American Surgeon最新文献

{"title":"Elements of Complexity in the Surgical Anatomy of Laparoscopic Median Arcuate Ligament Release.","authors":"Holland Korbitz, Enrique F Elli, Steven P Bowers","doi":"10.1177/00031348251378898","DOIUrl":"https://doi.org/10.1177/00031348251378898","url":null,"abstract":"<p><p>BackgroundVascular injury is a feared complication of minimally invasive median arcuate ligament (MAL) release. The identified elements of variant anatomy that predispose to injury.MethodsBetween August 2018 and March 2025, 64 patients underwent laparoscopic (51) or robotic (13) median arcuate ligament release operation. Surgical anatomy was prospectively recorded with respect to variants of vascular and visceral anatomy.ResultsOnly 17 cases (27%) had no observed anatomical variant. Visceral arterial variants occurred in 15 cases (23%), and included: Accessory left hepatic artery in 8 (requiring division in 6); common hepatic artery (CHA) variants were observed in 2 cases and included replaced CHA and early origin CHA; 5 left gastric artery (LGA) variants included early origin (N = 3) or duplicated LGA (N = 2). One or both IPA originated from the celiac artery in 32 cases (50%), of which anterior origin off the celiac was seen in 20 cases (31%). Both IPA originated separately from the anterior celiac in 2 cases, and from a common trunk in 9 cases (14%). One IPA arising from the anterior celiac was observed in 8 cases (13%). The coronary vein (CV) inserted into the portal vein superior to the CHA in 6 cases (9%), and coursed parallel to the CHA in 16 cases (25%). A high riding pancreas necessitating retraction was seen in 9 cases (14%).ConclusionMost patients undergoing median arcuate ligament release have elements of complexity that increase the difficulty of operation or increase operative risk.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251378898"},"PeriodicalIF":0.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embolization of an Intrahepatic Portal Vein Branch for Control of a Catastrophic Blunt Hepatic Injury.","authors":"Jacob R Stover, Hector Ferral, Bahri Ustunsoz, Alison A Smith, Angelis Vazquez-Perez, Harry Cahill, Andrew Ea, Lance Stuke","doi":"10.1177/00031348251381662","DOIUrl":"https://doi.org/10.1177/00031348251381662","url":null,"abstract":"<p><p>The treatment of hepatic trauma has evolved greatly in recent decades and has grown to involve interventions by interventional radiology, often via angiography. However, there is a paucity of literature on intrahepatic portal vein embolization for hemorrhage control in a stable trauma, let alone unstable patient. Our patient presented with an injury to a branch of his portal vein that was not amenable to surgical control despite multiple attempts. The massive hemorrhage was able to ultimately be controlled via percutaneous embolization of the portal vein branch by interventional radiology without any post-procedure complications. This marks the first published evidence of this procedure being performed in a hemodynamically unstable patient. This case is a proof of concept for portal vein embolization as a reasonable adjunct to managing injuries which are otherwise not amenable to surgical intervention.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251381662"},"PeriodicalIF":0.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reassessing Treatment Response Stratification in HER2-Positive Breast Cancer.","authors":"Bilal Turan, Ahmet Necati Sanli, Deniz Esin Tekcan Sanli, Serdar Acar, İsa Karaca","doi":"10.1177/00031348251381618","DOIUrl":"https://doi.org/10.1177/00031348251381618","url":null,"abstract":"<p><p>BackgroundIn HER2-positive breast cancer, response to neoadjuvant chemotherapy (NAC) is a key prognostic factor. While complete response (CR) is associated with improved survival, non-complete responses are typically treated as a homogeneous group in prognostic models. However, this binary classification may obscure clinically relevant differences, particularly for patients achieving partial response (PR).MethodsWe conducted a retrospective cohort study using a large national cancer registry to evaluate outcomes of HER2-positive female patients treated with NAC. Patients were classified into three groups based on treatment response: CR, PR, and no response (NR). Overall survival (OS) and disease-specific survival (DSS) were assessed using Kaplan-Meier analysis and multivariable Cox regression models adjusted for demographic, clinical, and treatment-related variables.ResultsAmong 4711 patients, 72.4% achieved CR, 24.9% PR, and 2.8% NR. Both OS and DSS were significantly higher in the PR group compared to the NR group (10-year OS: 74.7% vs 35.5%, <i>P</i> < .001). In multivariate analysis, PR was independently associated with better survival than NR (HR for OS: 2.51; HR for DSS: 2.75; both <i>P</i> < .001). Other independent predictors of poor survival included older age, higher T/N stage, unmarried status, and absence of surgery.ConclusionA tripartite classification of treatment response-CR, PR, and NR-provides improved prognostic discrimination in HER2-positive breast cancer compared to the conventional binary model. Recognizing partial responders as a distinct clinical group may improve risk stratification and guide individualized treatment planning in the post-neoadjuvant setting.