American journal of surgery最新文献

{"title":"Prospects for the use of objective assessment indicators of surgical skills in medical education: a twenty-year scoping review","authors":"Lei Fu ,&nbsp;Songlin Li ,&nbsp;Zhansheng Zou ,&nbsp;Li Gan ,&nbsp;Guolin He ,&nbsp;Lang Xie ,&nbsp;Jing Tian ,&nbsp;Yao Xiao","doi":"10.1016/j.amjsurg.2025.116606","DOIUrl":"10.1016/j.amjsurg.2025.116606","url":null,"abstract":"<div><h3>Purpose</h3><div>Automatic and objective evaluation indicators can address the limitations of subjective assessments of surgical skills that are easily influenced by individual subjectivity and provide a more collected and accurate evaluation method. The aim of this study is to investigate, synthesize, and discuss various objective assessment indicators for surgical skills as reported in current literature.</div></div><div><h3>Method</h3><div>A systematic search was conducted in the PubMed medical database following the PRISMA-ScR reporting guidelines. Inclusion criteria encompassed studies involving participants from the healthcare industry and scenarios involving surgical simulations or real surgical procedures. The research involved objective assessment indicators in two aspects: technical skills (TS) and non-technical skills (NTS).</div></div><div><h3>Result</h3><div>After searching 3366 articles, 70 articles met the inclusion criteria. According to the objective assessment methods used in the included literature, some of which involve multiple methods (n ​= ​3), the current real-time objective assessment indicators of surgical skills can be divided into physical indicators (n ​= ​29), physiological indicators related to brain function (n ​= ​30), and physiological indicators related to non-brain function (n ​= ​14). The surgery types encompassed open surgical procedures, minimally invasive surgical procedures, and basic operations, while the surgical settings involved simulation-based surgery and surgery on real patients.</div></div><div><h3>Conclusion</h3><div>Currently, research on automatic and objective assessment indicators for surgical skills is in its preliminary stages, and it can indicate the difference between novices and experts, but it lacks the ability of universal, accurate, and detailed differentiation. It is necessary to develop multi-dimensional and multi-scenario combined evaluation methods.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"249 ","pages":"Article 116606"},"PeriodicalIF":2.7,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060133","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":"Postoperative serum VEGF concentration and recurrence after curative colon cancer surgery: findings from a multicenter prospective cohort","authors":"Clara Téllez ,&nbsp;Meritxell Labró-Ciurans ,&nbsp;Sofía de la Serna ,&nbsp;Rubén Hernando ,&nbsp;Matteo Frasson ,&nbsp;Aleidis Caro ,&nbsp;David Parés ,&nbsp;Xavier Mayol ,&nbsp;Adrián Vizoso ,&nbsp;Xavier Durán ,&nbsp;Olga Morató ,&nbsp;Miguel Pera ,&nbsp;Marta Pascual","doi":"10.1016/j.amjsurg.2025.116603","DOIUrl":"10.1016/j.amjsurg.2025.116603","url":null,"abstract":"<div><h3>Background</h3><div>Angiogenesis is essential for tumor progression, with vascular endothelial growth factor (VEGF) as a key regulator. A prior single-center study identified VEGF &gt;370 ​pg/mL on postoperative day 4 (POD4) as a predictor of recurrence in colon cancer (CC).</div></div><div><h3>Methods</h3><div>We conducted a prospective study including 255 patients undergoing curative-intent CC surgery across seven Spanish institutions (NTC04851054). Serum VEGF was measured via ELISA on POD4.</div></div><div><h3>Results</h3><div>After a median follow-up of 34 months, recurrence occurred in 15.7 ​% of patients. The previously proposed VEGF cutoff was not validated. No significant differences in VEGF were observed between patients with and without recurrence. However, higher VEGF levels were associated with open surgery (p ​= ​0.013) and postoperative complications (p ​&lt; ​0.001), with a trend in anastomotic leakage (p ​= ​0.062).</div></div><div><h3>Conclusions</h3><div>VEGF was not predictive of recurrence in this setting but remains a relevant marker of perioperative angiogenic activity, warranting further investigation.