Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"The safety and efficacy of endoscopic submucosal dissection for superficial pharyngeal squamous cell neoplasms: a single-center study in China.","authors":"Xinghang Dai, Yi Liu, Lizhou Dou, Yueming Zhang, Yong Liu, Shibo Song, Guiqi Wang, Shun He","doi":"10.1007/s00464-025-11636-1","DOIUrl":"10.1007/s00464-025-11636-1","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic submucosal dissection (ESD) is a mainstream treatment for superficial pharyngeal squamous cell neoplasms (SPSCN) in Japan. There were few reports of it in China, which were small in scale and lack long-term follow-up data. Quality of life (QoL) outcomes of ESD for SPSCN have also not been studied. The aims of this study were to clarify the safety and efficacy of ESD for SPSCN and its outcomes in the Chinese setting.</p><p><strong>Methods: </strong>Eighty-four consecutive patients with 145 lesions treated with ESD for SPSCN from January 2014 to August 2022 were enrolled. Their curability, complications, metachronous SPSCN, local recurrence, lymph node metastasis, and overall and disease-specific survival rates were analyzed. The quality of life was measured by MD Anderson Symptom Inventory-Head and Neck (MDASI-HN).</p><p><strong>Results: </strong>The en-bloc resection rate was 94.5%, and the R0 resection rate was 74.5%. The postoperative adverse event rate was 2.6%. The median follow-up period was 36.28 months. The 3-year rates of metachronous pharyngeal cancer, local recurrence, lymph node metastasis, overall survival, and disease-specific survival were 14.1%, 7.6%, 9.6%, 92.4%, and 98.0%, respectively. The mean symptom composite score and interference score of MDASI-HN were 10.3 and 2.3, respectively.</p><p><strong>Conclusions: </strong>In the Chinese setting, pharyngeal ESD achieves curability, safety, and long-term outcomes comparable to those observed in Japan. The postoperative QoL is satisfactory.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3600-3609"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998897","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":"Robotic approach does not eliminate first assistant in bariatric surgery compared to laparoscopy.","authors":"Luis Pina, Conor M Eufemio, James Dove, G Craig Wood, Mark Mahan, Alexandra Falvo, Ryan Horsley, Benefsha Mohammad, Vladan Obradovic, Anthony T Petrick, David M Parker","doi":"10.1007/s00464-025-11719-z","DOIUrl":"10.1007/s00464-025-11719-z","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) constitute the most commonly performed bariatric metabolic surgery (BMS) procedures in the USA. The number of robotic-assisted BMS cases remains low, primarily due to the increased cost and extended operative time associated with this technology. Our primary objective is to assess whether robotic platform reduces the need for a surgical first assistant (FA). Our secondary objective is to compare the utilization of skilled surgical assistants.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the MBSAQIP Participant Use File cohort spanning from 2015 to 2019 to determine the prevalence of Attending Surgeon involvement in robotic-assisted, laparoscopic RYGB, and SG procedures, in comparison to non-physician surgical First Assistants. Cases involving medical trainees (residents and fellows) were excluded from the analysis. For each bariatric procedure, we established two distinct groups and employed propensity score matching to ensure patient comparability. A \"good match\" was defined as a standardized mean difference (SMD) of less than 0.10. All statistical analyses were two-sided, with a significance level set at P < 0.05.</p><p><strong>Results: </strong>A total of 113,682 patients underwent LRYGB, with 12,480 undergoing robotic RYGB (RRYGB). After a 1:1 match, attending-level FAs were involved in 25.9% of LRYGB cases, mid-level FAs in 55.6%, and no assistants in 18.5%. In contrast, RRYGB cases utilized attending-level FAs in 13.7% of cases, mid-level FAs in 68.4%, and had no assistants in 17.9% of cases (P < 0.0001). In LSG, attending-level FAs were present in 28.1% of cases, mid-level FAs in 51.6%, and no assistants in 20.3%. In comparison, robotic SG (RSG) cases had attending-level FAs in 16.1%, mid-level FAs in 55.6%, and no assistants in 28.3% of cases (P < 0.0001).</p><p><strong>Conclusion: </strong>The robotic platform failed to show a reduction in the need for an assistant in Roux-en-Y Gastric Bypass (RYGB) procedures but did lead to a decrease in the number of assistants required in sleeve gastrectomy (SG). Mid-level assistance was necessary for the majority of robotic and laparoscopic bariatric metabolic cases. The robotic platform was associated with an approximate 12% reduction in the requirement for attending-level assistance in robotic procedures.