Annals of surgery open : perspectives of surgical history, education, and clinical approaches最新文献

{"title":"Gaining Insight into Operative Performance: Analysis of an Automated 360-Degree Feedback Tool Among Perioperative Staff.","authors":"Stefanie J Soelling, Robert D Sinyard, Lauren Spigel, Max Riley, Paul Gregory, Nick Perdomo, Yves Sonnay, Steven Yule, Steven J Fishman, Douglas S Smink","doi":"10.1097/AS9.0000000000000532","DOIUrl":"10.1097/AS9.0000000000000532","url":null,"abstract":"<p><strong>Background: </strong>Surgery has seen limited adoption of 360-degree feedback tools, and no current tools evaluate intraoperative performance from a technical, nontechnical, or teaching skill perspective. We sought to evaluate the overall findings and perceived value of a novel 360-degree feedback tool for surgeons from their operating room colleagues.</p><p><strong>Methods: </strong>The 'intraoperative 360' (i360) combined 3 previously validated scales of surgeon performance. The electronic medical record at a single academic medical center was queried for perioperative staff involvement in recent cases for a cohort of surgeons. Staff with frequent surgeon case involvement were emailed a link to an anonymous i360 survey. Aggregated survey responses were provided to surgeons and surgical leadership. We performed semi-structured interviews with 10 surgeons and 5 surgical leaders. Combined inductive and deductive coding was used to determine their perceptions regarding the utility of and barriers to the i360.</p><p><strong>Results: </strong>Over 2-years, a total of 960 surveys were completed for 88 surgeons. The composite rating of technical skills was 4.87/5 (SD: 0.36); nontechnical skills, 4.65/5 (SD: 0.55); and teaching skills, 2.92/3 (SD: 0.24). There was no difference in mean scores based on gender, age, or years of tenure. Six themes emerged from the interviews: initial reactions, utility, additional needs, other feedback mechanisms, reciprocal feedback, and logistical challenges.</p><p><strong>Conclusions: </strong>A 360-degree feedback tool is feasible, and feedback is perceived as valuable and actionable for surgeons and surgeon leaders. The intraoperative focus provided surgeons with specific feedback on how to improve within the operating room to promote efficiency, teamwork, and patient safety.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e532"},"PeriodicalIF":0.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878756","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":"Comment on: \"Navigating a Path Toward Routine Recording in the Operating Room\": How Should We Approach Patient Consent for Surgical Video?","authors":"August A Culbert, Alejandro Bribriesco, Michael S O'Connor, Eric Kodish","doi":"10.1097/AS9.0000000000000530","DOIUrl":"10.1097/AS9.0000000000000530","url":null,"abstract":"","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e530"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878776","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":"Intraoperative Hyperspectral Imaging Predicts Early Allograft Dysfunction and Overall Survival in Liver Transplantation.","authors":"Andri Lederer, Antonia Alina Geisler, Robert Sucher, Daniel Seehofer, Hans-Michael Hau, Uwe Scheuermann, Sebastian Rademacher","doi":"10.1097/AS9.0000000000000528","DOIUrl":"10.1097/AS9.0000000000000528","url":null,"abstract":"<p><strong>Objective: </strong>This study explored the novel application of hyperspectral imaging (HSI) for in vivo allograft perfusion assessment during liver transplantation (LT) and its potential value for predicting early allograft dysfunction (EAD), graft, and overall survival (OS).</p><p><strong>Background: </strong>LT is a well-established therapy for acute and chronic liver diseases, with excellent outcomes. However, a significant proportion of recipients experience EAD, which affects graft and OS. EAD is associated with ischemia-reperfusion injury. HSI is a noninvasive imaging modality that provides information on tissue characteristics, such as tissue hemoglobin, water index, oxygenation, and perfusion.</p><p><strong>Methods: </strong>We included all patients who underwent orthotopic LT with full-size allografts between 2019 and 2021. HSI was performed 15 minutes after reperfusion of the donor liver and subsequently analyzed. Furthermore, we collected data on postoperative graft function and clinical outcomes.</p><p><strong>Results: </strong>A total of 73 LT recipients were included in this study. Around 56.9% had expanded criteria donors (N = 41). The mean model for end-stage liver disease score was 22 (±10). Eighteen patients (25%) had EAD. The statistical analysis demonstrated that recipients with EAD had significantly lower near-infrared (NIR) perfusion values after reperfusion. Recipients with low NIR had more pronounced reperfusion injury in postoperative laboratory studies. OS was significantly lower in recipients with low NIR than in those with high NIR (<i>P</i> = 0.049).