Annals of surgery最新文献

{"title":"Reconsidering Abdominal Drainage After Left Pancreatectomy: The Randomized Controlled PANDRA II Trial.","authors":"Joerg Kaiser, Willem Niesen, Ulf Hinz, Markus K Diener, Frank Pianka, Rosa Klotz, Oliver Strobel, Arianeb Mehrabi, Christoph Berchtold, Beat Müller, Martin Schneider, Martin Loos, Christoph Michalski, Markus W Büchler, Thilo Hackert, Pascal Probst","doi":"10.1097/SLA.0000000000006651","DOIUrl":"10.1097/SLA.0000000000006651","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate intra-abdominal drainage after left pancreatectomy (LP), as it has been a longstanding practice to mitigate postoperative complications, particularly postoperative pancreatic fistulas.</p><p><strong>Background: </strong>Recent studies challenge the necessity of routine drainage, suggesting potential benefits in omitting drains.</p><p><strong>Methods: </strong>The PANDRA II trial was a randomized controlled noninferiority study conducted at the University Hospital Heidelberg between 2017 and 2023. It compared outcomes between patients undergoing open or minimally invasive LP with and without abdominal drainage. The primary endpoint was overall postoperative morbidity assessed by the Comprehensive Complication Index (CCI).</p><p><strong>Results: </strong>A total of 246 patients were included in the intention-to-treat analysis (125 with drainage, 121 without drainage). The no-drain group demonstrated noninferiority to the drain group in terms of CCI (13.90 ± 16.51 vs 19.43 ± 16.92, P < 0.001 for noninferiority). Moreover, the no-drain group had lower overall complication rates (50.41% vs 78.40%, P < 0.001). Specific complications such as postoperative pancreatic fistula (14.88% vs 20.8%, P = 0.226) and postpancreatectomy hemorrhage (4.96% vs 4.80%, P > 0.999) did not differ significantly between groups.</p><p><strong>Conclusions: </strong>The results of the PANDRA II trial demonstrate that omitting routine abdominal drainage after LP is noninferior to placing routine abdominal drainage regarding morbidity measured by the CCI. Omitting a routine abdominal drainage even led to a significant reduction in the overall complication rate.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"203-209"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative COVID-19 Vaccination Is Associated with Decreased Perioperative Mortality After Major Vascular Surgery.","authors":"Molly Ratner, Karan Garg, Heepeel Chang, Anjali Nigalaye, Steven Medvedovsky, Glenn Jacobowitz, Jeffrey J Siracuse, Virendra Patel, Marc Schermerhorn, Charles DiMaggio, Caron B Rockman","doi":"10.1097/SLA.0000000000006341","DOIUrl":"10.1097/SLA.0000000000006341","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to examine the effect of COVID-19 vaccination on perioperative outcomes after major vascular surgery.</p><p><strong>Background: </strong>COVID-19 vaccination is associated with decreased mortality in patients undergoing various surgical procedures. However, the effect of vaccination on perioperative mortality after major vascular surgery is unknown.</p><p><strong>Methods: </strong>This is a multicenter retrospective study of patients who underwent major vascular surgery between December 2021 and August 2023. The primary outcome was all-cause mortality within 30 days of index operation or before hospital discharge. Multivariable models were used to examine the association between vaccination status and the primary outcomes.</p><p><strong>Results: </strong>Of the total 85,424 patients included, 19,161 (22.4%) were unvaccinated. Unvaccinated patients were younger compared with vaccinated patients (mean age 68.44 +/- 10.37 y vs 72.11 +/- 9.20 y, P <0.001) and less likely to have comorbid conditions, including hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dialysis. After risk factor adjustment, vaccination was associated with decreased mortality (OR 0.7, 95% CI: 0.62-0.81, P <0.0001). Stratification by procedure type demonstrated that vaccinated patients had decreased odds of mortality after open abdominal aortic aneurysm (OR 0.6, 95% CI: 0.42-0.97, P =0.03), endovascular aneurysm repair (OR 0.6, 95% CI: 0.43-0.83, P= 0.002), carotid artery stenting (OR 0.7, 95% CI: 0.51-0.88, P =0.004) and infrainguinal lower extremity bypass (OR 0.7, 95% CI: 0.48-0.96, P =0.03).</p><p><strong>Conclusions: </strong>COVID-19 vaccination is associated with reduced perioperative mortality in patients undergoing vascular surgery. This association is most pronounced in patients undergoing aortic aneurysm repair, carotid stenting, and infrainguinal bypass.