffe","doi":"10.1016/j.surg.2025.109593","DOIUrl":"10.1016/j.surg.2025.109593","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate short-term and long-term outcomes of hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma and gallbladder cancer.</p><p><strong>Methods: </strong>A systematic search of electronic data sources and bibliographic reference lists was conducted. All studies reporting outcomes of hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma or gallbladder cancer were included, and their risk of bias were assessed. Effect sizes were determined for clinically relevant postoperative pancreatic fistula, clinically relevant posthepatectomy liver failure, bile leak, Clavien-Dindo classification III or greater complications, mortality, and 1- to 5-year survival using random-effects modeling followed by meta-regression analyses.</p><p><strong>Results: </strong>Twenty-three retrospective studies (789 patients) conducted between 2007 and 2025 were included. Hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma was associated with clinically relevant postoperative pancreatic fistula: 52.1% (95% confidence interval, 38.8%-65.4%), CR-posthepatectomy liver failure: 31.5% (95% confidence interval, 14.5-48.4%), bile leak: 17.6% (95% confidence interval, 13.3-22.0%), Clavien-Dindo grade III or greater: 59.4% (95% confidence interval, 47.3-71.6%), mortality: 2.8% (95% confidence interval, 0.9-4.6%), and 1-year: 61.8% (95% confidence interval, 49.6-73.9%), 3-year: 30.2% (95% confidence interval, 23.5-36.9%) and 5-year survival: 23.7% (95% confidence interval, 17.3-30.2%). hepatopancreatoduodenectomy for gallbladder cancer was associated with clinically relevant postoperative pancreatic fistula: 48.7% (95% confidence interval, 19.9-77.5%), clinically relevant posthepatectomy liver failure: 15.7% (95% confidence interval, 0.2-31.2%), bile leak: 9.4% (95% confidence interval, 4.0-14.9%), Clavien-Dindo classification III or greater: 45.7% (95% confidence interval, 22.6-68.9%), mortality: 6.7% (95% confidence interval, 1.8-11.6%), and 1-year: 65.0% (95% confidence interval, 44.8-85.1%), 3-year: 19.9% (95% confidence interval, 10.8-29.0%), and 5-year survival: 14.0% (95% confidence interval, 5.2-22.9%). Portal vein resection was associated with clinically relevant postoperative pancreatic fistula (P = .003), clinically relevant posthepatectomy liver failure (P < .001), and Clavien-Dindo grade III or greater (P < .001) in extrahepatic cholangiocarcinoma, and clinically relevant postoperative pancreatic fistula (P < .001) and clinically relevant posthepatectomy liver failure (P < .001) in gallbladder cancer. Arterial resection was associated with clinically relevant posthepatectomy liver failure (P < .001), and Clavien-Dindo classification III or greater (P < .001) in extrahepatic cholangiocarcinoma. Portal vein embolization predicted posthepatectomy liver failure in both extrahepatic cholangiocarcinoma (P < .001) and gallbladder cancer (P < .001).</p><p><strong>Conclusion: </strong>Hepatopancreatoduodenectomy f","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109593"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812342","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":"Comparison of outcomes between robotic and laparoscopic right hemicolectomy for colon cancer in patients with diabetes: Results from the US Nationwide Inpatient Sample.","authors":"Chih-Jung Chen, Hsin-Yuan Hung","doi":"10.1016/j.surg.2025.109597","DOIUrl":"10.1016/j.surg.2025.109597","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus is a prevalent comorbid condition with colon cancer and may significantly impact surgical outcomes. This study aims to compare the postoperative outcomes between robotic-assisted right hemicolectomy and laparoscopic right hemicolectomy for right-side colon cancer in patients with co-existing diabetes mellitus.</p><p><strong>Methods: </strong>Data from Nationwide Inpatient Sample were analyzed retrospectively. Adult patients ≥20 years with diabetes mellitus who underwent either robotic-assisted right hemicolectomy or laparoscopic right hemicolectomy were included. Outcomes included in-hospital mortality, length of stay, total hospital costs, nonroutine discharge, major complications, and rates of conversion to open surgery. Univariate and multivariable logistic regression analyses were used to compare the outcomes between robotic-assisted right hemicolectomy and laparoscopic right hemicolectomy.