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3568-3575"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011519","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":"Failing to prepare: the erosion of intraoperative cholangiography in the rising surgical workforce-a national review of general surgery residents' laparoscopic cholecystectomy and intraoperative cholangiogram experience.","authors":"Katharine E Caldwell, Elizabeth C Wood, L Michael Brunt, Lucas P Neff, Carl Westcott, Michael M Awad, Shan L Kalmeta, Vahagn C Nikolian, Maggie E Bosley","doi":"10.1007/s00464-025-11733-1","DOIUrl":"10.1007/s00464-025-11733-1","url":null,"abstract":"<p><strong>Background: </strong>With the advent of advanced imaging and endoscopy, we hypothesized that IOC resident training has declined and is currently insufficient. To this end, we evaluated the national general surgery resident experience with laparoscopic cholecystectomy both with and without intraoperative cholangiography.</p><p><strong>Methods: </strong>The National Accreditation Council for Graduate Medical Education (ACGME) operative logs were evaluated from 2012 to 2023 for general surgery residents. The number of completed laparoscopic cholecystectomy (CCY) operations and CCY with cholangiogram were evaluated and compared by postgraduate year, program (academic, community, hybrid, military), and resident role (first assistant, surgeon junior, and surgeon chief). ANOVA testing was used to analyze the data.</p><p><strong>Results: </strong>The cholecystectomy case volumes of graduating general surgery residents in all cholecystectomies increased between the 2012-2013 and 2022-2023 academic years (123.9 v 143, p < 0.01). The number of performed CCY + IOC declined significantly over this period (25.1 v 21.6, p = 0.02). University-affiliated programs demonstrated statistically lower numbers of IOCs than community-based (19.3 v 34.1, p < 0.01), hybrid (24.0, p < 0.01), or military programs (26.3, p < 0.01). Community-based programs performed more CCY with IOC than any other group (p < 0.01). Despite the number of CCY + IOC declining during the study period, an increasing percentage of the CCY + IOC were performed by chief (PGY5) residents (p < 0.01).</p><p><strong>Conclusion: </strong>Trainee experience with IOC is declining. The decreased rate and number of IOCs performed by residents has correlated with a \"seniorization\" of resident experience. This change may result in a future general surgeon workforce with inadequate IOC experience and ultimately impact patient safety. To bolster experience with both technique and interpretation, liberal IOC should be advocated for in training environments. A national IOC assessment may be necessary to address this looming deficit.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3648-3653"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033298","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":"Minimally invasive vs. open radical cholecystectomy for gallbladder cancer: 30-day NSQIP outcomes analysis.","authors":"Joshua Hale, Kelsey R Landrum, Chris Agala, Roberto A Vidri, Elizabeth Gleeson, Michael T LeCompte","doi":"10.1007/s00464-025-11755-9","DOIUrl":"10.1007/s00464-025-11755-9","url":null,"abstract":"<p><strong>Background: </strong>Radical cholecystectomy (RC) is the standard procedure for gallbladder cancer (GBC) tumors stage TIb or higher. Advances in minimally invasive surgery (MIS) offer the potential for improved outcomes compared to the traditional open surgery. While small series have demonstrated the feasibility of an MIS approach, a detailed comparison of outcomes between the two approaches is lacking.</p><p><strong>Methods: </strong>The National Surgeon Quality Improvement Database (2010-2021) was queried to identify patients undergoing RC for GBC. Patients with T1b or higher disease were included. Thirty-day all-cause mortality and morbidity were evaluated. To assess associations between outcomes and covariates, we estimated risk ratios and risk differences using generalized linear models and adjusted the estimates using inverse propensity of treatment weights.</p><p><strong>Results: </strong>1303 patients were identified (239 MIS, 1064 Open) with 178 excluded due to the need for biliary reconstruction. There was no difference in the primary outcomes of mortality or major morbidity between the groups with four deaths occurring overall and major morbidity rates of MIS = 2.26% and Open = 2.45% (p = 0.7924). Patients who underwent MIS had significantly fewer days in the hospital (3.00 vs.5.00, p < 0.001). After weighting, the MIS group had significantly fewer blood transfusions (2.12% vs. 6.73%, p = 0.009) and superficial surgical site infections (0.45% vs. 3.29%, p = 0.020).</p><p><strong>Conclusion: </strong>Our findings contribute to the growing body of evidence supporting MIS for RC as a potential alternative to open resections.