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"299-303"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Opioid Prescribing and Consumption with Patient-reported Experiences and Satisfaction After Emergency Surgery in Michigan.","authors":"Lindsay Rosenthal, Vidhya Gunaseelan, Jennifer Waljee, Mark Bicket, Michael Englesbe, Ryan Howard","doi":"10.1097/SLA.0000000000006264","DOIUrl":"10.1097/SLA.0000000000006264","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationships among opioid prescribing, consumption, and patient-reported outcomes (PROs) in patients undergoing emergency surgery.</p><p><strong>Background: </strong>Overprescribing of opioids for pain management after surgery has become a public health concern and a major contributor to opioid misuse and dependency. Current guidelines do not address opioid prescribing after emergency surgical procedures, highlighting the importance of understanding the relationship between opioid prescribing and consumption in this setting.</p><p><strong>Methods: </strong>Retrospective analysis of the quantity of opioids prescribed and PROs in a population-based setting. The sample included adults ≥18 years undergoing emergency surgery across 69 hospitals in Michigan. Patients were included if they received a discharge opioid prescription and had valid data for opioid consumption and PROs. Surgical procedures took place between January 1, 2018 and December 31, 2020.</p><p><strong>Results: </strong>During the study period, a total of 3742 patients underwent an emergency operation. The mean number of opioid pills prescribed was 9.6 and the mean number of opioid pills consumed was 4.6. In a 2-model with logit in the first part and a linear regression in the second, prescription size was significantly associated with both the probability of consumption (adjusted odds ratio: 1.02; 95% CI: 1.01-1.04) and the amount of consumption conditional on any consumption (coefficient: 0.70; 95% CI: 0.54-0.86).</p><p><strong>Conclusions: </strong>Patients only consumed half of the opioids they were prescribed after undergoing emergency surgery. In addition, patients who were given larger prescriptions consumed more opioids, but did not experience less pain, higher satisfaction, better quality of life, or less regret to undergo surgery. Overall, this suggests that opioids may be excessively prescribed to patients undergoing emergency surgical procedures and that larger prescriptions do not improve the patient experience after surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"228-233"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory Cardiology or General Internal Medicine Assessment Before Scheduled Major Vascular Surgery Is Associated with Improved Outcomes.","authors":"Charles de Mestral, Husam M Abdel-Qadir, Peter C Austin, Alice S Chong, Finlay A McAlister, Thomas F Lindsay, Heather J Ross, George Oreopoulos, Duminda N Wijeysundera, Douglas S Lee","doi":"10.1097/SLA.0000000000006321","DOIUrl":"10.1097/SLA.0000000000006321","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the association between ambulatory cardiology or general internal medicine (GIM) assessment before surgery and outcomes after scheduled major vascular surgery.</p><p><strong>Background: </strong>Cardiovascular risk assessment and management before high-risk surgery remains an evolving area of care.</p><p><strong>Methods: </strong>This is a population-based retrospective cohort study of all adults who underwent scheduled major vascular surgery in Ontario, Canada, from April 1, 2004 to March 31, 2019. Patients who had an ambulatory cardiology and/or GIM assessment within 6 months before surgery were compared with those who did not. The primary outcome was 30-day mortality. Secondary outcomes included: composite of 30-day mortality, myocardial infarction or stroke, 30-day cardiovascular death, 1-year mortality, composite of 1-year mortality, myocardial infarction or stroke, and 1-year cardiovascular death. Cox proportional hazard regression using inverse probability of treatment weighting was used to mitigate confounding by indication.