</p><p><strong>Results: </strong>A total of 8,273 patients were included, with 1,119 undergoing robotic-assisted right hemicolectomy and 7,154 undergoing laparoscopic right hemicolectomy. Robotic-assisted right hemicolectomy was associated with shorter length of stay (adjusted beta, -0.86; 95% confidence interval, -0.89 to -0.83, P < .001), a lower risk of major complications (adjusted odds ratio, 0.80; 95% confidence interval, 0.67-0.96, P = .016), but greater total hospital costs (adjusted beta, 30.64; 95% confidence interval, 30.00-30.66, P < .001) compared with laparoscopic right hemicolectomy.</p><p><strong>Conclusion: </strong>Robotic-assisted right hemicolectomy offers significant advantages over laparoscopic right hemicolectomy for diabetic patients undergoing right hemicolectomy for colon cancer, including shorter hospital stays and lower rates of major complications. Despite greater total hospital costs, the improved short-term outcomes suggest that robotic-assisted right hemicolectomy is a safer and more effective surgical option for this patient population.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109597"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812339","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":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109753","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109753","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109753"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207640","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":"The risks of inflammation and metabolism in distinct phenotypes of bicuspid aortic valve–associated aortopathy and aortic dissection: A population-based cohort study","authors":"Haoyu Gao MD ,&nbsp;Bangjie Xun MD ,&nbsp;Xiang Liu MD ,&nbsp;Zhenghua Xiao MD ,&nbsp;Bin Shao PhD ,&nbsp;Jun Shi MD ,&nbsp;Yingqiang Guo MD","doi":"10.1016/j.surg.2025.109727","DOIUrl":"10.1016/j.surg.2025.109727","url":null,"abstract":"<div><h3>Background</h3><div>Bicuspid aortic valve is frequently associated with progressive dilation of the ascending aorta and aortic root, predisposing patients to life-threatening complications such as aortic dissection. The roles of systemic inflammation and glucose-lipid metabolism in bicuspid aortic valve–associated aortopathy remain poorly defined.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 1,678 bicuspid aortic valve patients diagnosed between 2008 and 2024. Imaging, echocardiographic, and peripheral blood biochemical data were collected. Principal components analysis was used to generate composite metabolic and inflammatory scores. Random forest, LASSO regression, and SHAP (SHapley Additive exPlanations) methods were used for feature selection. Logistic and Cox regression models, along with restricted cubic spline analysis and Kaplan-Meier curves, were applied to evaluate risk factors for aortic dilation and Stanford type A aortic dissection.</div></div><div><h3>Results</h3><div>Ascending aortic dilation (≥40 mm) was present in 66.98% of patients, and aortic root dilation in 19.79%. Both metabolic and inflammatory scores were significantly associated with ascending aortic diameter, but only the metabolic score remained independently associated with root diameter after adjustment. Triglyceride-glucose and monocyte-to-lymphocyte ratio were identified as the key metabolic and inflammatory markers. Triglyceride-glucose was independently associated with ascending aortic dilation (odds ratio = 2.15, <em>P</em> &lt; .001), but not with Stanford type A aortic dissection. Monocyte-to-lymphocyte ratio was independently associated with both ascending aortic dilation (odds ratio = 3.17, <em>P</em> = .001) and Stanford type A aortic dissection (hazard ratio = 8.87, <em>P</em> &lt; .01). A monocyte-to-lymphocyte ratio threshold of 0.38 stratified Stanford type A aortic dissection risk (log-rank <em>P</em> = .003). For aortic root dilation, neither the monocyte-to-lymphocyte ratio nor the triglyceride-glucose index showed significant independent associations overall. Subgroup analysis revealed that the triglyceride-glucose index was significantly associated with increased root diameter only in patients with aortic root diameter &lt;40 mm.</div></div><div><h3>Conclusions</h3><div>Systemic metabolic and inflammatory states are key contributors to ascending aortic dilation, but not to aortic root dilation, in patients with bicuspid aortic valve. Monocyte-to-lymphocyte ratio is a robust predictor of Stanford type A aortic dissection, offering a potential biomarker for early risk stratification and surgical decision making. These findings support the presence of phenotype-specific mechanisms in bicuspid aortic valve–associated aortopathy and underscore the distinct roles of inflammation and metabolism in different aortopathy phenotypes.