Search Results (632)

Background: Minimally invasive surgery has become the standard of care in colorectal cancer management, with laparoscopic techniques widely adopted due to their established short-term benefits and comparable oncological outcomes to open surgery. More recently, robotic-assisted surgery has emerged as an advanced minimally invasive alternative, offering enhanced visualization, improved instrument dexterity, and superior ergonomics. However, the extent to which these technical advantages translate into clinically meaningful improvements remains a subject of ongoing debate. Methods: A systematic review of the literature was conducted using PubMed, Scopus, and Web of Science databases, including studies published between 2005 and 2025. Eligible studies comprised randomized controlled trials, observational studies, cohort studies, and meta-analyses comparing laparoscopic and robotic colectomy for colon cancer. Outcomes of interest included intraoperative parameters (operative time, blood loss, conversion rate), postoperative outcomes (length of hospital stay, complications, mortality), and oncological endpoints (lymph node yield, resection margins, survival). The review was performed in accordance with PRISMA 2020 guidelines. Results: A total of 150 studies met the inclusion criteria. Robotic colectomy was consistently associated with reduced intraoperative blood loss, lower conversion rates to open surgery, and shorter length of hospital stay, albeit at the expense of longer operative times, particularly during the learning phase. Oncological outcomes, including lymph node harvest and margin status, were comparable between approaches, with some studies reporting a modest increase in lymph node yield in robotic procedures. The adoption of intracorporeal anastomosis was significantly higher in robotic surgery, contributing to improved postoperative recovery and reduced wound-related complications. Composite quality metrics, such as textbook outcome (TO), were more frequently achieved in robotic cohorts, largely driven by shorter hospitalization and lower complication rates. However, evidence from randomized controlled trials remains limited, and heterogeneity among studies persists. Conclusions: Robotic colectomy and rectal resection represent a safe and effective alternative to laparoscopic surgery in the treatment of colon cancer, offering potential advantages in perioperative outcomes and surgical precision. Its benefits appear particularly relevant in technically demanding cases, such as deep pelvic dissection and obese patients. Nevertheless, higher costs, longer operative times during the initial learning curve, and limited high-quality randomized evidence warrant cautious adoption. Future large-scale randomized studies are needed to clarify long-term oncological outcomes, cost-effectiveness, and the optimal integration of robotic platforms into standard colorectal surgical practice. Full article

Background: Liver cancer is a major public health problem in Thailand due to its high incidence and mortality. Although hepatectomy is a potentially curative treatment, it is a complex procedure with a high risk of postoperative complications, necessitating a structured and systematic approach to care. Objectives: This study aimed to develop a clinical practice guideline (CPG) for patients with liver cancer undergoing hepatectomy and to evaluate the feasibility of its implementation in relation to outcomes for healthcare providers, the organization, and patients. Methods: This implementation research was conducted in three phases: (1) an evidence-triggered phase, (2) an evidence-supported phase, and (3) an evidence-observed phase. The CPG covered five stages of care: preoperative, intraoperative, postoperative, discharge planning, and post-discharge follow-up. It was implemented through a multidisciplinary approach, with an advanced practice nurse (APN) facilitating adherence to Enhanced Recovery After Surgery (ERAS) components. Data were analyzed using descriptive statistics. Results: Healthcare personnel demonstrated high adherence to the CPG and reported high feasibility of implementation. After implementation, favorable trends were observed in postoperative complications, length of hospital stay, hospitalization costs, and patient satisfaction compared with the historical pre-implementation period. The CPG also appeared to support clearer care standards and multidisciplinary coordination. Conclusions: The developed CPG was feasible and contextually appropriate for ERAS-based hepatectomy care in this setting. Preliminary findings suggest favorable trends in care processes and selected outcomes. Larger controlled studies with longer follow-up are needed to determine effectiveness and sustainability. Full article