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251381618"},"PeriodicalIF":0.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who's Deciding? A Study of Patient-Surgeon Discussions About Contralateral Prophylactic Mastectomy.","authors":"Grace Anne Longfellow, Vinay Choksi, Peter A Ubel, Allison Kratka, Mara Buchbinder, Christine Kirby, Joseph Kelly Davis, Sarah T Hawley, Karen Sepucha, Michelle Specht, Clara Lee","doi":"10.1177/00031348251380167","DOIUrl":"https://doi.org/10.1177/00031348251380167","url":null,"abstract":"<p><p>BackgroundDespite rising rates of contralateral prophylactic mastectomy (CPM), little is known about how surgeons and patients communicate about the procedure. This study is among the first to use real-time audio recordings of CPM discussions, link conversations to treatment choice, and include multiple institutions. We assessed surgeon-patient discussions, focusing on how often CPM was addressed, who initiated it, and how decisions were made.MethodsWe recruited surgeons and patients from three academic centers and audio-recorded the first surgical consultation for patients with (1) early-stage unilateral breast cancer or ductal carcinoma in situ and (2) no strong family history or BRCA mutation. Transcripts were analyzed using an inductive, qualitative approach to generate themes and detect patterns.ResultsTwenty-seven patients and eight surgeons participated. In 14 cases, neither patient nor surgeon mentioned CPM. In the remaining 13, surgeons initiated the topic in 10, typically while introducing surgical options. Of the four patients who received CPM, each had a strong initial preference for CPM and was undeterred by the surgeon's cautionary statements against it. When patients lacked strong preferences for CPM, they generally followed surgeon recommendations to forego CPM or to delay the decision until tests (eg, genetics and MRI) were complete.DiscussionSurgeons, not patients, most commonly initiated CPM discussions. Initial patient preference strongly influenced surgical decisions. Surgeon recommendations to wait for additional information shaped decision making only when patients were initially undecided. Future research should explore how patients form preferences prior to consultation and how best to address them during clinical conversations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251380167"},"PeriodicalIF":0.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter re: CT vs MRI C-Spine Imaging for C-Spine Clearance in Obtunded Patients in Low-Energy Trauma Mechanisms.","authors":"Henry Krasner, Robert Rakosi, Allison G McNickle","doi":"10.1177/00031348251367032","DOIUrl":"https://doi.org/10.1177/00031348251367032","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251367032"},"PeriodicalIF":0.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Frailty Index as a Predictor of Contralateral Amputation and Mortality After Primary Amputation in Patients With Critical Limb Ischemia.","authors":"Juwan A Ives, Aprill N Park, Natalie T Chao, Khanjan H Nagarsheth","doi":"10.1177/00031348251381661","DOIUrl":"https://doi.org/10.1177/00031348251381661","url":null,"abstract":"<p><p>BackgroundCritical limb ischemia (CLI) is an advanced stage of peripheral arterial disease (PAD) often requiring major amputation. Frailty influences surgical outcomes but remains underexplored in CLI. This study evaluates the 5-item Modified Frailty Index (mFI-5) as a predictor of 1-year mortality and contralateral amputation following major amputation for CLI.Materials and MethodsA retrospective analysis was conducted on 327 patients who underwent primary above- or below-knee amputation (AKA or BKA) for CLI. Patients were stratified into 2 groups based on frailty: mFI-5 <3 (less frail) and mFI-5 ≥3 (severely frail). Binomial logistic regression was used to assess associations between frailty and outcomes, with significance set at <i>P</i> < .05.ResultsWhen analyzed as a continuous variable, mFI-5 did not significantly predict 1-year mortality or