</p><p><strong>Conclusions: </strong>HSI is a promising, noninvasive tool, offering real-time, detailed graft perfusion assessment during LT. The fusion of spatial and spectral information is unique to HSI, making it an essential imaging technology for the further development of AI applications in surgery.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e528"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878784","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":"Should I Do a General Surgery Away Rotation?: Perspectives From the Collaboration of Surgical Education Research Fellows (CoSEF).","authors":"Colleen E McDermott, Ananya Anand, Riley Brian, Connie Gan, Joseph C L'Huillier, Sarah Lund, Tejas Sathe, Caitlin Silvestri, John M Woodward","doi":"10.1097/AS9.0000000000000509","DOIUrl":"10.1097/AS9.0000000000000509","url":null,"abstract":"","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e509"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878507","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":"Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis.","authors":"Gabriela Pilz da Cunha, Jasper P Sijberden, Susan van Dieren, Paul Gobardhan, Daan J Lips, Türkan Terkivatan, Hendrik A Marsman, Gijs A Patijn, Wouter K G Leclercq, Koop Bosscha, J Sven D Mieog, Peter B van den Boezem, Maarten Vermaas, Niels F M Kok, Eric J T Belt, Marieke T de Boer, Wouter J M Derksen, Hans Torrenga, Paul M Verheijen, Steven J Oosterling, Arjen M Rijken, Marielle M E Coolsen, Mike S L Liem, T C Khé Tran, Michael F Gerhards, Vincent Nieuwenhuijs, Mohammad Abu Hilal, Marc G Besselink, Ronald M van Dam, Jeroen Hagendoorn, Rutger-Jan Swijnenburg","doi":"10.1097/AS9.0000000000000527","DOIUrl":"10.1097/AS9.0000000000000527","url":null,"abstract":"<p><strong>Objective: </strong>To compare nationwide outcomes of robotic liver resection (RLR) with laparoscopic liver resection (LLR).</p><p><strong>Background: </strong>Minimally invasive liver resection is increasingly performed using the robotic approach as this could help overcome inherent technical limitations of laparoscopy. It is unknown if this translates to improved patient outcomes.</p><p><strong>Methods: </strong>Data from the mandatory Dutch Hepatobiliary Audit were used to compare perioperative outcomes of RLR and LLR in 20 centers in the Netherlands (2014-2022). Propensity score matching (PSM) was used to mitigate selection bias. Sensitivity analyses assessed the impact of the learning curve (≥50 procedures for LLR and ≥25 procedures for RLR), concurrent noncholecystectomy operations, high-volume centers, and conversion on outcomes.</p><p><strong>Results: </strong>Overall, 792 RLR and 2738 LLR were included. After PSM (781 RLR vs 781 LLR), RLR was associated with less blood loss (median: 100 mL [interquartile range (IQR): 50-300] vs 200 mL [IQR: 50-500], <i>P</i> = 0.002), less major blood loss (≥500 mL,18.6% vs 25.2%, <i>P</i> = 0.011), less conversions (4.9% vs 12.8%, <i>P</i> < 0.001), and shorter hospital stay (median: 3 days [IQR: 2-5] vs 4 days [IQR: 2-6], <i>P</i> < 0.001), compared with LLR. There were no significant differences in overall and severe morbidity, readmissions, mortality, and R0 resection rate. Sensitivity analyses yielded similar results. When excluding conversions, RLR was only associated with a reduction in reoperations (1.1% vs 2.7%, <i>P</i> = 0.038).</p><p><strong>Conclusion: </strong>In this nationwide analysis, RLR was associated with a reduction in conversion, blood loss and length of hospital stay without compromising patient safety, also when excluding a learning curve effect. The benefits of RLR seem to be mostly related to a reduction in conversions.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e527"},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878504","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 Resuscitated Cardiac Arrest in the Brain-dead Donors on the Outcome of Liver Transplantation: A Retrospective and Propensity Score Matching Analysis.","authors":"Shengmin Mei, Jie Xiang, Li Wang, Yuan Xu, Zhiwei Li","doi":"10.1097/AS9.0000000000000522","DOIUrl":"10.1097/AS9.0000000000000522","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of cardiac arrest time (CAT) in brain-dead donors on graft and recipient outcomes following liver transplantation.</p><p><strong>Background: </strong>The outcome of livers from brain-dead donors with a history of cardiac arrest (CA) remains controversial, and the duration of the CAT has never been evaluated.</p><p><strong>Methods: </strong>A retrospective review of data from the Scientific Registry of Transplant Recipients between 2003 and 2022 was conducted. Propensity score matching was performed to minimize confounding effects.