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3873-3882"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033303","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":"Prediction of endoscopic restenosis after endoscopic balloon dilation in patients with Crohn's disease: a machine learning approach.","authors":"Tao Su, Yi Lu, Nan Lan, Hongzhen Wu, Luying Wu, Min Zhang, Xiaoling Wang, Jiachen Sun, Jiayin Yao, Min Zhi","doi":"10.1007/s00464-025-11751-z","DOIUrl":"10.1007/s00464-025-11751-z","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic balloon dilation (EBD) is recognized as a minimally invasive and effective procedure for managing intestinal stenosis in patients with Crohn's disease (CD). It offers an alternative to surgery and has been shown to improve the quality of life for these patients by reducing the need for more aggressive interventions. This study aimed to evaluate factors associated with endoscopic restenosis after EBD and construct a prognostic model.</p><p><strong>Methods: </strong>We retrospectively collected and analyzed data on patients receiving EBD treatment at the Sixth Affiliated Hospital of Sun Yat-sen University from 2013 to 2024. Seven machine learning (ML) algorithms were used to construct prognostic models. Subsequently, we conducted comparative tests on the performance of the models to ensure accuracy and reliability.</p><p><strong>Results: </strong>A total of 135 patients were included in the statistical analysis. 53% occurred endoscopic restenosis, with an average restenosis time of 183 days. COX and logistic regression analysis showed that 4 features including ever-use glucocorticoids, stenosis position, technical success, and albumin level were associated with restenosis risk. When comparing different ML models, CoxPH and LASSO models performed better on various evaluation metrics, including C-index which was greater than 0.7 in the train and test set. Based on SHapley Additive exPlanations (SHAP), stenosis position, balloon diameter, and albumin level were identified as the top 3 important features associated with prognosis.</p><p><strong>Conclusion: </strong>The ML-based prognostic model has good predictive performance and can accurately assess the risk of endoscopic restenosis after EBD treatment.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3896-3910"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035749","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":"Morbidity of emergent versus elective hiatal hernia repair: an analysis of the NIS database.","authors":"Alyssa Brandt, Zachary Leslie, Mitch Rawson, Sayeed Ikramuddin, Eric Wise","doi":"10.1007/s00464-025-11773-7","DOIUrl":"10.1007/s00464-025-11773-7","url":null,"abstract":"<p><strong>Background: </strong>Elective hiatal hernia repair (HHR) is associated with reduced morbidity compared to emergent HHR. However, few studies examine the specific factors contributing to morbidity in emergent HHR. This study uses the National Inpatient Sample (NIS) database to compare the morbidity of emergent versus non-emergent HHR and identify associated risk factors.</p><p><strong>Methods: </strong>Data from the NIS (2016-2021) were analyzed for all patients undergoing HHR. Health factors, including demographics, comorbidities, and operative details, were compared using chi-squared and T-tests. A multivariable logistic regression model was created to identify factors associated with morbidity, defined as postoperative complications such as sepsis, pneumonia, myocardial infarction, deep venous thrombosis (DVT), pulmonary embolism (PE), and others.</p><p><strong>Results: </strong>A total of 723,000 records existed with a hiatal hernia diagnosis code. Of these, 67,059 patients underwent HHR, with 61,586 (91.8%) undergoing non-emergent HHR. Emergent HHR was associated with increased morbidity (OR 3.95, 95% CI 1.0-1.05, p < 0.05). Risk factors for increased morbidity in both groups included hypertension and advanced age. Protective factors included female gender, GERD, and prior bariatric surgery. Diabetes increased morbidity in emergent HHR but not non-emergent HHR. Smoking, Medicare/Medicaid, mesh use, COPD, and history of DVT increased morbidity in elective HHR, but not emergent HHR. The robotic approach increased morbidity in non-emergent HHR but decreased it in emergent HHR.</p><p><strong>Conclusion: </strong>Emergent HHR is associated with higher morbidity compared to non-emergent HHR. Risk factors like smoking, COPD, and DVT increase morbidity in non-emergent HHR, while female gender, GERD, and prior bariatric surgery are protective. The NIS database provides valuable insights into the morbidity associated with HHR and can guide surgical decision-making.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3979-3985"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038409","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":"Reduced pancreatic fistula rates and comprehensive cost analysis of robotic versus open pancreaticoduodenectomy.","authors":"Taiga Wakabayashi, Federico Gaudenzi, Yusuke Nie, Kohei Mishima, Yoshiki Fujiyama, Kazuharu Igarashi, Yu Teshigahara, Sho Mineta, Emre Bozkurt, Go Wakabayashi","doi":"10.1007/s00464-025-11768-4","DOIUrl":"10.1007/s00464-025-11768-4","url":null,"abstract":"<p><strong>Background: </strong>Robotic pancreaticoduodenectomy (RPD) has emerged as a promising surgical approach for the treatment of periampullary neoplasms, offering the potential benefits of minimally invasive surgery. However, the impact of RPD on clinically relevant pancreatic fistula (CR-PF) rates and overall costs compared to open pancreaticoduodenectomy (OPD) remains unclear, limiting its widespread adoption.