BMJ connections surgery最新文献

{"title":"Preliminary clinical experience using the Leica ARveo with MyVeo in neurosurgery: an IDEAL stages 1 and 2a observational study.","authors":"Fumihiro Matano, Yohei Nounaka, Hiroyuki Dan, Takao Kitamura, Tadashi Higuchi, Katsuya Umeoka, Yasuo Murai","doi":"10.1136/bmjcsurg-2026-000006","DOIUrl":"10.1136/bmjcsurg-2026-000006","url":null,"abstract":"<p><strong>Objective: </strong>To report the initial clinical experience with the Leica ARveo system with MyVeo in neurosurgery, focusing on feasibility, ergonomics and visualisation characteristics during early clinical implementation.</p><p><strong>Design: </strong>This observational study was conducted in accordance with the IDEAL framework (stages 1 and 2a: Idea/Development and Exploration).</p><p><strong>Setting: </strong>Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan.</p><p><strong>Participants: </strong>Six patients undergoing neurosurgical procedures, including three aneurysm clippings, two microvascular decompressions and one superficial temporal artery-to-middle cerebral artery bypass for moyamoya disease.</p><p><strong>Intervention: </strong>MyVeo was used either by the assistant (cases 1-3) or collaboratively by the primary surgeon and assistant (cases 4-6), reflecting staged clinical implementation.</p><p><strong>Main outcome measures: </strong>Feasibility, ergonomics, visualisation characteristics, operative workflow and intraoperative safety were assessed based on intraoperative observations and team feedback.</p><p><strong>Results: </strong>All procedures were completed without intraoperative complications. MyVeo allowed flexible viewing and facilitated shared visualisation among surgical team members, with reported improvements in ergonomics and intraoperative collaboration. However, limitations were identified, including lower image resolution and depth perception compared with conventional microscopes as well as neck fatigue and workflow challenges related to cable management. The system required adaptation during use, particularly in the early phase.</p><p><strong>Conclusions: </strong>The use of Leica ARveo with MyVeo was feasible in this small case series and provided ergonomic and collaborative advantages in selected scenarios. However, given its current limitations in visualisation performance and system integration, it should be considered a complementary tool rather than a replacement for conventional operating microscopes. Further studies with objective outcome measures are required to define its clinical role.</p>","PeriodicalId":524179,"journal":{"name":"BMJ connections surgery","volume":"8 1","pages":"e000006"},"PeriodicalIF":0.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repetitive transcranial magnetic stimulation (rTMS) for the treatment of epilepsy: a systematic review and meta-analysis of clinical trials (from 1990 to 2025).","authors":"Leila Poursoleiman, Fatemeh Bahramnezhad, Shafiee Sabet Mahdi, SeyedAhmad SeyedAlinaghi, Dehghan Nayeri Nahid","doi":"10.1136/bmjcsurg-2026-000032","DOIUrl":"10.1136/bmjcsurg-2026-000032","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review and meta-analysis evaluates the efficacy of repetitive transcranial magnetic stimulation (rTMS) in reducing seizure frequency in patients with epilepsy, synthesising evidence from randomised controlled trials (RCTs).</p><p><strong>Design: </strong>Systematic review and meta-analysis of RCTs conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020 guidelines.</p><p><strong>Setting: </strong>Literature search across international (PubMed, EMBASE, Cochrane, Scopus, ScienceDirect, Google Scholar) and Iranian (SID, Magiran, IranMedex) databases.</p><p><strong>Participants: </strong>Adult patients diagnosed with epilepsy, including those with drug-resistant focal epilepsy, from 14 included RCTs (total n=516).</p><p><strong>Interventions: </strong>Active low-frequency rTMS (0.3-1 Hz) compared with sham stimulation or active control (eg, antiepileptic drug therapy).</p><p><strong>Main outcome measures: </strong>The primary outcome was the mean change in weekly seizure frequency analysed using standardised mean difference (SMD).</p><p><strong>Results: </strong>From 1952 retrieved records, 14 RCTs were reviewed and 8 were meta-analysed (n=367). The pooled analysis showed a statistically significant reduction in seizure frequency favouring rTMS (SMD=-0.46, 95% CI -0.57 to -0.34, p=0.001, Z=-7.67), with low heterogeneity (I²=0.1%). The combined mean seizures were 6.1 (intervention) versus 7.4 (control) per week. No significant publication bias was detected (Egger's test p=0.086).