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109727"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207685","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":"Postoperative respiratory morbidity in chronic obstructive pulmonary disease patients receiving botulinum toxin injection before abdominal wall surgery: A multicentric study","authors":"Gaëtan-Romain Joliat MD, PhD ,&nbsp;Pablo Ortega-Deballon MD, PhD ,&nbsp;Hessa Alsuwaidan MD ,&nbsp;David Moszkowicz MD, PhD ,&nbsp;Benoit Romain MD, PhD ,&nbsp;Yohann Renard MD, PhD ,&nbsp;Guillaume Passot MD, PhD","doi":"10.1016/j.surg.2025.109765","DOIUrl":"10.1016/j.surg.2025.109765","url":null,"abstract":"<div><h3>Background</h3><div>Botulinum toxin A injection is often used before abdominal wall surgery. Because botulinum toxin A inhibits the lateral abdominal muscles that have a secondary role in the breathing biomechanics, potential concerns regarding postoperative respiratory morbidity in patients with chronic obstructive pulmonary disease have been raised. This study assessed the incidence of postoperative pneumonias after abdominal wall surgery in patients with chronic obstructive pulmonary disease with and without botulinum toxin A injection.</div></div><div><h3>Methods</h3><div>A multicentric (4 centers) cross-sectional study was performed. Consecutive patients with chronic obstructive pulmonary disease who underwent abdominal wall surgery (2013–2024) were included. In case of large or complex hernia, botulinum toxin A was performed 4–8 weeks before surgery if judged necessary. Chronic obstructive pulmonary disease was defined based on the anesthesia preoperative consultation. The primary end point was the rate of postoperative hospital-acquired pneumonias.</div></div><div><h3>Results</h3><div>A total of 150 patients with chronic obstructive pulmonary disease were included: median age 68 years (interquartile range: 63–73), 61 women (41%), and median body mass index 29 kg/m² (interquartile range: 25–33 kg/m²). Sixty patients received botulinum toxin A (40%), and 90 did not receive botulinum toxin A (60%). In the botulinum toxin A group, more patients had loss of domain (28% vs 7%, <em>P</em> &lt; .001), and the median defect size was larger (12 vs 6 cm, <em>P</em> &lt; .001). Fifty-four (90%) and 61 (68%) patients had midline incisional hernias in the botulinum toxin A and non–botulinum toxin A groups (<em>P</em> = .006). Postoperative complications occurred in 26 patients in the botulinum toxin A group (43%) and 33 patients in the non–botulinum toxin A group (37%, <em>P</em> = .413). Postoperative pneumonia incidences were similar in both groups (3/60 vs 4/90, <em>P</em> = .874). On multivariable analysis, component separation was the only predictor of pneumonia (odds ratio: 8.7, 95% confidence interval: 1.7–44.9, <em>P</em> = .010) and not botulinum toxin A (odds ratio: 0.9, 95% confidence interval: 0.2–4.0, <em>P</em> = .920).</div></div><div><h3>Conclusion</h3><div>Regarding postoperative respiratory morbidity, botulinum toxin A seems safe in patients with chronic obstructive pulmonary disease undergoing abdominal wall surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109765"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207625","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":"Pediatric appendiceal neuroendocrine neoplasms: SEER registry analysis","authors":"Michal Perets MD ,&nbsp;Sameh Hany Emile MBBCh, MSc, M.D, FACS ,&nbsp;Nir Horesh MD ,&nbsp;Zoe Garoufalia MD ,&nbsp;Steven D. Wexner MD, PhD (Hon)","doi":"10.1016/j.surg.2025.109733","DOIUrl":"10.1016/j.surg.2025.109733","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109733"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207709","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":"Deviating from Thyroid Imaging Reporting and Data Systems (TI-RADS) guidelines in surgical planning for patients with parathyroid disease: What is the clinical impact?","authors":"Shaleen V Sathe, Abigail Chmiel, Caroline Jones, William E Gillanders, John A Olson, Taylor C Brown","doi":"10.1016/j.surg.2025.109705","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109705","url":null,"abstract":"<p><strong>Background: </strong>The American College of Radiology Thyroid Imaging Reporting and Data Systems standardizes thyroid nodule classification to assess malignancy risk. The use of preoperative ultrasound before parathyroidectomy often detects incidental thyroid nodules, prompting consideration of additional evaluation and/or concomitant thyroid surgery to minimize need for reoperative surgery. This study evaluated clinician adherence to Thyroid Imaging Reporting and Data Systems guidelines for patients with parathyroid disease and associated clinical outcomes.