BJS Open最新文献

{"title":"Comparison of catheter wound infusion, intrathecal morphine, and intravenous analgesia for postoperative pain management in open liver resection: randomized clinical trial.","authors":"Damien Rousseleau, Barthélémy Plane, Julien Labreuche, Adeline Pierache, Younes El Amine, Sabine Ethgen, Jean-Michel Wattier, Cédric Cirenei, Emmanuel Boleslawski, Gilles Lebuffe","doi":"10.1093/bjsopen/zraf074","DOIUrl":"10.1093/bjsopen/zraf074","url":null,"abstract":"<p><strong>Background: </strong>Pain relief is an important aspect of recovery after open liver resection. This randomized open-label single-centre trial assessed the efficacy of intravenous (i.v.) analgesia alone or in combination with catheter wound infusion (CWI) or intrathecal morphine (ITM) after open liver resection.</p><p><strong>Methods: </strong>Adult patients undergoing open liver resection were randomly assigned to receive either i.v. analgesia alone or in combination with ITM or CWI. In this study, i.v. analgesia consisted of systematic i.v. paracetamol and i.v. morphine via a patient-controlled analgesia pump, with i.v. nefopam as rescue analgesia for a Numeric Rating Scale (NRS) score > 4. The primary outcome was cumulative morphine dose at 24 hours (h). Secondary outcomes included pain intensity, cumulative opioid use at 48 and 72 h, and postoperative complications.</p><p><strong>Results: </strong>In all, 186 patients were included in the study (62 patients in each group). The median 24-h morphine dose was 14 (interquartile range (i.q.r.) 6-25) mg in the i.v. analgesia group, 14 (i.q.r. 7-23) mg in the CWI group, and 7 (i.q.r. 3-15) mg in the ITM group. ITM significantly reduced morphine use compared with i.v. analgesia alone (mean difference on log-transformed values 0.57; 95% confidence interval 0.21 to 0.93; Bonferroni-adjusted P = 0.002) and lowered pain scores during the first 12 h. No significant differences were observed between the CWI and i.v. analgesia groups. By 72 h, cumulative opioid use was similar across all groups. Adverse events and postoperative complications were comparable across the three groups.</p><p><strong>Conclusion: </strong>ITM reduced the cumulative morphine dose and pain intensity in the first 24 h after liver resection, providing a valuable option for postoperative analgesia.</p><p><strong>Registration number: </strong>NCT03238430 (http://www.clinicaltrials.gov).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of bilioenteric anastomosis leakage after major liver resection.","authors":"Sepehr Abbasi Dezfouli, Elmira Heidenreich, Mohammadamin Shahrbaf, Elias Khajeh, De-Hua Chang, Miriam Klauss, Markus Mieth, Martin Loos, Markus Büchler, Arianeb Mehrabi","doi":"10.1093/bjsopen/zraf075","DOIUrl":"10.1093/bjsopen/zraf075","url":null,"abstract":"<p><strong>Background: </strong>Post-hepatectomy bile leakage is a challenging issue that can lead to morbidities and mortality after liver resection. This leakage can occur either from a bilioenteric anastomosis (BEA) or from the transected surface of the liver. This study investigated the incidence, risk factors, and effective management of BEA leakage after major liver resection.</p><p><strong>Methods: </strong>Bile leakage was diagnosed through drain fluid analysis based on the International Study Group of Liver Surgery definition. Leakage from a BEA was confirmed via fluoroscopy during percutaneous interventions or reoperation. Perioperative data and data on the management of patients with BEA leakage were collected and analysed. Bivariate analysis used Mann-Whitney U and χ2 tests, and binary logistic regression identified risk factors for BEA leakage, with variables having P < 0.200 included in multivariable analysis.</p><p><strong>Results: </strong>Of 2936 patients undergoing hepatectomy between 2008 and 2023, 229 underwent liver resection with BEA. Leakage from the BEA was identified in 44 patients (19.2%). These patients had a higher rate of post-hepatectomy haemorrhage (P = 0.005), major complications (P = 0.001), BEA stenosis (P = 0.006), and mortality (P = 0.043). The success rate of the management of BEA leakage was 70% for reoperation and 58% for percutaneous transhepatic cholangiography and drainage (PTCD).</p><p><strong>Conclusion: </strong>BEA leakage after major liver resection is a severe complication associated with higher morbidity and mortality rates. Surgical treatment appeared to be more successful than PTCD in the early postoperative phase. PTCD proved to be a valuable additional therapy option following reoperation. These conclusions should be taken with caution and need to be confirmed through further prospective studies.