</p><p><strong>Conclusions: </strong>Low-frequency rTMS demonstrates a significant short-term reduction in seizure frequency. However, the clinical durability of this effect remains uncertain due to limited follow-up in existing trials. Definitive conclusions require larger, standardised RCTs with longer-term outcomes.</p><p><strong>Trial registration: </strong>No human participants included.</p>","PeriodicalId":524179,"journal":{"name":"BMJ connections surgery","volume":"8 1","pages":"e000032"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between preoperative inflammatory biomarkers and postoperative morbidity and mortality in stage I-III colorectal cancer patients: a single-centre prospective study.","authors":"Meriem Fella Guerni, Lilya Khelifi, Hakim Chatter, Meriem Mokhbi, Fetoma El Metennani, Kaouther Boughezala, Manel Amri, Imene Soufli, Houda Belguendouz, Rania Sihem Boussa, Chafia Touil-Boukoffa, Batoul Latreche, Nassim Sid Idris","doi":"10.1136/bmjcsurg-2026-000020","DOIUrl":"10.1136/bmjcsurg-2026-000020","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether preoperative inflammatory biomarkers have prognostic value in terms of postoperative surgical morbidity in stage I-III resectable colorectal cancer.</p><p><strong>Design: </strong>Prospective observational cohort study.</p><p><strong>Setting: </strong>This is a single centre study conducted at the general surgery department of Djilali Belkhenchir, formerly Birtraria, Hospital, in Algeria.</p><p><strong>Participants: </strong>We enrolled patients with non-metastatic colorectal cancer who underwent initial curative resection from May 2022 to May 2025.</p><p><strong>Main outcome measure: </strong>Preoperative inflammatory biomarkers such as neutrophil to lymphocyte ratio, platelets to lymphocyte ratio, monocyte to lymphocyte ratio and lymphocyte×albumin (LA) were calculated based on blood samples taken 30 days prior to surgery. The primary outcome was postoperative morbidity and the secondary outcome was postoperative mortality.</p><p><strong>Results: </strong>230 patients met the inclusion criteria and had curative resection. Multivariable regression analysis showed that tumour size (OR 1.264, 95% CI 1.098 to 1.455, p<0.001), LA (OR 0.501, 95% CI 0.284 to 0.881, p=0.016) and rectal location (OR 2.569, 95% CI 1.138 to 5.798, p=0.023) were independent factors associated with postoperative complications.</p><p><strong>Conclusion: </strong>The LA score, tumour size and tumour location were associated with post-operative morbidity in patients with stage I-III resectable colorectal cancer.</p>","PeriodicalId":524179,"journal":{"name":"BMJ connections surgery","volume":"8 1","pages":"e000020"},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Representation in robotic surgery randomised controlled trials: a systematic review.","authors":"Sara Varadharajulu, Robin Ji, Sanket Dhruva, John Neuhaus, Ken Cohen, Rita Redberg","doi":"10.1136/bmjcsurg-2026-000034","DOIUrl":"10.1136/bmjcsurg-2026-000034","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic surgery has been widely adopted across surgical specialties since its introduction in the 1980s, making it important to assess the representation of patients from varying demographic backgrounds in clinical trials. The objective of this study was to evaluate the demographic representativeness of randomised controlled trials (RCTs) on robotic surgery.</p><p><strong>Research design and methods: </strong>This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Embase and Web of Science databases were searched for English-language RCTs conducted between January 2000 and December 2022. Only RCTs that enrolled participants of both sexes and compared robotic surgery with a non-robotic comparator were included. Primary outcomes included the reporting of participants' demographic information, specifically sex, age, race and ethnicity, the inclusion of subgroup analyses based on these demographics and the distribution of demographics within each study.</p><p><strong>Results: </strong>Out of 75 RCTs, 71 (95%) trials reported participant sex, 73 (97%) RCTs reported age and four (5%) RCTs reported race or ethnicity. Six (8%) RCTs provided sex-specific results, three (4%) RCTs provided age-specific outcomes and no RCTs reported outcomes based on race or ethnicity. The average percentage of female patients per RCT was 47.1% and the average age was 59.7 (SD=9) years. Of the RCTs that reported race or ethnicity, 59.5% of the population was Caucasian, 25.0% was Hispanic, 13.9% was African American and 1.6% was Asian/Pacific Islander/other.