</p><p><strong>Methods: </strong>A retrospective review of 992 patients undergoing parathyroidectomy (2019-2024) examined the role of Thyroid Imaging Reporting and Data Systems in preoperative planning and the clinical decision-making after incidental discovery of thyroid nodules. Descriptive and univariate statistical analyses were performed to compare guideline-concordant and discordant care.</p><p><strong>Results: </strong>Of 957 patients with a formal preoperative ultrasound, 406 (42.4%) had at least 1 thyroid nodule with the Thyroid Imaging Reporting and Data Systems classification reported by a radiologist. Among those with a nodule, 154 (37.9%) underwent fine-needle aspiration and 56 (13.8%) underwent concomitant thyroid surgery for the nodule. Notably, 47 fine-needle aspiration procedures (30.5%) did not meet Thyroid Imaging Reporting and Data Systems criteria. Patients who received guideline-discordant fine-needle aspiration procedures were less likely to undergo thyroid surgery (12.8% vs 34.9%, P = .005) or receive a diagnosis of thyroid cancer (4.3% vs 16.8%, P = .037). Overall, most malignancies were low risk per American Thyroid Association guidelines (n = 20, 80.0%), regardless of Thyroid Imaging Reporting and Data Systems criteria.</p><p><strong>Conclusion: </strong>Many patients undergoing parathyroidectomy receive additional interventions for incidental thyroid nodules. However, adherence to Thyroid Imaging Reporting and Data Systems guidelines may help reduce unnecessary surgery, because most identified malignancies are low risk. The long-term impact remains unclear, emphasizing the need for shared decision-making between surgeons and patients.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109705"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207651","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":"Simulation-based training reduces unnecessary ultrasound referrals for developmental dysplasia of the hip in newborns","authors":"Krupa Patel BS ,&nbsp;Genaro D. Fullano MS, ATC ,&nbsp;Lauren Sickmiller BS ,&nbsp;Michelle Wang MS ,&nbsp;Mohamed Yassin BA ,&nbsp;Clifford L. Craig MD, FACS, FAAP ,&nbsp;Maria Skoczylas MD ,&nbsp;Heather L. Burrows MD, PhD ,&nbsp;Deborah M. Rooney PhD","doi":"10.1016/j.surg.2025.109735","DOIUrl":"10.1016/j.surg.2025.109735","url":null,"abstract":"<div><h3>Background</h3><div>Developmental dysplasia of the hip is a common newborn condition characterized by malformation or instability of the hip joint. Identifying dysplasia of the hip early is imperative for avoiding long-term consequences. In the United States, dysplasia of the hip screening of newborns uses the Ortolani and Barlow maneuvers. However, evidence suggests that inadequate training in these techniques may lead to unnecessary imaging referrals for further assessment. We investigated the impact of a dysplasia of the hip simulator (MiHip) and its associated training program on ultrasound referral rates and cost-savings at a single institution.</div></div><div><h3>Methods</h3><div>From July 2021 to June 2022, 54 residents on newborn rotations underwent training using the MiHip curriculum. All newborns born at our institution 1 year prior (<em>n</em> = 5,404) and 1-year posttraining period (<em>n</em> = 5,792) were identified. High-risk factors warranting automatic ultrasound referrals (family history of dysplasia of the hip, breech presentation, and multiple births) were excluded. χ² tests were used to compare pre- and posttraining incidences of dysplasia of the hip–relevant and unnecessary (defined as dysplasia of the hip–negative) ultrasound referrals. <em>P</em> ≤ .05 was considered statistically significant, and effect, <em>ω</em> ≥ 0.30 considered moderate.</div></div><div><h3>Results</h3><div>Initial referral rates for dysplasia of the hip decreased by 34.07%, χ² (1, <em>N</em> = 5,031) = 34.41, <em>P</em> = .02, <em>ω</em> = 0.08. Unnecessary referrals decreased by 23%, χ² (1, <em>N</em> = 33) = 17.96, <em>P</em> = .04, <em>ω</em> = 0.74. This coincided with a $14,400 annual savings.