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"249 ","pages":"Article 116603"},"PeriodicalIF":2.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060132","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":"“That's what sets you at ease:” A qualitative analysis of patient preferences during anorectal exams","authors":"Derek Chan ,&nbsp;Ava Ferguson Bryan ,&nbsp;Daniel Kim ,&nbsp;Julie Chor ,&nbsp;Lisa Cannon ,&nbsp;Kinga S. Olortegui","doi":"10.1016/j.amjsurg.2025.116600","DOIUrl":"10.1016/j.amjsurg.2025.116600","url":null,"abstract":"<div><h3>Introduction</h3><div>Increased attention is being paid to sensitive but necessary medical examinations, but the literature on guidelines for the anorectal exam remains limited. We performed a qualitative investigation of the patient experience to identify best practice recommendations from the patient's perspective for practitioners conducting the anorectal exam.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with patients aged 18 and older who had received at least one anorectal examination at the University of Chicago Medicine, Colon &amp; Rectal Surgery clinic. The interviews investigated contextual aspects of the anorectal examination, such as the urgency of the visit, the clinical environment, and patients' encounters with the anorectal examination. We sought recommendations on how to improve the examination experience. Interviews were digitally recorded and transcribed. Content analysis was performed by two independent researchers. Interviews were obtained until thematic saturation was reached.</div></div><div><h3>Results</h3><div>Twenty-three participants (48 ​% female, 48 ​% first-time examinees) completed interviews. Regarding examination preparation, most participants preferred obtaining exam information directly from their providers. Without prompting, many female patients expressed a preference for a female provider. Most exam logistics were non-contributory to the patient experience (exam room, gown, instrument use, etc.). Most patients did not mind chaperones if they were additionally serving another role (i.e. assisting in the examination). When chaperones were explicitly offered, every patient declined.</div></div><div><h3>Conclusion</h3><div>Recommendations included (1) establishing rapport and educating before the examination, (2) building practices to orient patients, (3) explaining procedural steps and eliciting continuous feedback, and (4) implementing routine use of chaperones instead of asking patients to opt-in, when possible. These findings emphasize the need for best practice guidelines and educational interventions to equip healthcare providers for conducting anorectal examinations.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116600"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003939","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":"The role of artificial intelligence in surgeon-performed ultrasonographic evaluation of cytologically indeterminate thyroid nodules","authors":"Man Him Matrix Fung ,&nbsp;Wai In Ng ,&nbsp;Henry Ethan Lee ,&nbsp;Tin Ho Chan ,&nbsp;Steven Tsz King Leung ,&nbsp;Yan Luk ,&nbsp;Brian Hung Hin Lang","doi":"10.1016/j.amjsurg.2025.116599","DOIUrl":"10.1016/j.amjsurg.2025.116599","url":null,"abstract":"<div><h3>Introduction</h3><div>Evaluating indeterminate thyroid nodules(ITN) is challenging, especially without molecular tests. This study examines whether artificial intelligence (AI) assistance can improve ITN diagnostic accuracy and bridge expertise gaps in surgeon-performed ultrasound.</div></div><div><h3>Methods</h3><div>134 ultrasound clips from 67 patients with ITN were reviewed by doctors of four levels: endocrine-surgery specialist, senior residents, junior residents, and medical student. After a 2-week wash-out, they re-evaluated the clips using AI-SONIC, an AI platform analyzing ultrasound real-time to predict cancer risk. Performance was validated against final histopathology.</div></div><div><h3>Results</h3><div>Without AI, medical students, junior residents and senior residents performed significantly worse than specialists(AUROC 0.530–0.560 vs 0.771, p ​&lt; ​0.05). AI-SONIC improved residents' and medical students' diagnostic accuracy to levels comparable with specialists(AUROC 0.733–0.751 vs 0.771). The specialists’ performance remained unchanged with AI assistance.