</p><p><strong>Results: </strong>Among 50,228 patients, 20,484 (40.8%) underwent an ambulatory assessment before surgery: 11,074 (54.1%) with cardiology, 8071 (39.4%) with GIM, and 1339 (6.5%) with both. Compared with patients who did not, those who underwent an assessment had a higher Revised Cardiac Risk Index [N with Index over 2 = 4989 (24.4%) vs 4587 (15.4%), P < 0.001] and more frequent preoperative cardiac testing [N = 7772 (37.9%) vs 6113 (20.6%), P < 0.001], but lower 30-day mortality [N = 551 (2.7%) vs 970 (3.3%), P < 0.001]. After the application of inverse probability of treatment weighting, cardiology or GIM assessment before surgery remained associated with a lower 30-day mortality [weighted hazard ratio (95% CI) = 0.73 (0.65-0.82)] and a lower rate of all secondary outcomes.</p><p><strong>Conclusions: </strong>Major vascular surgery patients assessed by a cardiology or GIM physician before surgery have better outcomes than those who are not. Further research is needed to better understand potential mechanisms of benefit.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"339-345"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraductal Papillary Mucinous Neoplasm Surveillance Leads to Early Diagnosis and Better Outcomes of Concomitant Cancer.","authors":"Hiroki Oyama, Tsuyoshi Hamada, Yousuke Nakai, Mariko Tanaka, Kaoru Takagi, Rintaro Fukuda, Ryunosuke Hakuta, Kazunaga Ishigaki, Sachiko Kanai, Yoshikuni Kawaguchi, Kohei Kurihara, Hiroto Nishio, Kensaku Noguchi, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Yukari Suzuki, Shinya Takaoka, Shuichi Tange, Naminatsu Takahara, Kiyoshi Hasegawa, Tetsuo Ushiku, Mitsuhiro Fujishiro","doi":"10.1097/SLA.0000000000006268","DOIUrl":"10.1097/SLA.0000000000006268","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether long-term surveillance of intraductal papillary mucinous neoplasms (IPMNs) leads to early diagnosis and better clinical outcomes of pancreatic ductal adenocarcinomas (PDACs) developing concomitantly with IPMNs.</p><p><strong>Background: </strong>Long-term image-based surveillance is recommended for patients with low-risk IPMNs. However, it is unknown whether the surveillance can improve surgical and survival outcomes of patients with concomitant PDACs.</p><p><strong>Methods: </strong>Using a prospective single-institutional cohort of 4620 patients with pancreatic cysts, including 3638 IPMN patients, we identified 63 patients who developed concomitant PDAC during long-term surveillance. We compared the overall survival of 46 cases with concomitant PDAC to that of 460 matched cases diagnosed with non-IPMN-associated PDAC at the same institution. Multivariable hazard ratios and 95% CIs for overall mortality were computed using the Cox regression model with adjustment for potential confounders.</p><p><strong>Results: </strong>Concomitant PDACs were identified at an earlier cancer stage compared to non-IPMN-associated PDACs, with 67% and 38% cases identified at stage 2 or earlier, respectively ( P <0.001) and 57% and 21% cases with R0 resection, respectively ( P <0.001). Compared with non-IPMN-associated PDACs, concomitant PDACs were associated with longer overall survival ( P =0.034) with a multivariable hazard ratio of 0.61 (95% CI: 0.39-0.96). The 5-year survival rate of patients with concomitant PDAC was higher compared with patients with non-IPMN-associated PDAC (34% vs 18%, respectively; P =0.018).</p><p><strong>Conclusions: </strong>The surveillance for patients with IPMNs was associated with early identification of concomitant PDACs and longer survival of patients diagnosed with this malignancy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"283-290"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of Central Venous Pressure in Elective Robotic and Laparoscopic Liver Resection: The PRESSURE Trial-A Randomized Clinical Study.","authors":"Patrick Téoule, Niccolo Dunker, Johanna Debatin, Dorothée Sturm, Svetlana Hetjens, Valentin Walter, Erik Rasbach, Christoph Reissfelder, Emrullah Birgin, Nuh N Rahbari","doi":"10.1097/SLA.0000000000006721","DOIUrl":"10.1097/SLA.0000000000006721","url":null,"abstract":"<p><strong>Objective: </strong>To compare perioperative outcomes in patients undergoing minimally invasive liver surgery (MILR) with or without central venous pressure (CVP) reduction (≤5 mm Hg).</p><p><strong>Background: </strong>Reduction of CVP during parenchymal transection is widely accepted in open hepatectomy to reduce intraoperative blood loss, as a major predictor of postoperative outcomes. However, the effect of CVP reduction on blood loss in MILR remains unclear.