Background/Objectives: Postoperative pain after robot-assisted gynecologic surgery delays recovery and prolongs hospitalization, yet evidence on the role of ultrasound-guided rectus sheath block (RSB) in this setting is limited. We investigated whether preoperative ultrasound-guided RSB was associated with a shorter length of hospital stay (LOS) after robot-assisted gynecologic surgery. Methods: This single-center retrospective cohort study included 266 consecutive female patients who underwent robot-assisted gynecologic surgery between November 2023 and April 2024. RSB was introduced in January 2024; 113 patients from the RSB-eligible era who received the block and 153 patients before RSB introduction served as the RSB and comparator groups, respectively. The primary outcome was LOS. Secondary outcomes included rescue intravenous fentanyl and rescue antiemetic use in the post-anesthesia care unit (PACU) and rescue analgesic administration on the general ward through postoperative day (POD) 2. Multivariable quasi-Poisson regression was used to adjust for potential confounders. Results: LOS was significantly shorter in the RSB group (median 3 [IQR 3–3] vs. 4 [³,⁴,⁵] days; p < 0.001; adjusted IRR 0.78, 95% CI 0.72–0.85). The RSB group also required less PACU rescue fentanyl (0.86 [0.68–1.38] vs. 1.17 [0.85–1.69] μg/kg; p < 0.001), fewer rescue antiemetics (3.5% vs. 11.8%; p = 0.029), and fewer ward rescue analgesics on POD 0 (52.2% vs. 68.6%; p = 0.009) and POD 1 (13.3% vs. 34.2%; p < 0.001). Conclusions: Preoperative ultrasound-guided RSB was associated with shorter LOS, reduced PACU opioid and antiemetic requirements, and fewer early ward rescue analgesics. Randomized trials are warranted to confirm these benefits. Full article

Background: Minimally invasive liver surgery has continuously developed with the advent of robotic systems that could present some advantages regarding dexterity and visualization. Single-port robotic devices have been introduced more recently in order to minimize the invasiveness of surgery. Unfortunately, scientific literature on this topic is still poor. This pilot feasibility study aimed to assess the technical applicability and short-term outcomes of single-port robotic liver resection. Methods: The study was designed as a retrospective analysis of 11 consecutive patients treated with single-port robotic liver resection. All interventions were performed in order to treat lesions localized in the anterolateral segments of the liver. All preoperative, intraoperative, and postoperative data were collected retrospectively and considered for the analysis. Cirrhotic patients were graded according to the Child–Pugh score. Results: The median age was 67 years (IQR 41–78), and 63.6% of the patients were women. There was cirrhosis in 27.3% of the cases, and all cases were categorized as Child–Pugh class A. Neoadjuvant chemotherapy was not administered in any of the patients. All procedures were considered Tampa grade II. The median operation time was 190 min (IQR 70–320), and the median blood loss was 50 mL (IQR 0–300). Pedicle clamping was done in 36.4% of the cases. An additional assistant trocar was needed in 45.4% of the procedures. In total, two anatomical and nine non-anatomical resections were done. There were no postoperative complications, reinterventions, and 90-day readmissions. The median length of hospitalization was 2 days (IQR 1–3). The postoperative pain was minimal, with a median VAS and NRS score of 0 on postoperative days 0 and 1. Analgesic treatment was ceased on postoperative day 1, and the median time to first flatus was 1 day in all patients. Conclusions: Single-port robotic liver resection seems to be technically possible in selected patients with intermediate-difficulty lesions in anterolateral segments. Additional research is necessary to establish its role in minimally invasive liver surgery. Full article