</p><p><strong>Results: </strong>A total of 115,202 recipients were included, 7364 (6.4%) and 107,838 (93.6%) of whom were of the CA and non-CA group, respectively. After 1:1 propensity score matching, each group consisted of 7157 cases. The CA group demonstrated shorter hospital stay (15.5 ± 20.0 days vs. 16.2 ± 21.3 days, <i>P</i> = 0.041), with comparable incidence of early graft failure (EGF, 5.8% vs. 6.2%, <i>P</i> = 0.161). The CA group demonstrated slightly higher graft survival rates (1 year, 90% vs. 88%; 5 years, 76% vs. 74%; and 10 years, 61% vs. 58%, <i>P</i> < 0.001). CAT positively correlated with EGF [odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.02-1.04, <i>P</i> < 0.001], with a sensitivity and specificity of 73% and 86% at a cutoff of 30 minutes. The CAT <30 minutes group demonstrated significantly lower incidence of EGF (5.0%), compared with 7.8% of the CAT >30 minutes group and 6.2% of the non-CA group (<i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>The use of brain-dead donors with a history of CA did not increase the risk of liver graft failure in our study. A downtime of <30 minutes may confer protective effects on transplanted grafts.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e522"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878782","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":"Trends in Specialty Training and National Institutes of Health Funding Among Surgeon-Scientists.","authors":"Gabriel Velez, Vinit B Mahajan, Ronald J Weigel, Steven R Lentz","doi":"10.1097/AS9.0000000000000521","DOIUrl":"10.1097/AS9.0000000000000521","url":null,"abstract":"<p><strong>Purpose: </strong>To determine if dual-degree training [ie, completion of a National Institutes of Health (NIH)-funded MD/PhD program], among other professional development and demographic variables, predicted academic productivity (eg, K-to-R conversion, number of publications, etc.) among early-career surgeon-scientists.</p><p><strong>Methods: </strong>We analyzed publicly available data from the National MD/PhD Program Outcomes Study and the Association of American Medical Colleges Graduate Medical Education Track database to identify trends in the number and proportion of MD/PhD graduates pursuing surgical specialties. NIH Research Portfolio Online Reporting Tool Expenditures and Results was interrogated to identify a cohort of early-career academic surgeon-scientists receiving K-awards from 2011 to 2021.</p><p><strong>Results: </strong>The total number of MD/PhD program graduates completing Graduate Medical Education training increased each decade after the Medical Scientist Training Program was established by the National Institute of General Medical Sciences, but the proportion completing surgical specialties did not change significantly (<i>P</i> = 0.96) from 1965 to 2014. More recent residency match trends demonstrate an increase in both the proportion and number of MD/PhD graduates entering surgical specialties, with 21.5% entering surgical residency training in 2020. Among 476 early-career academic surgeon-scientists receiving K-awards at 70 institutions, 27% were faculty members at only 4 universities, suggesting that federally funded surgeon-scientists are concentrated at a small number of institutions. Although MD/PhD graduates represented only 2.3% of active surgical residents from 2011 to 2020, they constituted a much higher fraction of K-awardees (29%). Of 296 surgeon-scientists who completed K-awards, 35% successfully obtained an R01-equivalent award.</p><p><strong>Conclusions: </strong>These findings emphasize the need for comprehensive career development and institutional resources to support early-career surgeon-scientists.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e521"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878471","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 Enhanced Recovery After Surgery Protocol Compliance on Outcome After Pancreatic Surgery: Results From a Certified ERAS Center.","authors":"Alina S Ritter, Thilo Welsch, Freya Brodersen, Julia Auinger, Parisa Moll-Khosrawi, Mara R Goetz, Jan Bardenhagen, Christine Nitschke, Tobias Schneider, Björn Wellge, Anna Suling, Faik G Uzunoglu, Asmus Heumann, Felix Nickel, Thilo Hackert, Jakob R Izbicki","doi":"10.1097/AS9.0000000000000501","DOIUrl":"10.1097/AS9.0000000000000501","url":null,"abstract":"<p><strong>Objective: </strong>The aim was to evaluate the sustainability of the pancreatic Enhanced Recovery After Surgery (ERAS) program and the effect of ERAS items on patient morbidity and hospital stay.</p><p><strong>Background: </strong>The current ERAS guideline recommendations encompass 27 items to improve recovery after pancreatoduodenectomy (PD).