Updates in Surgery最新文献

{"title":"Letter to the Editor: Training the diagnostic artificial intelligence in thyroid sonography: how well is deep learning truly learning?","authors":"Lijing Miao","doi":"10.1007/s13304-026-02847-9","DOIUrl":"https://doi.org/10.1007/s13304-026-02847-9","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum rehabilitation and late-onset fecal incontinence after obstetric trauma: a life-course perspective.","authors":"Jiali Xu, Wangfang Yu","doi":"10.1007/s13304-026-02849-7","DOIUrl":"https://doi.org/10.1007/s13304-026-02849-7","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-port robotic system approach for pulmonary lobectomy: our technique and preliminary results.","authors":"Monica Casiraghi, Antonio Mazzella, Giorgio Lo Iacono, Lara Girelli, Luca Bertolaccini, Matteo Chiari, Giovanni Caffarena, Shehab Mohamed, Lorenzo Spaggiari","doi":"10.1007/s13304-026-02846-w","DOIUrl":"https://doi.org/10.1007/s13304-026-02846-w","url":null,"abstract":"<p><p>This study evaluates safety of SP robotic anatomic lung resection for primary lung cancer, and the perioperative outcomes in our early clinical experience. From March 2025 to March 2026, 14 consecutive patients with lung cancer underwent SP robotic lobectomy and systematic lymphadenectomy using da Vinci SP system via subcostal approach. All 14lobectomies (7 right upper, 5 right lower, and 2 middle lobectomy) were completed without conversion or intraoperative complications. Median operative time was 176 min (120-220 min). Twelve patients had adenocarcinoma with pathological stage IA1 in 4 (33.3%) patients, IA2 in 4 (33.3%) patients and stage IB in 4 (33.3%) patients; two patients had typical carcinoid tumor with pathological stage IB. No postoperative complications occurred. Median chest tube duration was 2 days (range 2-6), with median hospital stay of 3 days (3-7). SP robotic lung resection using da Vinci SP system via a subcostal approach demonstrates feasibility, safety, and favorable perioperative outcomes as well as adequate lymphadenectomy. Further multi-institutional studies with longer oncologic follow-up are needed.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence assessment of Parkland's grading scale in laparoscopic cholecystectomy: a step toward real-world outcome prediction.","authors":"Yuval Mirkin, Monica Ortenzi, Eran Nizri, Danit Dayan","doi":"10.1007/s13304-026-02761-0","DOIUrl":"https://doi.org/10.1007/s13304-026-02761-0","url":null,"abstract":"<p><p>Routine real-world use of a surgical artificial-intelligence (AI) platform has led us to adopt Parkland's Grading Scale (PGS) for disease-severity in laparoscopic cholecystectomy (LC). We evaluated model performance in estimating PGS and explored correlations with surgical outcomes. The platform routinely video-captured LCs and automatically assigned PGS scores across 249 consecutive LCs that were classified into Low (PGS 1-2; n = 78, 31.3%) and High (PGS 3-5; n = 171, 68.7%) groups. Surgical outcomes were compared. Case-control matching (CCM; n = 84) was performed to balance possible confounders. Two surgeons independently reviewed a video sample (n = 75) twice to establish ground-truth for F1-score calculations. Model discrimination (AUC) and calibration were evaluated separately against each rater. High-severity cases presented with significantly older age (63.2y vs. 47.1y), higher ASA scores (≥ 3: 29.8% vs. 9%), cholecystitis (47.4% vs. 10.3%), and urgent surgery (12.3% vs. 0) (all p < 0.001). The High group experienced longer operative durations (57.6 vs. 35.3 min; p < 0.001), more intraoperative events (80.1% vs. 61.5%; p = 0.003) and bailouts (10.5% vs. 0; p < 0.001). Hospitalizations were longer (2d vs. 1d; p < 0.001), with more 90-day major complications and readmissions (10.5% vs. 2.6%; p = 0.04). After CCM, operative durations (mean rank 49.51 vs. 35.49; p = 0.008) and hemorrhage-related events (mean rank 46.0 vs. 39.0; p = 0.047) maintained significance. The AI model achieved high F1 scores (High = 0.96, Low = 0.93), strong discrimination (AUC: 0.932 and 0.896), and robust calibration- peaking at PGS = 3. The AI model shows promise for surgical outcome prediction in LC and, with further validation, could be integrated into routine clinical frameworks.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive liver transplantation: technical evolution, evidence maturity, and translational boundaries.","authors":"Tianfei Gao, Zengxi Luo, Yingpeng Zhao","doi":"10.1007/s13304-026-02842-0","DOIUrl":"https://doi.org/10.1007/s13304-026-02842-0","url":null,"abstract":"<p><p>Liver transplantation is an established treatment for end-stage liver disease and selected hepatic malignancies, but conventional open transplantation remains associated with substantial operative trauma and incision-related morbidity. With the expansion of laparoscopic, robotic, and digital platforms, minimally invasive concepts have progressively entered donor hepatectomy, recipient hepatectomy, and graft implantation. This narrative review searched PubMed/MEDLINE, Embase, and the Web of Science Core Collection from January 2020 to 1 June 2026 and prioritized guidelines, consensus statements, systematic reviews, meta-analyses, multicenter studies, prospective registries, and representative case series. The available evidence