Background/Objectives: Adductor canal blocks (ACBs) are widely used for postoperative analgesia following total knee arthroplasty (TKA). However, the duration of analgesia with a single-shot ACB is limited. Pharmacological adjuncts may enhance and prolong the duration of single-injection blocks, but their efficacy in this setting remains unclear. The aim of this study was to assess the analgesic effectiveness of adjuncts added to local anaesthetic for single-shot ACBs following TKA. Methods: An extensive systematic literature review was performed on Medline, Embase, CINAHL, Cochrane CENTRAL, and Web of Science. Adult patients undergoing primary TKA who received a single-shot ACB with an adjunct added to LA were eligible, with a single-shot ACB with LA alone as the comparator. The primary outcome was postoperative analgesic efficacy, assessed by pain scores (VAS/NRS), time to first rescue analgesia, total postoperative opioid consumption, or sensory block duration. Secondary outcomes included functional recovery measures and adverse events. Risk of bias was evaluated using the Cochrane RoB 2 tool, and the certainty of evidence for each adjunct–outcome combination was assessed using GRADE. Due to clinical heterogeneity, a meta-analysis was not feasible and findings were synthesised narratively. Results: Nine randomised controlled trials (RCTs) assessing the analgesic efficacy of adjuncts added to local anaesthetic in ACB following TKA were included in this review. Adjuncts included dexmedetomidine, dexamethasone, butorphanol, buprenorphine, and magnesium sulphate. Three RCTs demonstrated improvements in early postoperative analgesia with dexmedetomidine at doses of 0.5 µg/kg, while lower doses (0.25 µg/kg) did not. Dexamethasone also decreased early postoperative pain across two RCTs and showed the most evidence for significant prolongation in sensory blockade, with a dose of 4 mg needed to produce significant effects. Butorphanol and buprenorphine demonstrated a significant reduction in postoperative opioid consumption and improved pain, but evidence was limited to single trials. Findings for magnesium were inconsistent. No adjunct was associated with any serious side effect or adverse event. Conclusions: Pharmacological adjuncts added to single-shot ACBs following TKA generally improved early postoperative pain and reduced opioid consumption compared with LA alone, with the most consistent benefits observed for dexmedetomidine (0.5 µg/kg) and dexamethasone (≥4 mg). However, these effects appeared dose-dependent, were largely confined to the first 24 h after surgery, and were supported by moderate-to-low certainty evidence with limited functional outcome data. Further high-quality, adequately powered RCTs with standardised functional endpoints and longer follow-up are required to define optimal dosing, clarify safety, and determine whether improved analgesia translates into meaningful gains in rehabilitation and recovery. Full article

Background/Objectives: Iatrogenic nerve injury is a significant challenge in urologic surgery, with radical prostatectomy posing a high risk due to complex pelvic neural anatomy. Despite advances in robotic-assisted and nerve-sparing techniques, postoperative urinary incontinence and erectile dysfunction remain prevalent, adversely affecting patients’ quality of life and imposing substantial healthcare costs. Methods: A narrative review was conducted using PubMed, MEDLINE, and the Cochrane Library (searches through February 2026) for studies on radical prostatectomy epidemiology, mechanisms of nerve injury, functional outcomes, and economic burden. Emerging intraoperative fluorescence imaging technologies, surgical strategies to mitigate iatrogenic nerve injuries, and the financial costs of post-prostatectomy complications were assessed. Results: Robotic-assisted radical prostatectomy now accounts for >80% of procedures in the United States, and has been associated in observational studies with improved early recovery of erectile function compared with open and laparoscopic approaches. However, the lack of real-time nerve visualization remains a limiting factor. Recent milestones (January 2026) include the Food and Drug Administration Investigational New Drug clearance for the nerve-specific fluorophore LGW16-03 (NerveTrace), which enables real-time identification of sub-millimeter nerve branches, and the 510(k) premarket clearance of Dendrite imaging (November 2025). Conclusions: Enhanced intraoperative nerve discrimination via molecularly targeted imaging has the potential to reduce iatrogenic complications and improve long-term functional and economic outcomes in prostate cancer surgery, although these benefits have yet to be demonstrated in prospective clinical and health-economic studies. Full article