</p><p><strong>Methods: </strong>Patients who underwent pancreatic resection at the University Hospital Hamburg-Eppendorf between February 2016 and June 2023 were included. The datasets were retrospectively collected from a central database. The effects of individual ERAS items and compliance on morbidity and hospital stay were assessed by uni- and multivariable analyses.</p><p><strong>Results: </strong>In total, 594 patients who underwent PD (44.8%), distal pancreatectomy (14.6%), total pancreatectomy (17.8%), or other pancreatic resections (22.7%) were included. Of these, 90 patients (15.2%) achieved a high overall ERAS compliance of ≥70%. High compliance was associated with significantly less complications (Clavien-Dindo ≥ 3a), reduced 30-day mortality, and a shorter hospital stay. Early mobilization on the first postoperative day (POD1), restrictive intravenous fluid administration, and timely removal of urinary catheters were significant multivariable predictors for lower morbidity. Early mobilization on POD1 also correlated with reduced morbidity in the subcohort of PD cases.</p><p><strong>Conclusions: </strong>The pancreatic ERAS protocol can be sustainably implemented and applied to both, PD and non-PD cases. A high level of compliance with the ERAS protocol after pancreatic resections correlated with improved outcomes but was achieved by less than one-fifth of patients. Early mobilization on POD1 and restrictive fluid management were key indicators for optimized short-term outcomes.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e501"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878781","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":"Comment on \"Right Ex Situ Split Grafts for Adult Liver Transplantation A Multicenter Benchmarking Analysis\".","authors":"Andrea Lauterio, Umberto Cillo, Riccardo De Carlis, Davide Bernasconi, Enrico Gringeri, Domenico Pinelli, Michele Colledan, Enzo Andorno, Luciano De Carlis","doi":"10.1097/AS9.0000000000000526","DOIUrl":"10.1097/AS9.0000000000000526","url":null,"abstract":"","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e526"},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878773","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":"Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy.","authors":"Nejo Joseph, Chris Varghese, James Lucocq, Matthew J McGuinness, Samuel Tingle, Giovanni Marchegiani, Kjetil Soreide, Mohammed Abu-Hilal, Jas Samra, Marc Besselink, Steve White, Sanjay Pandanaboyana","doi":"10.1097/AS9.0000000000000507","DOIUrl":"10.1097/AS9.0000000000000507","url":null,"abstract":"<p><strong>Background: </strong>The use of minimally invasive (laparoscopic and robotic) pancreatoduodenectomy (PD) is being increasingly adopted despite the lack of hard evidence to support its utilisation. With recent randomised controlled trials (RCTs) comparing open pancreatoduodenectomy (OPD) with robotic or laparoscopic pancreatoduodenectomy (RPD or LPD), we undertook a network meta-analysis (NMA) comparing all 3 approaches to evaluate comparative outcomes.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, EMBASE, and Cochrane CENTRAL was conducted up to May 2024 and relevant RCTs were identified. A random-effects meta-analysis and trial sequential analysis (TSA) were conducted for primary outcomes, followed by a Bayesian NMA of length of stay (LOS), duration of surgery, intraoperative blood loss, and pancreas resection-related outcomes.</p><p><strong>Results: </strong>Seven RCTs involving 1336 patients were included, 5 investigating LPD compared with OPD and 2 RPD to OPD. Pairwise meta-analysis indicated that LPD was associated with shorter hospital stay (mean difference [MD], -1.39; 95% confidence interval [CI], -2.33 to -0.45) and lower intraoperative blood loss compared with OPD (MD, -131; 95% CI, -146 to -117). However, LPD was associated with significantly longer operative duration (MD, 39.5; 95% CI, 34-45). TSA confirmed the robustness of the positive and negative findings on pairwise meta-analysis. In comparison, there were no significant differences between RPD and OPD in pairwise meta-analysis, which could not be confirmed by TSA. Network meta-analysis tended to favour LPD in most outcome parameters including LOS, duration of surgery, and pancreas resection-related outcomes.</p><p><strong>Conclusions: </strong>The current RCT evidence suggests potential better outcomes in LPD in comparison with RPD and OPD. However, few studies demonstrated robust statistical significance in outcome measures, suggesting an underpowered evidence base and possible selection bias. Hence, with current equivocal data, there is a need for ongoing RCTs to validate the role of minimally invasive approaches in PD.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e507"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878786","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}