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving concept of conversion surgery for upfront unresectable upper gastrointestinal and hepato-pancreato-biliary cancers: comprehensive review.","authors":"Giampaolo Perri, Jennie Engstrand, Robin D Wright, Sebastiaan F C Bronzwaer, Tiuri E Kroese, Biying Huang, Belkacem Acidi, Alessandro Vitale, Hop S Tran Cao, Richard van Hillegersberg, Magnus Nilsson, Ernesto Sparrelid, Matthew H G Katz, Giovanni Marchegiani, Umberto Cillo","doi":"10.1093/bjsopen/zraf070","DOIUrl":"10.1093/bjsopen/zraf070","url":null,"abstract":"<p><strong>Background: </strong>In the absence of a commonly accepted definition, conversion surgery is generally considered as surgical resection with the intent of prolonging survival after non-surgical induction therapy in patients with upfront unresectable disease at diagnosis. Despite the heterogeneity of possible targets, conversion surgery is a quickly evolving concept, with commonalities for upper gastrointestinal (UGI) and hepato-pancreato-biliary (HPB) malignancies.</p><p><strong>Methods: </strong>A comprehensive narrative review of the most recent and relevant literature was conducted by experts in the field of different UGI and HPB tumours.</p><p><strong>Results: </strong>The increased interest of the surgical scientific community in the concept of conversion surgery can be explained by the continuous improvements in non-surgical therapies aimed at controlling the systemic tumour burden and the local extension of cancer, supported by improvements in surgical outcomes for advanced resections in expert centres. The toolbox of the surgical oncologist seeking conversion in the case of unresectable UGI and HBP tumours is large and includes (but is not limited to) systemic chemotherapy, (chemo)radiation, targeted therapy/immunotherapy, locoregional ablation techniques, intra-arterial therapies, liver hypertrophy induction techniques, treatments of underlying medical conditions, and prehabilitation.</p><p><strong>Conclusions: </strong>Conversion surgery represents a powerful instrument to prolong the survival of patients with unresectable UGI and HPB malignancies. However, most of the available evidence is of a low level and at very high risk of selection bias. Alongside a profound understanding of (and respect for) the biology of cancer, which remains key to selecting appropriate patients and avoiding non-therapeutic surgeries, a commonly accepted definition is urgently needed to standardize practice, monitor outcomes, and improve the quality of research.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of postoperative analgesic effects of ultrasound-guided intercostal nerve block and transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy: randomized clinical trial.","authors":"Hongchun Xu, Dandan Song, Zhiqiang Wu, Chao Lin, Wuchang Fu, Fangjun Wang","doi":"10.1093/bjsopen/zraf022","DOIUrl":"10.1093/bjsopen/zraf022","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to compare the postoperative analgesic effects of ultrasound-guided intercostal nerve block and transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>Patients undergoing laparoscopic cholecystectomy for chronic cholecystitis with gallstones were randomly allocated to ultrasound-guided T7-11 intercostal nerve block or subcostal transversus abdominis plane block (both with 40 ml 0.3% ropivacaine). The primary outcome was the dose of tramadol required for remedial analgesia 24 h after surgery. The secondary outcomes included visual analogue scale scores at different time points after surgery, the time of initial use of tramadol for postoperative analgesia, patient satisfaction with postoperative pain control, the time to flatus, and the incidence of postoperative adverse events.</p><p><strong>Results: </strong>A total of 64 patients were included. Compared with the transversus abdominis plane block group, the intercostal nerve block group had lower visual analogue scale scores at 3 h after surgery (mean(s.d.) of 2.4(0.8) versus 1.6(0.6)), 6 h after surgery (mean(s.d.) of 2.2(0.3) versus 1.4(0.6)), and 8 h after surgery (mean of 1.7(0.5) versus 1.3(0.4)) (P < 0.001, P < 0.001, and P = 0.002 respectively), a lower dose of tramadol for remedial analgesia within 24 h after surgery (median of 100 (interquartile range 0-100) versus 50 (interquartile range 0-50) mg) (P = 0.012), and a significantly delayed time of initial use of tramadol for postoperative analgesia (mean(s.d.) of 9.1(7.5) versus 14.6(8.3) h) (P = 0.015). The incidences of postoperative dizziness and postoperative nausea and vomiting were higher in the transversus abdominis plane block group (47% and 69% respectively) than in the intercostal nerve block group (19% and 41% respectively) (P = 0.032 and 0.035 respectively). Patient satisfaction with postoperative analgesia was higher in the intercostal nerve block group than in the transversus abdominis plane block group (P = 0.037). The time to flatus was similar between the two groups (P > 0.050).</p><p><strong>Conclusion: </strong>Compared with ultrasound-guided subcostal transversus abdominis plane block, ultrasound-guided T7-11 intercostal nerve block with 0.3% ropivacaine provides better postoperative analgesia, requires a lower dose of tramadol for remedial analgesia 24 h after surgery, and significantly delays the time of initial use of tramadol for postoperative analgesia.