</p><p><strong>Conclusions: </strong>There was underreporting of demographic data, especially race and ethnicity of participants, a lack of demographic-specific study outcomes and underrepresentation of women and non-white participants across RCTs. This study highlights the need for greater efforts to improve diversity in robotic surgery clinical trials.</p>","PeriodicalId":524179,"journal":{"name":"BMJ connections surgery","volume":"8 1","pages":"e000034"},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of telemonitoring systems in cancer care: a systematic review.","authors":"Theologia Tsitsi, Andreas Charalambous, Maria-Dolores Christofi, Constantina Cloconi, Koralia Michail, Victoria Leclercq, Efthyvoulos Kyriacou","doi":"10.1136/bmjcsurg-2026-000038","DOIUrl":"10.1136/bmjcsurg-2026-000038","url":null,"abstract":"<p><p>This systematic review evaluates the impact, usability, technical performance and adherence of telemonitoring systems in adult cancer care. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Peer Review of Electronic Search Strategies guideline. PubMed, MEDLINE and CINAHL were searched from June 2013 to March 2025. Search terms covered cancer care, telemonitoring systems, mobile health (mHealth), eHealth, health outcomes and evaluation tools. Included studies were randomised controlled trials, controlled clinical trials or prospective trials involving adult patients with cancer using telemonitoring systems for symptom management. Exclusion criteria included cross-sectional, retrospective or non-English studies. Two reviewers screened and extracted data, with a third reviewer resolving disagreements. Risk of bias was assessed using Cochrane Risk of Bias Tool V.1. Due to heterogeneity, a narrative synthesis was conducted, categorising studies by intervention type, clinical outcomes, adherence and usability. 16 studies were included. Telemonitoring appears to hold potential in oncology care, with indications of improved quality of life, symptom management and patient engagement, particularly when real-time clinician feedback is included. While mHealth apps were well received, asynchronous systems were associated with lower adherence. Few studies addressed data security or long-term outcomes. The search was aligned with European Union (EU) - assigned eHealth for Cancer Prevention & Care (eCAN Joint Action) priorities, which may have narrowed the results and limited the overall completeness of this systematic review. Telemonitoring shows promise in oncology care but requires personalisation, workflow integration and long-term evaluation. Real-time clinician support may enhance adherence and outcomes. PROSPERO registration number CRD42023430639.</p>","PeriodicalId":524179,"journal":{"name":"BMJ connections surgery","volume":"8 1","pages":"e000038"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of natural language processing for surgical complication surveillance: detecting 11 postoperative complications from electronic health records.","authors":"Emilie Even Dencker, Alexander Bonde, Anders Troelsen, Martin Sillesen","doi":"10.1136/bmjcsurg-2026-000039","DOIUrl":"10.1136/bmjcsurg-2026-000039","url":null,"abstract":"<p><p>INTRODUCTION Postoperative complications (PCs) rates are crucial quality metrics in surgery, as they reflect both patient outcomes, perioperative care effectiveness and healthcare resource strain. Despite their importance, efficient, accurate and affordable methods for tracking PCs are lacking. This study aimed to evaluate whether natural language processing (NLP) models could detect 11 PCs from surgical electronic health records at a level comparable to human curation. RESEARCH AND DESIGN METHODS Retrospective study in 18 hospitals across two regions in Denmark. A total of 17 486 surgical cases spanning 6 years were included. The dataset was divided into training, validation and test sets for NLP-model development and evaluation (50.2%/33.6%/16.2%). Model performance was compared against the current method of PC monitoring (International Classification of Diseases, 10th Revision (ICD-10) codes) and manual curation, the latter serving as the gold standard. 