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a high-volume Japanese referral center from 2017 to 2023. A total of 193 patients diagnosed with periampullary neoplasms underwent either RPD (n = 81) or OPD (n = 112). To account for potential selection bias, propensity score matching (PSM) was used to balance patient demographics and clinical characteristics, resulting in two well-matched groups of 60 patients each. Perioperative outcomes, CR-PF rates, and a comprehensive cost analysis were evaluated.</p><p><strong>Results: </strong>RPD resulted in a significantly lower rate of CR-PF (10%) compared to OPD (33.3%) (p = 0.003). Additionally, patients who underwent RPD experienced shorter hospital stays (15 days) compared to those in the OPD group (22.5 days) (p < 0.001). Despite longer operative times for RPD (633 vs. 395 min; p < 0.001), total hospital costs were comparable between the two groups. The higher operative costs associated with RPD were offset by reduced postoperative complications and shorter hospitalization.</p><p><strong>Conclusions: </strong>RPD offers significant clinical advantages, including lower CR-PF rates and reduced hospital stays, without increasing overall hospital costs compared to OPD. These findings support the feasibility and potential benefits of adopting RPD for the management of periampullary neoplasms in clinical practice.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3921-3929"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039290","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":"Contemporary inguinal hernia repair: do cost and operative time still differ by approach?","authors":"Benjamin C Greenspun, Daniel Aryeh Metzger, Daniella De Freitas, Gala Cygiel, Anjani Turaga, Brendan M Finnerty, Cheguevara Afaneh, Thomas J Fahey, Rasa Zarnegar","doi":"10.1007/s00464-025-11722-4","DOIUrl":"10.1007/s00464-025-11722-4","url":null,"abstract":"<p><strong>Background: </strong>Concerns about the expense of robotic surgery for inguinal hernia repairs have emerged alongside the growing interest and skill in robotic techniques over the past decade. This study aimed to assess whether the costs of robotic inguinal hernia repairs are comparable to those of laparoscopic or open methods.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of consecutive open, laparoscopic, and robotic inguinal hernia repairs using mesh at a single tertiary academic medical center from 2020 to 2023. We compared costs and operation times for initial unilateral and bilateral cases.</p><p><strong>Results: </strong>In unilateral repairs-open (n = 384), laparoscopic (n = 35), and robotic (n = 312)-the median operative times were 62, 67, and 67 min, respectively. Open repairs were quicker than laparoscopic (p = 0.010), but no significant difference was noted compared to robotic repairs (p = 0.066), and there was no substantial difference between laparoscopic and robotic repairs (p = 0.5). The total costs for unilateral open repairs ($11,218) were lower than the costs for laparoscopic ($13,819, p =  < 0.001) or robotic ($15,610, p =  < 0.001) repairs, with laparoscopic also being less expensive than robotic (p = 0.019). For bilateral repairs, the median operative times were 104 min for open (n = 56), 101 min for laparoscopic (n = 23), and 88 min for robotic (n = 70). There were no significant differences in times between open and laparoscopic repairs (p = 0.6); however, robotic repairs were quicker than both open (p = 0.012) and laparoscopic (p = 0.017) repairs. The cost for laparoscopic bilateral repair was higher compared to open ($19,727 vs $18,516, p = 0.014), but robotic surgery ($19,172) did not show a significant difference when compared to open (p = 0.11) or laparoscopic (p = 0.4) repairs.</p><p><strong>Conclusions: </strong>Bilateral inguinal hernia repair is performed most quickly using robotic techniques and exhibits costs similar to those of open and laparoscopic surgery. Further studies exploring how surgeon experience with robotics affects costs and operative time are necessary.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3587-3591"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998731","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":"Deep learning-based intraoperative visual guidance model for ureter identification in laparoscopic sigmoidectomy.","authors":"Balsam Khojah, Ghada Enani, Abdulaziz Saleem, Nadim Malibary, Abdulrahman Sabbagh, Areej Malibari, Wadee Alhalabi","doi":"10.1007/s00464-025-11694-5","DOIUrl":"10.1007/s00464-025-11694-5","url":null,"abstract":"<p><strong>Background: </strong>Identifying the left ureter is a key step while performing laparoscopic sigmoid resection to prevent intraoperative injury and postoperative complications.