</p><p><strong>Methods: </strong>This study is a randomized controlled, double-blinded trial. Patients undergoing elective MILR between August 2020 and April 2023 were equally randomized to either no CVP reduction (No CVP reduction group) or CVP reduction by anesthesiological interventions (CVP reduction group). The remaining perioperative care was kept identical between groups. The primary endpoint was total intraoperative blood loss.</p><p><strong>Results: </strong>In total, 120 patients were randomized and 112 were analyzed. Baseline characteristics did not differ between groups. Total intraoperative blood loss in MILR was equivalent between groups [No CVP reduction: 280 mL (120-560) vs CVP reduction: 360 mL (150-640); P = 0.30], despite higher CVP values during resection in the No CVP reduction group (9.3 mm Hg ± 4.2 vs 3.2 mm Hg ± 2.2; P < 0.001). Similarly, there was no difference in blood loss during parenchymal transection between the No CVP reduction (220 mL; 80-400) and the CVP reduction group (240 mL; 110-560; P = 0.39). Postoperative 90-day mortality (No CVP reduction: n=3, 5% versus CVP reduction: n=2, 4%; P = 0.68) and total morbidity rates (No CVP reduction: n = 10, 18% vs CVP reduction: n = 11, 20%; P = 0.77) were comparable. Intraoperative hemodynamic instability was less frequent in the No CVP reduction group (n = 7, 12% vs CVP reduction group: n = 16, 30%; P = 0.03).</p><p><strong>Conclusions: </strong>MILR without CVP reduction during liver transection is safe and is not associated with increased intraoperative blood loss. Moreover, a no CVP reduction strategy might prevent potential adverse effects of fluid restriction in MILR, such as hemodynamic instability.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"210-218"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Preoperative Opioid Use with Postdischarge Outcomes: A Cohort Study of the Michigan Surgical Quality Collaborative.","authors":"Stephan G Frangakis, Bethany Kavalakatt, Vidhya Gunaseelan, Yenling Lai, Jennifer Waljee, Michael Englesbe, Chad M Brummett, Mark C Bicket","doi":"10.1097/SLA.0000000000006265","DOIUrl":"10.1097/SLA.0000000000006265","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association of prescription opioid fills over the year before surgery with postoperative outcomes.</p><p><strong>Background: </strong>Nearly one-third of patients report opioid use in the year preceding surgery, yet an understanding of how opioid exposure influences patient-reported outcomes after surgery remains incomplete. Therefore, this study was designed to test the hypothesis that preoperative opioid exposure may impede recovery in the postoperative period.</p><p><strong>Methods: </strong>This retrospective cohort study used a statewide clinical registry from 70 hospitals linked to opioid fulfillment data from the state's prescription drug monitoring program to categorize patients' preoperative opioid exposure as none (naïve), minimal, intermittent, or chronic. Outcomes were patient-reported pain intensity (primary), as well as 30-day clinical and patient-reported outcomes (secondary).</p><p><strong>Results: </strong>Compared with opioid-naïve patients, opioid exposure was associated with higher reported pain scores at 30 days after surgery. Predicted probabilities were higher among the opioid exposed versus naive group for reporting moderate pain [43.5% (95% CI: 42.6%-44.4%) vs 39.3% (95% CI: 38.5%-40.1%)] and severe pain [13.% (95% CI: 12.5%-14.0%) vs 10.0% (95% CI: 9.5%-10.5%)], and increasing probability was associated increased opioid exposure for both outcomes. Clinical outcomes (incidence of emergency department visits, readmissions, and reoperation within 30 days) and patient-reported outcomes (reported satisfaction, regret, and quality of life) were also worse with increasing preoperative opioid exposure for most outcomes.</p><p><strong>Conclusions: </strong>This study is the first to examine the effect of presurgical opioid exposure on both clinical and nonclinical outcomes in a broad cohort of patients and shows that exposure is associated with worse postsurgical outcomes. A key question to be addressed is whether and to what extent opioid tapering before surgery mitigates these risks after surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"234-241"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making Choices: A Multi-institutional, Longitudinal Cohort Study Assessing Changes in Treatment Outcome Valuation for Low-risk Thyroid Cancer.","authors":"Alexis G Antunez, Brandy R Sinco, Megan C Saucke, Kyle J Bushaw, Catherine B Jensen, Sophie Dream, Abbey L Fingeret, Masha J Livhits, Aarti Mathur, Alexandria McDow, Sanziana A Roman, Corrine I Voils, Justin Sydnor, Susan C Pitt","doi":"10.1097/SLA.0000000000006347","DOIUrl":"10.1097/SLA.0000000000006347","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the relative importance of treatment outcomes to patients with low-risk thyroid cancer (TC).