17 486 surgical cases from spanning 6 years were included. The dataset was divided into training, validation and test sets for NLP-model development and evaluation (50.2%/33.6%/16.2%). Model performance was compared against the current method of PC monitoring (International Classification of Diseases, 10th Revision (ICD-10) codes) and manual curation, the latter serving as the gold standard. RESULTS The NLP-models had a receiver operating characteristic area under the curve between 0.901 and 0.999 for the test set and significantly outperformed ICD-10 coding in detecting PCs. Sensitivity of the models when compared with manual curation ranged from 0.701 to 1.00, except for myocardial infarction (0.500). Positive predictive value (PPV) ranged from 0.0165 to 0.947, and negative predictive value from 0.995 to 1.00. Using a Human-in-the-Loop approach, only 16.3% of cases required manual review to reach a PPV of 1.00. CONCLUSIONS The NLP models alone were able to detect PCs at an acceptable level and outperformed ICD-10 codes. While combining NLP with manual review (Human-in-the-Loop) improved overall accuracy and reduced workload, the models still failed to identify some complications. Therefore, NLP algorithms may support (but not replace) manual surveillance and present a potential solution for more scalable PC monitoring.</p>","PeriodicalId":524179,"journal":{"name":"BMJ connections surgery","volume":"8 1","pages":"e000039"},"PeriodicalIF":0.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a new robotic system: challenges for the surgical team and ethical concerns about patient safety, a longitudinal questionnaire study.","authors":"Ibrahim Alkatout, Désirée Meinhold-Heerlein, Paula Rosam, Julian Pape, Nicolai Maass, Huy Duc Le, Sören von Otte, Zino Ruchay, Johannes Ackermann, Thomas Becker, Julius Pochhammer, Pernilla Virginia Conrad, Claudia Bozzaro, Veronika Günther","doi":"10.1136/bmjcsurg-2026-000041","DOIUrl":"10.1136/bmjcsurg-2026-000041","url":null,"abstract":"<p><strong>Introduction: </strong>The da Vinci robot continues to be the leading robotic system used in surgery. Following the expiry of its patent, many manufacturers started to develop other systems. We accompanied this sensitive initial phase of implementing a new surgical system in a clinic at which the previously established robotic system has completed its learning curve. Is it ethically justifiable to implement a new robotic system although an established, reliable and low-risk procedure is available?</p><p><strong>Research design and methods: </strong>We conducted a longitudinal and interdisciplinary questionnaire study from November 2022 to April 2023. Specific questionnaires - answered on a visual analog scale from 1 to 100 - were created for four target groups: surgeons, anesthesiologists, residents, and operating-room (OR) nurses.</p><p><strong>Results: </strong>A total of 63 participants filled the questionnaire and answered the tailored questions. While the surgeons, along with the OR nurses, initially had the greatest reservations about the Dexter robot and patient safety, their reservations lessened as the number of Dexter procedures performed increased. In contrast, the OR nurses were critical of the new robot and their ratings did not change as the number of Dexter procedures increased. Of all four groups, the residents rated the Dexter robot most positively.</p><p><strong>Conclusions: </strong>The establishment of a new surgical system that has been approved, yet not established so far, constitutes a major challenge with regard to ethical issues concerning patient safety. A standardized, mandatory curriculum for the entire surgical team would be desirable in order to achieve a similar level of technical expertise as that existing for the established robot system. In addition, we need comprehensible and transparent information for patients. To date, we lack regulations concerning these aspects, which are handled differently in the individual hospitals.</p>","PeriodicalId":524179,"journal":{"name":"BMJ connections surgery","volume":"8 1","pages":"e000041"},"PeriodicalIF":0.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RESPOND intervention: protocol for a cluster-randomized stepped-wedge trial of a human factors intervention to reduce failure to rescue in emergency general surgery.","authors":"Peter McCulloch, Sachal Safdar, Mark Sujan, Nicola Macintosh, Mudathir Ibrahim, Joanne Kitchin, Laurie Earl, Abhishek Dey, William Plath, Saydia Wellesley, Rose Baker, Felix Achana, Lesley Booth","doi":"10.1136/bmjsit-2025-000379","DOIUrl":"10.1136/bmjsit-2025-000379","url":null,"abstract":"","PeriodicalId":524179,"journal":{"name":"BMJ connections surgery","volume":"8 1","pages":"e000379"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}