</p><p><strong>Methods: </strong>This feasibility study aims to evaluate the real-time performance of a deep learning-based computer vision model in identifying the left ureter during laparoscopic sigmoid resection. A deep learning model for ureteral identification was developed using a semantic segmentation algorithm trained from intraoperative images of ureteral dissection in videos depicted from laparoscopic sigmoid resection. We used 86 laparoscopic sigmoid resection recordings performed at King Abdulaziz University Hospital (KAUH), which were further processed with manual annotation. A total of 1237 images were extracted and annotated by three colorectal surgeons. Deep learning You Only Look Once (YOLO) versions 8 and 11 models were applied to the video recording of ureteral identification. Per-frame five-fold cross-validation was used to evaluate model performance.</p><p><strong>Results: </strong>Experiments showed high results with a mean Average Precision (mAP50) of 0.92 for the Intersection over Union (IoU) threshold greater than or equal to 0.5. The precision, recall, and Dice Coefficient (DC) evaluation metrics are 0.94, 0.88, and 0.90, respectively. The highest DC result is 0.95, achieved through the fourth-fold cross-validation. The stricter IoU threshold between 0.5 and 0.95 is represented by mAP50-95, which is 0.53. The model operated at a speed of 32 Frames Per Second (FPS), indicating it can work in real-time.</p><p><strong>Conclusion: </strong>Deep learning YOLO 8 and 10 for semantic segmentation demonstrates accurate real-time identification of the left ureter in selected videos. A deep learning model could be used to project high-accuracy identification of real-time left ureter during laparoscopic sigmoidectomy using surgeons' expertise in intraoperative image navigation. Limitations included the sample size, lack of diversity in the methods of surgery, incomplete surgical processes, and lack of external validation.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3610-3623"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015261","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":"Large language model-generated clinical practice guideline for appendicitis.","authors":"Amy Boyle, Bright Huo, Patricia Sylla, Elisa Calabrese, Sunjay Kumar, Bethany J Slater, Danielle S Walsh, R Wesley Vosburg","doi":"10.1007/s00464-025-11723-3","DOIUrl":"10.1007/s00464-025-11723-3","url":null,"abstract":"<p><strong>Background: </strong>Clinical practice guidelines provide important evidence-based recommendations to optimize patient care, but their development is labor-intensive and time-consuming. Large language models have shown promise in supporting academic writing and the development of systematic reviews, but their ability to assist with guideline development has not been explored. In this study, we tested the capacity of LLMs to support each stage of guideline development, using the latest SAGES guideline on the surgical management of appendicitis as a comparison.</p><p><strong>Methods: </strong>Prompts were engineered to trigger LLMs to perform each task of guideline development, using key questions and PICOs derived from the SAGES guideline. ChatGPT-4, Google Gemini, Consensus, and Perplexity were queried on February 21, 2024. LLM performance was evaluated qualitatively, with narrative descriptions of each task's output. The Appraisal of Guidelines for Research and Evaluation in Surgery (AGREE-S) instrument was used to quantitatively assess the quality of the LLM-derived guideline compared to the existing SAGES guideline.</p><p><strong>Results: </strong>Popular LLMs were able to generate a search syntax, perform data analysis, and follow the GRADE approach and Evidence-to-Decision framework to produce guideline recommendations. These LLMs were unable to independently perform a systematic literature search or reliably perform screening, data extraction, or risk of bias assessment at the time of testing. AGREE-S appraisal produced a total score of 119 for the LLM-derived guideline and 156 for the SAGES guideline. In 19 of the 24 domains, the two guidelines scored within two points of each other.</p><p><strong>Conclusions: </strong>LLMs demonstrate potential to assist with certain steps of guideline development, which may reduce time and resource burden associated with these tasks. As new models are developed, the role for LLMs in guideline development will continue to evolve. Ongoing research and multidisciplinary collaboration are needed to support the safe and effective integration of LLMs in each step of guideline development.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3539-3551"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982857","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}