indicates asymmetric maturity across the minimally invasive liver transplantation spectrum. These maturity judgments represent an interpretive synthesis of predominantly nonrandomized and center-specific evidence. Laparoscopic donor hepatectomy has the most mature evidence, while robotic-assisted donor hepatectomy has a growing evidence base; both may reduce donor trauma and facilitate recovery in selected donors at experienced centers. In contrast, recipient-side minimally invasive procedures remain at the feasibility stage, whereas evidence for fully robotic liver transplantation remains preliminary because of limited exposure, bleeding-control demands, vascular and biliary reconstruction, ischemia-time constraints, anesthetic complexity, cost, and learning-curve requirements. Digital adjuncts, including fluorescence imaging, three-dimensional reconstruction, simulation, and artificial intelligence, may support planning, navigation, reconstruction, and training, but their value should be judged by clinical outcome validation rather than feasibility alone. Clinical translation should therefore remain stepwise: donor-side integration may be considered in trained teams, whereas recipient-side and fully robotic approaches should remain within prospective registries, ethical oversight, standardized reporting, and safe conversion pathways.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic nipple-sparing mastectomy in breast cancer: current evidence, technical considerations, and clinical outcomes.","authors":"Zhiyao Wang, Weijie Kong, Huiming Wu, Jie Pei, Jing Zhang","doi":"10.1007/s13304-026-02838-w","DOIUrl":"https://doi.org/10.1007/s13304-026-02838-w","url":null,"abstract":"<p><p>Nipple-sparing mastectomy (NSM) has emerged as an important advancement in breast surgery, offering significant improvements in postoperative aesthetic outcomes and patient quality of life while maintaining oncologic safety. However, conventional open and endoscopic approaches to NSM remain associated with technical limitations, including restricted surgical exposure, challenges in confined operative spaces, and the need for remote and concealed incisions. In recent years, robotic nipple-sparing mastectomy (R-NSM) has been increasingly introduced into clinical practice. With its advantages of three-dimensional magnified visualization, enhanced instrument dexterity, and stable operative control, R-NSM has demonstrated potential benefits for precise dissection under complex anatomical conditions. Given the substantial heterogeneity among R-NSM studies in terms of surgical techniques, study designs, and outcome assessments, this review adopts a narrative review approach to provide a structured synthesis of the current literature. We particularly focus on the technical characteristics of R-NSM, including improved visualization, enhanced instrument flexibility, and optimized operative stability, and summarize the available clinical evidence regarding oncologic safety, perioperative outcomes, and aesthetic results. Current evidence suggests that R-NSM provides acceptable short- to mid-term safety profiles and may offer favorable outcomes in selected perioperative and aesthetic parameters. Nevertheless, its application remains limited by prolonged operative time, increased procedural costs, and other resource-related considerations. Moreover, the existing evidence is largely derived from retrospective studies and multicenter observational experiences, with limited long-term follow-up and high-quality prospective validation. Overall, R-NSM represents an important direction in the evolution of minimally invasive and precision-oriented breast surgery. However, its true clinical value regarding long-term oncologic safety and sustained patient benefit remains to be established. Future multicenter, large-scale, and prospective studies with extended follow-up are warranted to further define its clinical role and identify the patient populations most likely to benefit.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Regarding: Nachira D, Calabrese G, Bertolaccini L, et al. Oncological outcomes and prognostic factors of pulmonary metastasectomy in pancreatic cancer.","authors":"Dania Nachira, Giuseppe Calabrese, Luca Bertolaccini, Elisa Meacci, Maria Teresa Congedo, Pierluigi Novellis, Angela De Palma, Rosalia Romano, Pietro Bertoglio, Gianmaria Ferretti, Jessica Evangelista, Annalisa Campanella, Matteo Chiari, Francesca Misceo, Francesco De Blasi, Mariangela Valentini, Leonardo Valentini, Jury Brandolini, Marco Taurchini, Giuseppe Bogina, Giulia Veronesi, Giuseppe Marulli, Lorenzo Spaggiari, Stefano Margaritora","doi":"10.1007/s13304-026-02844-y","DOIUrl":"https://doi.org/10.1007/s13304-026-02844-y","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for complications after cytoreductive surgery (CRS) and HIPEC in 290 peritoneal malignancies of primary and secondary origins.","authors":"Ludovico Carbone, Gianmario Edoardo Poto, Aurora Visani, Riccardo Mainenti, Marta Fasulo, Eleonora Andreucci, Engjell Kelmendi, Stefania Piccioni, Irene Crecchi, Giovanna Gallucci, Lucia Bobbio, Zhouqiao Wu, Salvatora Tindara Miano, Roberto Petrioli, Franco Roviello, Daniele Marrelli","doi":"10.1007/s13304-026-02839-9","DOIUrl":"https://doi.org/10.1007/s13304-026-02839-9","url":null,"abstract":"<p><p>Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is