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The Validation Status of Current and Emerging Minimally Invasive Robotic Surgical Platforms

Most existing robotic surgical platforms are at the early stages of evaluation, with the majority being in the preclinical to developmental and exploratory stage. A scoping review of 23 different robotic platforms from 21 companies revealed that only one multiport system is fully evaluated, while the rest are at various stages of assessment. None of the single-port systems have undergone full evaluation. The study emphasizes the importance of using the ideal framework to ensure comprehensive evaluation of emerging robotic platforms for patient safety and informed decision-making.

Review by Boal M, Di Girasole CG (…) Francis N et 5 al. in Surg Endosc

© 2023. The Author(s).

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Metabolic surgery leads to weight loss, improved comorbid conditions, lower incidence of cardiovascular events, cancer, and death, but also carries risks.

Metabolic/bariatric surgery is an effective and durable treatment for obesity, resulting in significant weight loss and improvements in comorbid conditions, including type 2 diabetes. It is associated with a lower incidence of cardiovascular events, cancer, and death. However, there is a risk of weight regain and an increased risk of developing substance and alcohol use disorders, suicidal ideation/attempts, and accidental death. Lifelong follow-up is necessary to reduce these complications. Different surgical procedures have varying risks and benefits, and more research is needed on less invasive and emerging procedures.

Review by Courcoulas AP, Daigle CR and Arterburn DE in BMJ

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Systemwide Quality Improvement Increases Primary Care-Initiated Evaluation of Adrenal Incidentalomas

Following the implementation of a systemwide quality improvement (QI) program, researchers assessed the management of incidental adrenal masses (IAMS) in 437 patients from January 2018 to December 2019. The QI intervention included various strategies such as providing chart-based messages, emails to primary care providers (PCPs), standardized recommendations, and access to a multispecialty adrenal clinic. The study found that the QI cohort had a significantly higher rate of PCP-initiated evaluations for IAMS compared to the historical cohort (35.5% vs. 27.6%). The intervention was associated with an increased likelihood of PCP-initiated IAMS evaluations. Adrenal surgery rates did not significantly differ between the cohorts.

Journal Article by Woods AP, Feeney T (…) Drake FT et 3 al. in J Am Coll Surg

Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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No Significant Impact of Preoperative Midazolam on Patient Satisfaction in Older Surgical Patients

Despite its widespread use, the effect of preoperative oral midazolam on patient satisfaction in older surgical patients remained unclear. Researchers conducted a double-blind, placebo-controlled clinical trial on 607 patients aged 65 to 80 years undergoing elective inpatient surgery. The study found that a single low dose of oral midazolam did not significantly alter global perioperative patient satisfaction compared to the placebo group. The results suggest the need for further trials using different patient populations and dosage levels to evaluate the impact of midazolam on patient-centered outcomes.

Journal Article by Kowark A, Keszei AP (…) Coburn M et 25 al. in JAMA Surg

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Preoperative 18F-FDG PET/CT Associated with Pathological Tumor Grade in Pseudomyxoma Peritonei

The clinical effectiveness of preoperative 18F-FDG PET/CT in predicting pathological tumor grade in patients with pseudomyxoma peritonei (PMP) originating from the appendix was evaluated in this retrospective cohort study. The study found that high-grade PMP patients had a significantly higher median standardized uptake value (SUVmax) on 18F-FDG PET/CT compared to low-grade patients. The highest area under the curve was 0.81, suggesting that SUVmax could serve as a reliable indicator for predicting pathological grade in PMP cases.

Journal Article by Aso K, Gohda Y (…) Yano H et 4 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Standardizing Indocyanine Green Fluorescence Angiography in Colorectal Surgery Impacts on Interpretation Consistency

The study aimed to assess the impact of a standardized protocol on interpretation consistency of indocyanine green fluorescence angiography (ICGFA) in colorectal surgery. Experienced and junior surgeons completed a questionnaire and interpreted nine ICGFA videos. Results showed good transection level concordance across all videos and expertise levels. However, poor agreement was observed with the standardized protocol for overlay presentation and monochrome display. The study suggests that standardizing ICGFA acquisition and display may diminish interpretation consistency and highlights the need for dedicated protocols for computational development of ICGFA videos.

Journal Article by Dalli J, Joosten JJ (…) Cahill RA et 5 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Laparoscopic Cholecystectomy Effectively Alleviates Symptoms in Patients with Normal Ejection Fraction

Laparoscopic cholecystectomy is found to be effective in improving symptoms for patients with abdominal pain and biliary dyskinesia (low ejection fraction <35%), but there is a lack of evidence regarding its effectiveness for patients with biliary symptoms and a normal ejection fraction (>35%). In a retrospective study of 117 patients with negative workup, including normal ejection fraction, who underwent laparoscopic cholecystectomy, 84% reported resolution of pre-operative symptoms. There was no significant correlation between pain during hida scan and ejection fraction with symptom resolution.

Journal Article by Sharrak A, Aubrey J (…) Banks-Venegoni A et 3 al. in Am J Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Subtotal Cholecystectomy: Safe Approach with Postoperative ERCP for Bile Leak Resolution

This study examined 102 cases of subtotal cholecystectomy (STC) as a strategy for difficult cholecystectomies. Of all patients with STC, 47.1% underwent intra- or postoperative ERCP. Bile leak was the main indication for ERCP, with a higher resolution rate for postoperative ERCP (95.7%) compared to intraoperative ERCP (60.0%). No injuries to the central bile ducts were reported among STC patients. The study found that STC was a safe approach in difficult cases and concluded that postoperative ERCP was more effective in resolving bile leaks.

Journal Article by Fasting MH, Strønen E (…) Mala T et 3 al. in Scand J Gastroenterol

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Optimal Surgical Management and Outcomes of Abdominal Catastrophes Secondary to Intestinal Lymphomas

A systematic review was conducted to assess the presentation, diagnosis, optimal surgical approach, and post-operative outcomes of abdominal catastrophes secondary to intestinal lymphomas. A total of 95 patients were identified, with Burkitt’s lymphoma and diffuse large B-cell lymphoma being the most common types. Small bowel resections had a 25% complication rate and a 13.8% 30-day mortality, while ileocolonic resections had a 27% complication rate and an 18% mortality. Primary repair had a 25% complication rate and 25% mortality. Aggressive surgical management, including small bowel resection, may yield similar remission rates for these patients.

Review by Butterworth JW, Brooker-Thompson C (…) Dawas K et 2 al. in Eur J Surg Oncol

© 2023 Published by Elsevier Ltd.

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Extent of Surgery Found to Impact Gastrointestinal Function in Patients Undergoing CRS and HIPEC

This study investigated the impact of the extent of surgery on late adverse effects (LAEs) in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The study found that patients undergoing extensive CRS experienced persistent impaired gastrointestinal function in terms of diarrhea, compared to those undergoing less extensive surgery. However, the levels of other symptom scales significantly decreased from 3 to 12 months post-surgery. Clinicians should be attentive in detecting and addressing these LAEs in order to guide patients accordingly.

Journal Article by Ravn S, Grønfeldt JM, Thaysen HV and Iversen LH in Eur J Surg Oncol

© 2023 Published by Elsevier Ltd.

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