</p><p><strong>Background: </strong>Overuse of total thyroidectomy (TT) for low-risk TC is common. Emotions from a cancer diagnosis may lead patients to choose TT, resulting in outcomes that do not align with their preferences.</p><p><strong>Methods: </strong>Adults with clinically low-risk TC enrolled in a prospective, multi-institutional, longitudinal cohort study from November 2019 to June 2021. Participants rated treatment outcomes at the time of their surgical decision and again 9 months later by allocating 100 points among 10 outcomes. t tests and Hotelling T 2 statistic compared outcome valuation within and between subjects based on chosen extent of surgery (TT vs lobectomy).</p><p><strong>Results: </strong>Of 177 eligible patients, 125 participated (70.6% response) and 114 completed the 9-month follow-up (91.2% retention). At the time of the treatment decision, patients choosing TT valued the risk of recurrence more than those choosing lobectomy and the need to take thyroid hormone less ( P <0.05). At repeat valuation, all patients assigned fewer points to cancer being removed and the impact of treatment on their voice and more points to energy levels ( P <0.05). The importance of the risk of recurrence increased for those who chose lobectomy and decreased for those choosing TT ( P <0.05).</p><p><strong>Conclusions: </strong>The relative importance of treatment outcomes changes for patients with low-risk TC once the outcome has been experienced to favor quality of life over emotion-related outcomes. Surgeons can use this information to discuss the potential for asthenia or changes in energy levels associated with total thyroidectomy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"275-282"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telesurgery: A Systematic Literature Review and Future Directions.","authors":"Sumeet Kumar Reddy, Shady Saikali, Ahmed Gamal, Marcio Covas Moschovas, Travis Rogers, Mischa Dohler, Jacques Marescaux, Vipul Patel","doi":"10.1097/SLA.0000000000006570","DOIUrl":"10.1097/SLA.0000000000006570","url":null,"abstract":"<p><strong>Objective: </strong>To undertake a systematic review of the medical literature on telesurgery, with a key focus on identifying the key technical and nontechnical themes searched in medical articles and to analyze gaps in the current knowledge base on telesurgery.</p><p><strong>Background: </strong>It has now been over 2 decades since the first successful case of telesurgery and since this time, there have been significant technological and telecommunications advancements.</p><p><strong>Methods: </strong>A systematic review of the literature was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Details of the protocol for this systematic review were registered on PROSPERO (CRD42024511530).</p><p><strong>Results: </strong>In total, 102 unique references were allocated into 5 categories: technical, cybersecurity, ethical, financial, and regulatory considerations to discuss key themes. The vast majority of references were related to technical considerations, which have demonstrated the feasibility of telesurgery. The nontechnical considerations have a paucity of literature and a lack of guidance on telesurgery which appears to still be the major barriers to telesurgery.</p><p><strong>Conclusions: </strong>Telesurgery presents many interdisciplinary challenges, encompassing both important technical and nontechnical (such as cybersecurity, ethical, financial, and regulatory) considerations. Further research, collaboration between stakeholders, a collaborative community of experts, and the development of comprehensive consensus frameworks are essential steps toward the widespread adoption of telesurgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"219-227"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Scalpel: Tackling Challenges Faced by LGBTQ+ Surgical Trainees and Faculty.","authors":"Steven Xie, Andrew Schlussel, Jenny Shao","doi":"10.1097/SLA.0000000000006715","DOIUrl":"10.1097/SLA.0000000000006715","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"196-198"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}