effective for selected peritoneal malignancies but carries potential postoperative morbidity. Defining complication rates, severity and predictors is crucial to optimize management, patient selection, and risk stratification. A retrospective observational study was conducted including patients with primary or secondary peritoneal surface malignancies who underwent CRS-HIPEC between 2002 and 2025. Postoperative complications were graded according to CTCAE and Clavien-Dindo classifications. Early postoperative renal function was evaluated in a select cohort receiving sodium thiosulfate nephroprotection. A total of 290 patients were included (median age 60 years, PCI 5). Standard-extended peritonectomy was performed in 167 (57.6%) cases, and multivisceral resection in 27 (10.7%). Optimal debulking was achieved in 263 (90.7%). Postoperative complications occurred in 51.7%, medical and chemotherapy-related complications in 45.5% and surgical ones in 12.4% of cases. Postoperative anemia was common (32.7%), predominantly at CTCAE Grade 3. Severe complications, graded as 3-5 according to ClavienDindo score, occurred in 11.7%, mainly in elderly (20.4% vs. 9.7%, p = 0.090), with no 30-day mortality. Older age, higher comorbidity burden and splenectomy emerged as predictors of severe complications. In 22 patients receiving sodium thiosulfate, creatinine and urine output were significantly lower on postoperative day 5-7, suggesting a renal protective effect. Overall, 3-year survival was 62.2%. Anastomotic fistula (HR 2.43, p = 0.015), surgical site infection (1.81, p = 0.070), and thrombocytopenia (3.64, p < 0.001) were independent negative prognostic factors. CRS and HIPEC can be performed with acceptable morbidity and low mortality in specialized center. Further efforts to reduce complications are essential to improve postoperative outcomes and overall prognosis.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tract de-epithelialization with internal orifice closure: a sphincter-sparing fistula-in-ano repair: DOCS-FR.","authors":"Wafi Attaallah, Roberto Bergamaschi","doi":"10.1007/s13304-026-02836-y","DOIUrl":"https://doi.org/10.1007/s13304-026-02836-y","url":null,"abstract":"<p><p>Cryptoglandular perianal fistula is a common condition that negatively affects patients' quality of life and can potentially lead to life-threatening perianal sepsis. In the specific case of. the inter- or trans-sphincteric variants, the risk of incontinence remains a concern. The aim of the present technical note is to describe a surgical technique aimed at: (1) De-epithelializing the fistula tract with a stainless-steel wire rope guided helical curettage; (2) Excising the fistula external orifice; (3) Suture closing the fistula internal orifice thereby isolating the de-epithelialized tract; (4) Leaving the sphincter alone. The main advantages of the present technique include potentially more definitive benefits compared with seton placement, applicability in patients not suitable for fistulotomy due to risk of incontinence, low cost, and ease of implementation in clinical settings.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Damage control surgery and open abdomen in Hinchey III-IV acute diverticulitis: current practice from a nationwide Italian survey.","authors":"Alessio Giordano, Manuela Mastronardi, Andrea Mingoli, Hayato Kurihara, Eugenio Cucinotta, Mauro Zago, Massimo Chiarugi, Roberto Cirocchi, Paolo Prosperi, Alan Biloslavo, Gianluca Costa","doi":"10.1007/s13304-026-02834-0","DOIUrl":"https://doi.org/10.1007/s13304-026-02834-0","url":null,"abstract":"<p><strong>Introduction: </strong>Damage control surgery (DCS) with staged reconstruction may offer an alternative to Hartmann's procedure in selected unstable patients with generalized peritonitis from acute diverticulitis, but its adoption in routine practice is uncertain.</p><p><strong>Methods: </strong>A nationwide web-based survey explored management of Hinchey III-IV acute diverticulitis, institutional use of open abdomen, and knowledge and application of DCS. Categorical data were summarized as n (%). The survey was endorsed by Italian Society of Emergency and Trauma Surgery (SICUT).</p><p><strong>Results: </strong>Among 175 respondents, 71.4% reported using Hartmann's procedure in at least half of severe cases, whereas 37.7% used primary anastomosis in at least one-quarter. Open abdomen was available in 82.3% of institutions. Awareness of DCS was reported by 148/174 (85.1%), and 116/168 (69.0%) had used it for severe diverticulitis; however, only 33/147 (22.4%) used a clinical score. Hemodynamic instability (83.1%), severe peritoneal contamination (73.2%), and the opportunity for delayed anastomosis (64.1%) were the main indications. Respondents with greater emergency surgery commitment more often reported primary anastomosis (48.1% vs. 20.9%; P < 0.001), open abdomen availability (93.5% vs. 64.2%; P < 0.001), and previous DCS use (75.5% vs. 58.1%; P = 0.024).</p><p><strong>Conclusion: </strong>DCS is familiar to and has been used by most respondents, but selection and implementation remain heterogeneous and rarely score-based. Standardized criteria, shared terminology, and prospective outcome evaluation are needed.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}