contralateral amputation (<i>P</i> = .059, .693). When stratified by frailty status, severe frailty (mFI-5 ≥3) was associated with increased odds of 1-year mortality (OR 1.815, <i>P</i> = .030). Among patients undergoing index AKA, severely frail individuals had the highest risk of mortality (OR 2.67; 95% CI 1.52-4.78; <i>P</i> < .001). Contralateral amputation was also linked to increased 1-year mortality compared to similarly frail patients without a second amputation (<i>P</i> = .010).ConclusionSevere frailty is associated with worse outcomes, particularly 1-year mortality, following amputation for CLI. While frailty did not independently predict contralateral amputation, its occurrence was linked to increased mortality in frail patients. These findings support incorporating frailty assessment into CLI surgical decision-making and postoperative care.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251381661"},"PeriodicalIF":0.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Ischiatic Hernia: Diagnostic Challenges, Surgical Evolution, and Outcomes.","authors":"Fahim Kanani, Khaled Otman, Alaa Zahalka, Naheel Mahajna, Narmin Zoabi, Katia Dayan, Nir Messer","doi":"10.1177/00031348251378904","DOIUrl":"https://doi.org/10.1177/00031348251378904","url":null,"abstract":"<p><p>IntroductionIschiatic (sciatic) hernias represent one of the rarest forms of pelvic floor herniation, with fewer than 100 documented cases worldwide since first described by Papen in 1750. Their rarity, combined with often-cryptic clinical presentation, contributes to significant diagnostic and therapeutic challenges.MethodsFollowing PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane databases from 1947 to 2024, identifying 68 relevant articles. Our search strategy combined terms related to ischiatic/sciatic hernias with various publication types. Data extraction focused on patient demographics, clinical presentation, diagnostic methods, hernia contents, surgical approaches, and outcomes.ResultsOur analysis revealed striking female predominance (98.5%), particularly among elderly patients (mean age 71 ± 12.8 years). Ureter was the most commonly herniated structure (58.8%), followed by small intestine (20.6%). Most patients (80.9%) lacked an external gluteal bulge, contributing to diagnostic delays. CT emerged as the primary diagnostic modality (63.2%), with the pathognomonic \"curlicue sign\" representing a key feature in ureterosciatic herniation. Management approaches were evenly distributed between minimally invasive techniques (35.3%), open surgery (35.3%), and conservative management with ureteral stenting (29.4%). Laparoscopic and robotic approaches demonstrated shorter hospital stays (1-2 days vs 5-14 days for open repairs) and reduced postoperative pain, despite slightly longer operative times. Complication rates were low (5.9% surgical site infections), with no reported mortality.ConclusionIschiatic hernias require a high index of clinical suspicion for timely diagnosis, particularly in elderly females presenting with unexplained pelvic or sciatic pain. The evolution from open to minimally invasive surgical approaches has significantly transformed management outcomes, while ureteral stenting offers an alternative for high-risk patients with ureterosciatic hernias. The optimal approach remains individualized based on patient characteristics, hernia contents, and available surgical expertise.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251378904"},"PeriodicalIF":0.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Surgical Resident Education Through Augmented Reality: A Pilot Study Using 3D Holograms to Delineate Renal Vascular Anatomy.","authors":"George Youssef, Christian Renz, Jeanne Wu, Michael Marin, Celia Divino","doi":"10.1177/00031348251378913","DOIUrl":"https://doi.org/10.1177/00031348251378913","url":null,"abstract":"<p><p>BackgroundAugmented reality offers multiple enhanced diagnostic imaging visualization opportunities. The objective of this pilot study was to assess the applicability of HoloLens augmented reality in resident education.Methods34 categorical general surgery residents, postgraduate years (PGY) 1-5, reviewed a CTA and 3D hologram on Intravision XR using the Microsoft HoloLens 2 of the renal anatomy of 2 donor nephrectomy patients. Residents were randomized into 2 groups altering which modality was visualized first then described their findings and answered a device usability questionnaire.Results45.5% PGY-1s, 75% PGY-2s, and 86.7% PGY-3-5s correctly identified the pathology on the HoloLens compared with 45.5%, 50%, and 86.7%, respectively, on the CTA. 84% of participants appreciated improved visualization of the illustrated pathology with AR. 82% of participants stated an improved view of the vasculature using the HoloLens model. 