Surgical intervention in Crohn’s disease remains a significant contributor to patient morbidity, with postoperative complication rates reported between 20% and 50%. These complications include a broad spectrum of adverse outcomes, such as surgical site infections, intra-abdominal abscesses, and anastomotic leakage, all of which can substantially impact recovery, healthcare costs, and long-term prognosis. Although several clinical and perioperative risk factors have been identified, accurate prediction of postoperative outcomes remains challenging, highlighting the need for improved risk stratification strategies. In recent years, the evolution of biological therapies has transformed the management of Crohn’s disease, raising important questions regarding their influence on surgical outcomes and postoperative healing. Consequently, a more nuanced understanding of the interplay between medical and surgical approaches is required to optimize patient care. This systematic review aims to evaluate established and emerging predictive biomarkers associated with postoperative complications in Crohn’s disease surgery. Particular emphasis is placed on inflammatory markers, nutritional parameters, and novel molecular signatures. Furthermore, the review explores the growing role of multiomics approaches—including genomics, proteomics, and metabolomics—as well as the integration of machine learning models to enhance predictive accuracy. By synthesizing current evidence, this study underscores the potential of combining biomarkers with advanced analytical tools to support personalized risk assessment and guide clinical decision-making in Crohn’s disease surgery. Full article

Background: Accurate preoperative prediction of length of hospital stay (LOS) after surgery for colorectal liver metastases (CRLMs) could improve patient counselling and resource planning, yet reliable risk tools are lacking. We aimed to develop an interpretable machine learning model predicting LOS following first-time liver-directed surgery for CRLMs. Methods: In this multicenter cohort study, we included patients who underwent first-time liver resection, ablation, or a combination for CRLMs at three Danish hepatobiliary centers between 2016 and 2023. Preoperative features from two national registries were used to train Elastic Net, Random Forest, HistGradientBoosting, and Explainable Boosting Machine (EBM) algorithms. Hyperparameters were optimized using five-fold cross-validation. Performance was evaluated on a 20% hold-out test sample using mean absolute error (MAE) with bootstrapped 95% confidence intervals (CIs). Results: Among 915 patients, median LOS was 4.0 days (interquartile range (IQR) 3.0–6.0). All four algorithms achieved comparable prediction error (MAE 3.0–3.1 days). The EBM (MAE 3.1 days, 95% CI 2.6–4.3) algorithm was selected for its inherent interpretability. Surgical approach was the strongest predictor, where percutaneous and laparoscopic approaches were associated with reductions of 1.9 and 1.2 days, respectively. Tumor burden, including number of lesions and largest lesion diameter, showed progressive non-linear associations with longer stays. Nonetheless, overall explained variance was low (R² ≤ 0.10), and calibration showed systematic underestimation of stays beyond five days. Conclusions: An inherently interpretable machine learning model matched the predictive performance of opaque algorithms for LOS after CRLM surgery, although overall predictive accuracy was modest and longer stays were underestimated. Explainability analysis identified surgical approach and tumor burden as the most influential predictors. External validation in healthcare systems with different discharge practices is warranted. Full article

Objective: To characterize the structural organization of Enhanced Recovery After Surgery (ERAS) component implementation in gynecologic oncology and determine whether ERAS elements operate as an interconnected perioperative system during early pathway integration. Methods: This study represents a secondary analysis of the prospective multicenter Enhanced Recovery in Gynecologic Oncology (ERGO) cohort, including the first 300 consecutive patients undergoing surgery for gynecologic malignancy across five tertiary institutions. Components with prevalence between 5% and 95% were included in a regularized Ising network model to estimate conditional dependencies between pathway elements. Node-level centrality metrics and global network characteristics were calculated to identify structurally influential ERAS components and to describe the overall implementation architecture. Results: Thirteen central ERAS components met the predefined prevalence criterion (5–95%) and were included in the conditional dependency network. The estimated network demonstrated substantial inter-component connectivity, indicating that ERAS practices were frequently implemented in coordinated patterns rather than as isolated interventions. Centrality analysis identified postoperative laxatives or chewing gum, tranexamic acid administration, perioperative intravenous fluid management, and avoidance of drain placement as highly connected elements within the network. Early nutritional advancement and postoperative bowel stimulation measures also demonstrated relatively central positions within the recovery-related component cluster. Community detection analysis revealed distinct modules of co-adopted ERAS practices spanning multiple perioperative phases. Conclusions: ERAS implementation in gynecologic oncology appears to follow a structured architecture characterized by interconnected perioperative practices rather than independent protocol elements. Understanding these implementation structures may help guide targeted quality-improvement strategies aimed at optimizing ERAS integration in routine clinical practice. Full article