</div></div><div><h3>Conclusion</h3><div>AI enhances ultrasound evaluation of ITN by junior surgeons and medical students, elevating their accuracy to expert levels, supporting clinical assessment and medical education.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"249 ","pages":"Article 116599"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010112","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":"Understanding beyond words: The impact of English proficiency in postoperative outcomes after solid organ transplantation","authors":"Stalin Canizares ,&nbsp;Ritah Chumdermpadetsuk ,&nbsp;Benjamin G. Allar ,&nbsp;Maria Rivera ,&nbsp;Anna Modest ,&nbsp;Martin Dib ,&nbsp;Eckhoff Devin","doi":"10.1016/j.amjsurg.2025.116604","DOIUrl":"10.1016/j.amjsurg.2025.116604","url":null,"abstract":"<div><h3>Background</h3><div>Transplantation is the final step in a multi-stage process where effective communication is essential for optimal postoperative outcomes. Language discordance may provide many challenges through this process.</div></div><div><h3>Methods</h3><div>We compared patient/graft survival, rejection, readmission, and length of hospitalization (LOS) between patients with and without limited English proficiency (LEP). Liver and kidney patients were assessed separately. Hazard ratios, linear regression, and binomial logistic regression were retrieved from a propensity matched cohort. Word clouds and thematic analysis were used to explore reasons for readmission.</div></div><div><h3>Results</h3><div>Compared to English-speakers, patients with LEP undergoing liver transplant had a higher risk of readmission from discharge (p ​&lt; ​0.006), and longer LOS (p ​= ​0.03). Kidney recipients with LEP had longer LOS (p ​= ​0.042).</div></div><div><h3>Conclusion</h3><div>Transplant recipients with LEP have worse postoperative outcomes. They represent a diverse population, where language is just one of many barriers encountered. Enhanced educational exposure and system-level interventions could improve clinical outcomes.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116604"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044201","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 assessment tools for women with breast atypia: A systematic review","authors":"Tori C. Nierenberg ,&nbsp;Juliet C. Dalton ,&nbsp;Rylan Howell ,&nbsp;Samantha Kaplan ,&nbsp;Akiko Chiba ,&nbsp;Ton Wang ,&nbsp;Jennifer K. Plichta","doi":"10.1016/j.amjsurg.2025.116598","DOIUrl":"10.1016/j.amjsurg.2025.116598","url":null,"abstract":"<div><h3>Background</h3><div>Breast atypia is a benign breast disease found in a minority of percutaneous biopsies and is associated with an increased risk of breast cancer. Risk assessment calculators/tools have variable performance in this subgroup. We systematically reviewed tools developed or validated for women with breast atypia to guide clinicians and inform future model development.</div></div><div><h3>Methods</h3><div>We searched three databases for original studies published prior to November 13, 2023, that investigated the development or validation of risk assessment tools in atypia patients. PROBAST was used to assess the risk of bias and applicability.</div></div><div><h3>Results</h3><div>From 6252 records, 12 studies (1993–2022) were included (91.6 ​% U.S.-based; median sample size 540). The Gail model (C-index 0.5) and Tyrer-Cuzick model (0.49–0.54) performed poorly. Newer models demonstrated improved calibration (0.59–0.68), though 41.6 ​% had high risk of bias.</div></div><div><h3>Conclusions</h3><div>Current tools inadequately predict breast cancer risk in atypia patients. Novel, population-specific models are needed.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116598"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010040","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":"Hernia rate after damage control laparotomy: a retrospective review using ten core outcomes for damage control laparotomy","authors":"John Cord Helmken ,&nbsp;Julia Lunt ,&nbsp;John D. Cull","doi":"10.1016/j.amjsurg.2025.116601","DOIUrl":"10.1016/j.amjsurg.2025.116601","url":null,"abstract":"<div><h3>Background</h3><div>Long-term outcomes including incisional hernia (IH) after damage control laparotomy (DCL) are poorly understood. Ten core outcomes were recently proposed to standardize DCL studies. We evaluated these outcomes and IH rates post-DCL, hypothesizing that delayed closure, abdominal complications, leak, abscess and fistula would be associated with IH.