25% of residents preferred using the HoloLens to traditional CT imaging.ConclusionsDespite being unable to obtain statistically significant results due to sample size, we observed that HoloLens renderings were non-inferior to conventional CT scans when it came to residents detecting pathology on an imaging study and superior at the PGY-2 level with an increasing preference towards use of the HoloLens with more senior PGY levels. This technology may assist residents in getting a fresh perspective on imaging studies and anatomical variations and improve resident education.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251378913"},"PeriodicalIF":0.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Importance of Prehospital Interventions on Shock Index and Patient Outcomes at a Rural Appalachian Level 1 Trauma Center.","authors":"Viraj V Brahmbhatt, Sarah A King, Hannah Collins, Matthew Leonard, James B Burns","doi":"10.1177/00031348251380173","DOIUrl":"https://doi.org/10.1177/00031348251380173","url":null,"abstract":"<p><p>Prehospital interventions, used individually or in combination, can have better patient outcomes; however, rural areas have limited resources. Shock index (SI) has been found to predict resource utilization, hospital outcomes, and mortality. Reducing SI through utilization of prehospital interventions could benefit patient outcomes. A total of 274 trauma activation patients between January 2017 and March 2024 were brought directly from the scene to a level 1 trauma center with a SI >1.0. Demographics, prehospital interventions (transfusions, tranexamic acid (TXA), and tourniquet use), transportation time, change in SI, and patient outcomes were analyzed. Reducing SI correlated with better patient outcomes (<i>P</i> < 0.05) and combining TXA with blood or TXA with tourniquet reduced SI and LOS (<i>P</i> < 0.05). Optimization of prehospital interventions in rural areas may improve a patient's condition prior to hospital arrival, ultimately benefiting patients and minimizing hospital costs through reduced resource utilization.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251380173"},"PeriodicalIF":0.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Number of Revascularization Procedures is Associated With Final Amputation Level for Chronic Limb-Threatening Ischemia.","authors":"Aprill N Park, Juwan A Ives, Anahita Shiva, Natalie T Chao, Khanjan H Nagarsheth","doi":"10.1177/00031348251381659","DOIUrl":"https://doi.org/10.1177/00031348251381659","url":null,"abstract":"<p><p>BackgroundThe relationship between the number of revascularization procedures and the level of major lower extremity amputation in chronic limb-threatening ischemia (CLTI) remains unclear. We aim to determine whether the revascularization frequency is associated with the level of amputation and whether procedural burden influences postoperative outcomes.MethodsWe performed a retrospective chart review of 252 patients who underwent major lower extremity amputations for CLTI from 2014 to 2022. The primary outcome was the association between revascularization frequency and amputation level, categorized into above-knee amputation (AKA) or non-AKA (through-knee and below-knee). Secondary outcomes included the association of revascularization level and type (open, endovascular, or hybrid) with AKA risk. Other outcomes were postoperative complications, readmission, reamputation, and mortality. Multivariable logistic regression adjusted for age, diabetes, and disease level.ResultsThe mean age was 55.9 years, with 61.9% male patients, and 58.3% identifying as Black. Most had hypertension (86.5%) and diabetes (62.3%). Among the cohort, 45% of the patients had no revascularizations. 47.6% underwent 1-2 procedures, and 7.5% underwent three or more procedures. Undergoing ≥3 revascularizations was significantly associated with increased odds of above-knee amputation (AKA) (OR: 6.33, 95% CI: 2.00-20.00, <i>P</i> = 0.002). Disease level and type of revascularization were not significantly associated with amputation level. There were no significant differences in postoperative complications, readmissions, reamputations, or mortality between AKA and non-AKA groups.ConclusionPatients undergoing three or more revascularization procedures were significantly more likely to undergo an AKA, suggesting a threshold effect where additional interventions may diminish patient benefits.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251381659"},"PeriodicalIF":0.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}