Enhanced Recovery After Surgery (ERAS^®) is a multimodal perioperative framework designed to mitigate the physiological stress response to major surgery. While ERAS protocols consistently reduce length of hospital stay, overall complication rates, and healthcare costs compared to conventional care, their specific impact on surgical site infections (SSIs) remains poorly defined. This review explores the potential synergistic benefits of integrating ERAS protocols with established infection prevention bundles. By evaluating the current clinical evidence, we analyze how the co-implementation of these two evidence-based strategies can collectively reduce the incidence of SSIs. Full article

The introduction of minimally invasive surgery (MIS) marked a turning point in the history of medicine, driving one of the sharpest declines in surgical mortality and morbidity ever recorded—saving millions of lives and sparing an estimated one billion patients the suffering once inherent to large-incision surgery. Within a single generation, this once highly contested surgical innovation became the global standard of care, transforming surgical practice across disciplines and on a global scale. By every measure of public health, these outcomes place modern minimally invasive and robotic-assisted surgery as among the most consequential life-saving advances in modern medical history. This review examines the clinical impact and global dissemination of MIS, tracing its evolution from Camran Nezhat’s pioneering expansion of laparoscopy beyond diagnostics to complex therapeutic procedures across surgical disciplines. Drawing on decades of evidence across gynecology, general surgery, and urology, we show that MIS is associated with substantial reductions in perioperative mortality, major complications, blood loss, infections, thromboembolic events, postoperative pain, and length of hospital stay, while maintaining oncologic equivalence and improving functional and quality-of-life outcomes. Beyond these technical advances, MIS catalyzed a broader reimagining of surgery itself, challenging long-standing norms rooted in large-incision approaches and shifting the field toward precision, organ preservation, and pathology-directed intervention. These changes were accompanied by parallel advances in multiple domains, including in imaging, intraoperative visualization technologies, surgical anatomy, instrumentation, and nerve- and organ-sparing techniques—developments that collectively established the foundation for contemporary minimally invasive and robotic-assisted surgery. Collectively, these advances have contributed to the prevention of an estimated 10–20 million surgery-related deaths that would likely have occurred under the large-incision approaches of the past. Full article

Background/Objectives: Peripheral artery disease (PAD) is frequently asymptomatic, requiring non-invasive approaches for disease evaluation and therapy monitoring. This study demonstrates that multispectral optoacoustic tomography (MSOT) and laser speckle contrast imaging (LSCI) can non-invasively assess changes in tissue vascular oxygenation and perfusion, respectively, in a mouse hindlimb PAD model, enabling comparison of age-dependent vascular responses. Methods: PAD was induced by cauterization of the femoral artery in young (2 months) and old (18 months) mice, which were imaged using MSOT and LSCI at baseline (Day 0) and on Days 3, 7, and 14 post-surgery. Correlative histology including Hematoxylin and Eosin (H&E), Masson’s Trichrome for collagen, and immunofluorescence for CD31 and Ki-67 were performed. Results: Reduced tissue oxygenation was observed by MSOT in the ischemic limb shortly after surgery and faster recovery occurred in young compared to old mice. LSCI revealed time-dependent perfusion recovery in both groups, with consistently better recovery in young mice. Histological analyses confirmed ischemic damage and demonstrated enhanced angiogenesis and cellular proliferation in young muscle tissues. The observations were consistent for each methodology. Conclusions: These results indicate that both MSOT and LSCI serve as effective, non-invasive tools for longitudinal monitoring of muscle injury, capable of revealing age-dependent vascular responses without the need for exogenous contrast agents. Full article