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiseptic wound irrigation to prevent surgical site infection after laparotomy: meta-analysis.","authors":"Tara C Mueller, Niel Mehraein, Victoria Kehl, Rebekka Dimpel, Helmut Friess, Daniel Reim","doi":"10.1093/bjsopen/zraf072","DOIUrl":"10.1093/bjsopen/zraf072","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection after laparotomy is a major postoperative complication. The efficacy of prophylactic laparotomy wound irrigation to reduce surgical site infection rates remains controversial. This study evaluates the impact of antiseptic wound irrigation on surgical site infection prevention.</p><p><strong>Methods: </strong>A systematic review and meta-analysis, following PRISMA 2020, included randomized clinical trials and observational studies (published after 1999) comparing antiseptic or saline irrigation versus saline or no irrigation before laparotomy closure in adult patients with surgical site infection as the primary outcome. Databases searched included MEDLINE, EMBASE, Cochrane Library, and Google Scholar (September 2024). Risk of bias was assessed using RoB 2 and ROBINS-I; Grading of Recommendations Assessment, Development, and Evaluation evaluated evidence certainty.</p><p><strong>Results: </strong>Eighteen studies (6368 patients) reported an overall surgical site infection rate of 14.7%. Thirteen studies compared antiseptic with saline irrigation, showing no significant effect (relative risk 0.80, 95% confidence interval 0.58 to 1.09; P = 0.159) with very low evidence certainty. Excluding laparoscopic cases and high-risk bias studies revealed a favourable effect for antiseptic irrigation (relative risk 0.75, 0.64 to 0.87; P < 0.001) with moderate certainty. Three studies compared antiseptic with no irrigation, and four compared saline with no irrigation. Meta-analysis indicated reduced surgical site infection rates with any irrigation (antiseptic or saline) versus no irrigation (relative risk 0.52, 0.37 to 0.74; P < 0.001) with moderate certainty.</p><p><strong>Conclusion: </strong>Wound irrigation (antiseptic or saline) likely reduces surgical site infection rates after laparotomy. Evidence comparing antiseptic versus saline is uncertain but suggests a potential benefit after excluding the high risk of bias studies. Further high-quality, standardized trials are needed.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term implant survival in delayed breast reconstruction.","authors":"Fredrik Brorson, Anna Paganini, Koen Simons, Anna Elander, Emma Hansson","doi":"10.1093/bjsopen/zraf071","DOIUrl":"10.1093/bjsopen/zraf071","url":null,"abstract":"<p><strong>Background: </strong>The primary aim of this study was to establish the incidence of implant-related operations and revisions after delayed implant-based breast reconstruction over a 20-year period.</p><p><strong>Methods: </strong>This study is an ancillary study to the Gothenburg Breast Reconstruction Study (GoBreast; NCT03963427). The first included patient was operated on in 2003, and the last was operated on in 2011. All breast reconstructions were delayed procedures. The Kaplan-Meier method was used to estimate the time until implant loss. Log-rank tests (Mantel-Haenszel) were used for comparisons. A Cox proportional hazards model was used for multivariable analysis, and hazard ratios were estimated.</p><p><strong>Results: </strong>The study included 881 implants and 603 patients. The mean follow-up for the implants was 8.2 years. With regard to first implants, 17% had at least one unplanned procedure with implant failure. If all implants are pooled together, the 20-year implant survival rate is 57% (95% confidence interval 54 to 61%). Most implants were lost during the first 2 years, but the cumulative risk of implant loss increased steadily with time. When different surgical methods were compared, implant survival was statistically lower for direct-to-implant than for the other techniques (P < 0.001).</p><p><strong>Conclusion: </strong>About half of the implants in delayed breast reconstructions in this study survived for up to two decades without any additional surgery. Serial implant revisions seem more common than single implant revisions; if the first implant needed revision, there was a tendency for the second implant to also require revision.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-thyroid surgery adhesion prevention using oxidized regenerated cellulose and hyaluronic acid: prospective, single-blinded, randomized study.","authors":"Ting-Chun Kuo, Kuen-Yuan Chen, Yi-Jhih Tsai, Ming-Tsan Lin, Chin-Hao Chang, Ming-Hsun Wu","doi":"10.1093/bjsopen/zraf079","DOIUrl":"10.1093/bjsopen/zraf079","url":null,"abstract":"<p><strong>Background: </strong>Postoperative adhesions following thyroidectomy significantly affect patient quality of life, yet prevention strategies remain understudied. This trial evaluated the safety and efficacy of oxidized regenerated cellulose and high molecular weight hyaluronic acid in preventing post-thyroidectomy adhesions.