</div></div><div><h3>Methods</h3><div>We performed a single-center retrospective review of 262 patients who underwent DCL (2016–2019). IH was assessed by exam or CT at one year. Core outcomes measured were fascial closure at index hospitalization, days to closure, abdominal complications, major complications requiring reoperation or unplanned re-exploration, GI anastomotic leak, secondary intra-abdominal sepsis, enterocutaneous fistula, in-hospital mortality, 30 day mortality, and 12-month functional outcome.</div></div><div><h3>Results</h3><div>IH occurred in 50.5 ​% of patients; 10.0 ​% had planned ventral hernias. No core outcome was significantly associated with IH.</div></div><div><h3>Conclusion</h3><div>IH is common one year after DCL. Further studies are needed to identify modifiable factors and develop strategies to reduce IH rates.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116601"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044202","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":"Conversion therapy for patients with unresectable intermediate-advanced hepatocellular carcinoma: A comparative analysis in a real-world cohort","authors":"Yangyang Ou ,&nbsp;Yiyu Chen ,&nbsp;Kang Chen ,&nbsp;Ming Yao,&nbsp;Guanglin Ling,&nbsp;Chun Liao,&nbsp;Yanlong Liu,&nbsp;Haizhao Cao,&nbsp;Jianjun Li,&nbsp;Chunming Wang,&nbsp;Yuanneng Nong,&nbsp;Ji'an Chen,&nbsp;Fei Huang,&nbsp;Yubin Huang,&nbsp;Xiaoyong Cai,&nbsp;Yihe Yan","doi":"10.1016/j.amjsurg.2025.116602","DOIUrl":"10.1016/j.amjsurg.2025.116602","url":null,"abstract":"<div><h3>Background</h3><div>Conversion therapy offers new hope for patients with unresectable hepatocellular carcinoma (uHCC), thereby becoming a pivotal advancement in the field of liver cancer treatment.</div></div><div><h3>Methods</h3><div>This study consecutively collected clinical data of patients who received different conversion therapy regimens from June 2020 to March 2024, and retrospectively analyzed their efficacy and survival prognosis.</div></div><div><h3>Results</h3><div>In this study, the conversion success rate of patients with uHCC after conversion therapy was 20.4 ​%. Patients who successfully converted had a better long-term prognosis than those who failed. Compared with patients treated with combination therapy, the conversion rate and objective response rate of single local treatment were lower.</div></div><div><h3>Conclusions</h3><div>The choice of conversion therapy is crucial for the prognosis of patients with uHCC. The triple therapy of Hepatic Arterial Infusion Chemotherapy (HAIC) combined with Tyrosine Kinase Inhibitor (TKI) and Immune Checkpoint Inhibitor (ICI) demonstrates favorable outcomes and manageable safety profiles.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116602"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044339","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":"Reconsidering the timeline: Delayed cosyntropin stimulation testing in adrenalectomy patients receiving perioperative steroids.","authors":"Alexa Lisevick Kumar, George A Taylor, Tracy S Wang, Sophie Y Dream","doi":"10.1016/j.amjsurg.2025.116596","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116596","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116596"},"PeriodicalIF":2.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051599","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":"Socioecological model and designing interventions for surgical patients with non-English preferred language.","authors":"Jesus Mejia, Brittany M Dacier, Jenny Ventura, Emily E Witt, Regan W Bergmark, Gezzer Ortega","doi":"10.1016/j.amjsurg.2025.116597","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116597","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116597"},"PeriodicalIF":2.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013718","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}