Minimally invasive spine surgery (MISS) has progressively transformed the management of spinal disorders by reducing soft-tissue disruption, perioperative morbidity, and recovery time while maintaining clinical outcomes comparable to conventional open techniques. Beyond its technical evolution, MISS has increasingly assumed a central role in the treatment of bone-related spinal conditions, including vertebral fractures, degenerative instability, metastatic disease, and osteoporosis-associated pathology. This narrative review provides a comprehensive overview of the evolution of MISS with a specific focus on its interaction with vertebral bone biology, implant stability, and fusion processes. A structured literature search of the PubMed/MEDLINE database was conducted, including English-language studies published between 1980 and June 2025 addressing MISS techniques, enabling technologies, and bone-related clinical outcomes. Current evidence suggests that MISS may preserve paraspinal vascularization and soft tissue integrity, potentially supporting bone healing and fusion, although high-quality comparative data remain limited. The effectiveness of MISS in osteoporotic and metastatic vertebral disease is closely linked to bone quality, implant anchorage, and biomechanical considerations, particularly in the context of pedicle screw fixation and interbody support. Emerging technologies—including navigation, robotics, and artificial intelligence—may enhance accuracy in implant placement and reduce bone-related complications, but robust evidence of long-term benefit is still lacking. Despite its advantages, MISS presents important limitations, including a steep learning curve, increased costs, and uncertain superiority in terms of fusion rates and long-term biomechanical stability. Future research should prioritize high-quality comparative studies focusing on bone healing, implant integration, and patient-specific factors such as bone density. MISS should therefore be interpreted not only as a surgical paradigm shift but as an evolving strategy for optimizing outcomes in bone-related spinal disorders. Full article

Perioperative anxiety is a common psychophysiological stress response experienced by patients before and after surgery, with a global prevalence of approximately 48%. Its occurrence is influenced by multiple factors including age, sex, type of surgery, and psychosocial determinants. The underlying pathophysiological mechanisms are complex, involving multi-system interactions such as autonomic nervous system imbalance, dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, dysfunction of limbic system neural circuits, and neuroinflammation. Current assessment strategies are evolving from sole reliance on psychological scales toward multimodal approaches incorporating objective biomarkers including heart rate variability, cortisol, and electroencephalography. Management paradigms have shifted from traditional pharmacological premedication to integrated systems encompassing structured patient education, digital health tools, neuromodulation techniques, and cognitive behavioral therapy. However, significant gaps persist regarding standardized screening protocols, biomarker validation, and targeted intervention pathways for high-risk populations. Future management is likely to require more individualized risk assessment and intervention selection. Biomarker-based risk prediction, artificial intelligence-assisted intervention decision-making, and the deep integration of digital therapeutics such as virtual reality with existing enhanced recovery pathways will be key directions for improving patient outcomes and recovery quality. This structured narrative review summarizes current evidence on perioperative anxiety in adults, focusing on epidemiology, pathophysiological mechanisms, assessment tools, biomarkers, and multimodal management strategies. Full article

Background and Objectives: Perioperative nutrition is a core component of Enhanced Recovery After Surgery (ERAS) pathways. Understanding the patient experience of nutrition recommendations provides insight into the acceptability of perioperative nutrition care and facilitates the achievement of ERAS targets. This systematic review aimed to synthesise patients’ experiences of nutrition within ERAS pathways for colorectal surgery. Methods: A systematic search of Ovid MEDLINE, Embase, Emcare, and CINAHL was conducted to identify studies published up until July 2025. Eligible studies included qualitative, mixed-methods, or descriptive survey designs. Data were extracted and synthesised using an inductive thematic analysis. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Results: Fifteen studies were included (40% qualitative, 33% quantitative, 27% mixed-methods), representing data from 1431 patients. Eleven studies met all quality criteria. Five themes were identified. Information gaps and misconceptions about nutrition (Theme 1) resulted from unclear advice across care settings. Oral intake post-surgery (Theme 2) was limited by nausea, reduced appetite, early satiety, and dissatisfaction with hospital food. Experiences with oral nutritional supplements (Theme 3) were variable, with palatability affecting acceptability. Healthcare professionals (Theme 4) were central in shaping patient confidence in nutrition care. The transition to home (Theme 5) was a vulnerable period where follow-up support was highly valued. Heterogeneous reporting of nutrition in ERAS contexts was a limitation. Conclusions: Patient engagement with ERAS nutrition is shaped by individual and healthcare system factors. Addressing information gaps, providing nutrition support, and integrating patient perspectives through codesigned education and research initiatives may enhance perioperative nutrition experiences and optimise recovery outcomes. Full article