</div></div><div><h3>Conclusion</h3><div>The MiHip training curriculum significantly reduced unnecessary ultrasound referrals, demonstrating the value of simulation-based training in enhancing dysplasia of the hip examination skills. This training has the potential to lower financial and emotional burdens associated with extensive imaging, specialist consultations, and follow-up care.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109735"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207695","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":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109794","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109794","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109794"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207656","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":"Laryngeal ultrasound-guided adhesive transcutaneous electrodes versus conventional endotracheal electrodes for intraoperative neuromonitoring during thyroid and neck surgery.","authors":"Man Him Matrix Fung, Chun Chung Cheng, Yan Luk, Brian Hung Hin Lang","doi":"10.1016/j.surg.2025.109709","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109709","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Conventional intraoperative neuromonitoring during thyroid surgery commonly uses electromyography electrodes embedded in endotracheal tubes. Adhesive transcutaneous electrodes may be a novel, noninvasive and low-cost alternative, but its accuracy and limitations remain less known. This prospective study compared the accuracy of adhesive transcutaneous electrodes placed under laryngeal ultrasound guidance to that of conventional endotracheal tube electrodes and assessed the factors associated with success in adhesive transcutaneous electrodes intraoperative neuromonitoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Consecutive patients undergoing open thyroid and neck surgery in a tertiary endocrine surgery unit were prospectively recruited. Before skin incision, the position of vocal cords relative to the thyroid cartilage was marked with laryngeal ultrasonography, and a pair of adhesive transcutaneous electrodes was placed on the overlying skin. Endotracheal tube electrode was used simultaneously. Standardized vagus and recurrent laryngeal nerve stimulation protocol was followed. On each stimulation, electromyography signals were simultaneously recorded by adhesive transcutaneous electrodes and endotracheal tube electrodes and later verified by postoperative flexible laryngoscopy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From 2023 to 2024, 300 nerves at risk from 216 patients were analyzed. Median age was 59 (50-70) years; 72.7% were female. Adhesive transcutaneous electrode electromyography had lower amplitudes for both recurrent laryngeal nerve and vagus nerve (P &lt; .001). All 4 vocal cord vocal cord paresis (1.33%, transient and unilateral) were detected by adhesive transcutaneous electrodes and endotracheal tube electrodes, that is, 100% sensitivity and negative predictive value for vocal cord vocal cord paresis. Adhesive transcutaneous electrodes had slightly lower specificity (91.6% vs 96.5%) and accuracy (91.8% vs 96.6%), and lower positive predictive value (14.3% vs 28.6%). Signal interference in adhesive transcutaneous electrodes occurred in 6 patients (2.8%). Higher body mass index (BMI) was the only factor associated with false results from adhesive transcutaneous electrodes (P = .002, odds ratio 1.176, 95% confidence interval 1.060-1.305). Accuracy of adhesive transcutaneous electrodes (94.6%) became comparable to endotracheal tube electrodes in patients with body mass index &lt;25. Adhesive transcutaneous electrodes cost less than endotracheal tube electrodes (32 vs 427 US dollars) for each surgery. Two patients with misplaced endotracheal tube electrodes (false endotracheal tube electrodes signal loss) had normal recurrent laryngeal nerve function correctly predicted by adhesive transcutaneous electrodes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Laryngeal ultrasound-guided adhesive transcutaneous electrode intraoperative neuromonitoring has comparable sensitivity and negative predictive value to endotracheal tube electrodes an","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109709"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201375","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}