</p><p><strong>Methods: </strong>In this prospective, single-blinded, randomized study, patients undergoing thyroidectomy were randomized 1 : 1 : 1 to receive oxidized regenerated cellulose (Interceed™), high molecular weight hyaluronic acid (HANBIO BarriGel), or no adhesion barrier (control). The primary outcome was change in the Dysphagia Handicap Index (DHI) from baseline to 1 month. Secondary outcomes included the Voice Handicap Index, Swallowing Impairment Score, laryngotracheal elevation, and adhesion severity scores at 2 weeks, and 1, 6, and 12 months after operation.</p><p><strong>Results: </strong>Forty -five patients were enrolled. Changes in DHI were not significant from baseline to 1 month among the three groups. The adhesion barrier groups demonstrated significantly smaller increases in Voice Handicap Index scores compared with the control group at 2 weeks (oxidized regenerated cellulose: mean(s.d.) 4.8(5.8); high molecular weight hyaluronic acid: 0.8(6.3); control: 8.4(9.6); P = 0.032) and at 1 month (3.0(5.2), 1.0(7.1), and 9.1(12.3), respectively; P = 0.047). Changes in Swallowing Impairment Scores were significantly lower in the adhesion barrier groups (2.1(5.6) versus 6.0(5.9); P = 0.037), although no significant differences were observed among the three groups (oxidized regenerated cellulose: 1.4(4.2); high molecular weight hyaluronic acid: 2.8(6.8); control: 6.0(5.9); P = 0.095) at 2 weeks. The high molecular weight hyaluronic acid group demonstrated superior preservation of laryngotracheal elevation among groups (P = 0.006) and compared with the oxidized regenerated cellulose group (P = 0.041) at 1 month. No adhesion barrier-related complications were observed. By 6 months, most parameters had returned to near-baseline levels across all groups.</p><p><strong>Conclusion: </strong>Both oxidized regenerated cellulose and high molecular weight hyaluronic acid appear safe and potentially effective in reducing early post-thyroidectomy adhesion symptoms, with high molecular weight hyaluronic acid showing superior outcomes in certain parameters. These findings support the use of adhesion barriers in thyroid surgery, although larger studies are needed to confirm their long-term benefits.</p><p><strong>Registration number: </strong>NCT05851560 (http://www.clinicaltrials.gov).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to recovery following open and endoscopic carpal tunnel decompression: meta-analysis.","authors":"Olivia J Hartrick, Rebecca K Turner, Alexander Freethy, Chetan Khatri, Lauren Chong, Ryckie G Wade, Justin C R Wormald, Akira Wiberg, Jeremy N Rodrigues, Conrad Harrison","doi":"10.1093/bjsopen/zraf085","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf085","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel release (CTR) can be performed using either an open or endoscopic approach. The patient recovery trajectories remain poorly understood. This study aimed to define and compare patient-reported recovery following unilateral open and endoscopic CTR.</p><p><strong>Methods: </strong>A PRISMA-compliant, preregistered (CRD42023427718) systematic review was conducted, searching PubMed, Embase, and Cochrane databases on 4 July 2023 and 21 August 2024. Studies were included if they reported recovery data (patient-reported outcome measures (PROMs)) at predefined time points for adults undergoing unilateral CTR. Boston Carpal Tunnel Questionnaire and Quick Disabilities of Arm, Shoulder, and Hand scores were extracted. Standardized mean change (SMC) scores from baseline were pooled using random-effects meta-analysis. An innovative modification of the National Institutes of Health quality assessment tools was used to evaluate the risk of bias.</p><p><strong>Results: </strong>In all, 49 studies were included (4546 participants included in the analysis; 3137 open CTR, 1409 endoscopic CTR). Both approaches improved PROM scores over 12 weeks, with early (4-week) outcomes strongly correlating (>0.89) with later (12-week) outcomes. Symptoms continued improving up to 104 weeks. At 1 week, open CTR showed symptomatic deterioration (SMC 10.29; 95% confidence interval (c.i.) 6.35 and 14.21 respectively), comparatively, endoscopic CTR demonstrated an improvement (SMC -2.83; 95% c.i. -7.80 and 2.14 respectively). By 2 weeks, symptom severity remained slightly worse in open CTR, but confidence intervals overlapped from week 3 and thereafter open CTR showed greater symptomatic improvement. Most studies had a high risk of bias and measured outcomes too infrequently for a granular comparison.</p><p><strong>Conclusions: </strong>Patient-reported recovery trajectories for CTR can inform patient counselling and future research. Endoscopic CTR may result in fewer symptoms in the first 2 weeks, but open CTR may offer comparable or potentially greater improvement thereafter. Future trials with high-frequency PROM capture should prioritize early (first 3 weeks) and long-term (≥24 weeks) outcomes.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688858","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":"Use of artificial intelligence in the analysis of digital videos of invasive surgical procedures: scoping review.","authors":"Anni King, George E Fowler, Rhiannon C Macefield, Hamish Walker, Charlie Thomas, Sheraz Markar, Ethan Higgins, Jane M Blazeby, Natalie S Blencowe","doi":"10.1093/bjsopen/zraf073","DOIUrl":"10.1093/bjsopen/zraf073","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical videos are a valuable data source, offering detailed insights into surgical practice. However, video analysis requires specialist clinical knowledge and takes considerable time. Artificial intelligence (AI) has the potential to improve and streamline the interpretation of intraoperative video data. This systematic scoping review aimed to summarize the use of AI in the analysis of videos of surgical procedures and identify evidence gaps.</p><p><strong>Methods: </strong>Systematic searches of Ovid MEDLINE and Embase were performed using search terms 'artificial intelligence', 'video', and 'surgery'. Data extraction included reporting of general study characteristics; the overall objective of AI; descriptions of data sets, AI models, and training; methods of data annotation; and measures of accuracy. Data were summarized descriptively.</p><p><strong>Results: </strong>In all, 122 studies were included. More than half focused on gastrointestinal procedures (75 studies, 61.5%), predominantly cholecystectomy (47, 38.5%). The most common objectives were surgical phase recognition (40 studies, 32.8%), surgical instrument recognition (28, 23.0%), and enhanced intraoperative visualization (23, 18.9%). Of the studies, 79.5% (97) used a single data set and most (92, 75.4%) used supervised machine learning techniques. There was considerable variation across the studies in terms of the number of videos, centres, and contributing surgeons. Forty-seven studies (38.5%) did not report the number of annotators, and details about their experience were frequently omitted (102, 83.6%). Most studies used multiple outcome measures (67, 54.9%), most commonly overall or best accuracy of the AI model (67, 54.9%).</p><p><strong>Conclusion: </strong>This review found that many studies omitted essential methodological details of AI training, testing, data annotation, and validation processes, creating difficulties when interpreting and replicating these studies. Another key finding was the lack of large data sets from multiple centres and surgeons. Future research should focus on curating large, varied, open-access data sets from multiple centres, patients, and surgeons to facilitate accurate evaluation using real-world data.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation as a treatment for cancer: comprehensive review.","authors":"Bobby V M Dasari, Pal-Dag Line, Gonzalo Sapisochin, Taizo Hibi, Prashant Bhangui, Karim J Halazun, Shishir Shetty, Tahir Shah, Christian T J Magyar, Conor Donnelly, Dev Chatterjee","doi":"10.1093/bjsopen/zraf034","DOIUrl":"10.1093/bjsopen/zraf034","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation for cancer indications has gained momentum in recent years. This review is intended to optimize the care setting of liver transplant candidates by highlighting current indications, technical aspects and barriers with available solutions to facilitate the guidance of available strategies for healthcare professionals in specialized centres.</p><p><strong>Methods: </strong>A review of the most recent relevant literature was conducted for all the cancer indications of liver transplantation including colorectal cancer liver metastases, hilar cholangiocarcinoma, intrahepatic cholangiocarcinoma, neuroendocrine tumours, hepatocellular carcinoma and hepatic epitheloid haemangioendothelioma.</p><p><strong>Results: </strong>Transplant benefit from the best available evidence, including SECA I, SECA II, TRANSMET studies for colorectal liver metastases, various preoperative protocols for cholangiocarcinoma patients, standard, extended selection criteria for hepatocellular carcinoma and neuroendocrine tumours, are discussed. Innovative approaches to deal with organ shortages, including machine-perfused deceased grafts, living donor liver transplantation and RAPID procedures, are also explored.</p><p><strong>Conclusion: </strong>Cancer indications for liver transplantation are here to stay, and the selection criteria among all cancer groups are likely to evolve further with improved prognostication of tumour biology using adjuncts such as radiomics, cancer genomics, and circulating DNA and RNA status. International prospective registry-based studies could overcome the limitations of smaller patient cohorts and lack of level 1 evidence.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}