Surgeries, Volume 6, Issue 1 (March 2025) – 25 articles

Background/Objectives: Research is widely recognized as an essential element of medical education across all levels. This study explores the association between publishing before, during, and after general surgery residency, shedding light on research productivity trends in medical education. By examining a diverse cohort of general surgery residents, the research aims to uncover factors influencing research output at various training levels. Methods: This study analyzed graduates’ Curriculum Vitae from a single institution’s general surgery residency program from 2017–2024. Linear regression models assessed whether variables encompassing total research output (manuscripts, abstracts, posters, and podium presentations) could predict graduates’ research outcomes in the next stage of training. Results: Out of the 38 eligible graduates, 20 submitted their Curriculum Vitae and were included in the study, resulting in a response rate of 52.6%. Total research activity before residency was not found to be predictive of total research activity in residency (t(18) = 1.020, p = 0.322) but was found to be related to total research activity in fellowship (t(10) = 5.399, p < 0.005). Total research activity during residency was not found to be related to fellowship research (t(10) = 0.834, p = 0.424). No sequential correlation was found between undergraduate, medical school, residency, or fellowship publications. Additionally, there was no correlation between first authorship and publication total in the subsequent phase of medical education. Conclusions: Research productivity during medical school does not have predictive value for future research during residency but is found to be predictive of future works in fellowship. These findings suggest that the research emphasis should be strategically managed throughout medical education to sustain long-term academic engagement. Full article

Background: Posterior cruciate ligament (PCL) injuries are relatively rare, with limited consensus on the optimal treatment for isolated acute cases. Conservative management and surgical reconstruction each offer potential benefits, but their comparative efficacy remains unclear. Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) framework and PRISMA-ScR guidelines. A systematic search of MEDLINE, Cochrane CENTRAL, Scopus, PEDro, and Web of Science was completed on 23 December 2024. Studies comparing conservative treatment and surgical reconstruction for isolated acute PCL injuries were included. Outcomes such as functional recovery, stability, and long-term complications were extracted and synthesized qualitatively. Results: Six studies were included, comprising case series, prospective, retrospective, and review designs. Conservative treatment demonstrated significant improvements in functional recovery (IKDC scores: 67–90.3/100) but showed limited improvement in stability (STSD reduction: 0–3 mm). Surgical reconstruction yielded superior stability (STSD reduction: 8.2 to 2.7 mm) and lower rates of degenerative changes but was associated with a higher risk of complications. Functional outcomes were comparable between approaches in some studies, although surgical patients showed slightly better long-term stability. Conclusions: Both conservative and surgical treatments achieve satisfactory outcomes for isolated acute PCL injuries. Treatment selection should be tailored to patient-specific factors, considering functional demands and injury severity. Full article

Standardized frameworks for interpreting medical images, such as the radiological Reporting and Data Systems (RADS), are designed to improve the consistency and accuracy of radiological assessments across different imaging modalities, anatomical locations, and disease processes. Clear communication and information sharing between radiologists and referring physicians, including surgeons, is a key goal of the RADS guidelines. Therefore, familiarity with these guidelines is crucial for all physicians involved in patient care. This review synthesizes current RADS guidelines relevant to surgical practice. Our analysis identified 28 radiological RADS with potential applications in surgical workflows, primarily in oncology. Of the RADS examined, nine were validated by the American College of Radiology (ACR), one was validated through a collaboration between the ACR and other scientific societies, and seventeen were developed by other scientific organizations. Numerous surgical specialties may encounter RADS in clinical practice, including neurosurgery, head and neck surgery, cardiovascular surgery, thoracic surgery, endocrine surgery, breast surgery, gastrointestinal surgery, hepatobiliary surgery, gynecological surgery, urological surgery, orthopedic surgery, emergency surgery, and surgical oncology. The effective utilization and validation of RADS necessitates close collaboration between radiologists and surgeons, coupled with widespread education for all healthcare professionals involved in patient care. Artificial intelligence software will play an important role in facilitating the dissemination and use of RADS in clinical practice. Full article

Background: Irreversible pulpitis is a severe inflammation of the dental pulp. The purpose of this clinical trial was to evaluate the effectiveness of an inferior alveolar nerve block (IANB) injection followed by oral dexamethasone administration in reducing the pain associated with symptomatic irreversible pulpitis (SIP) in mandibular molars, without performing conventional pulpotomy. Methods: A sample of 80 subjects suffering from acute pain due to SIP on a mandibular molar were assigned to the dexamethasone group, who received an IANB injection followed by one oral dose of 4 mg of dexamethasone during the emergency visit followed by one dose of 4 mg after 8 h, or the control group, who received a conventional pulpotomy. Both groups received complete endodontic treatment after five to six days. The intensity of the preoperative pain and pain levels were measured in both groups at different times after each intervention. The Mann–Whitney U test was used to compare the pain scores between the groups at the same time point, while Friedman’s test was used to compare the pain scores between the four time points within the same intervention group, followed by the Bonferroni correction for multiple pairwise comparisons. Success was determined when the pain score on the visual analogue scale (VAS) was 20 or lower. Results: A survival analysis was conducted, where the event was considered as the disappearance of symptoms (or success: pain score ≤ 20). For both groups, the pain significantly decreased 8 h postoperatively (p < 0.05). The success rates at 8 and 12 h were significantly higher in the dexamethasone group compared to the control group (p = 0.05). However, the pain scores at 24 h remained comparable. Conclusions: An IANB injection followed by 8 mg of oral dexamethasone could reduce pain significantly in patients with SIP without performing conventional pulpotomy. The oral administration of dexamethasone could therefore be a valuable strategy to temporarily alleviate SIP symptoms until definitive treatment becomes feasible. Dexamethasone is a temporary pain management strategy rather than a replacement for pulpotomy. Full article

Background: The attractiveness of the central area (the so-called mid-face area or middle third) has a strong impact on the observer, and the treatment of aging in this area is therefore considered a key component in facial rejuvenation. A standardized photographic and three-dimensional analysis was conducted in this observational study to determine the outcome of volumetric restoration procedures of the mid-face area with HA injection, providing an objective, repetitive, and reliable evaluation of this facial rejuvenation technique. Methods: In total, 47 patients were treated with two types of HA-based dermal fillers, and calibrated, stereoscopic images of the face were taken with volume reconstruction and analysis software performed before (t0), 45 days after HA implantation (t1), and at the check-up after the end of follow-up (t2). Results: In total, 39 out of 47 patients completed the study, which showed an overall volume restoration of 4.46 ± 1.34 mL at 45 days (t0–t1) after HA implantation, maintaining a value of 1.23 ± 0.68 mL at the end of the 318-day follow-up (t0–t2). Conclusions: The results of this study indicate that rejuvenation of the mid-facial region through volumetric restoration with an HA filler leads to an indirect volumetric effect that is clinically more significant than the actual injected volume and equally long-lasting. Full article

Objective: The aim of this systematic review is to compare the survival rates of zirconia and titanium dental implants, by evaluating the most recent scientific evidence, in order to comprehend the behaviour of zirconia implants as an alternative to titanium, due to the latter’s biological properties. Methods: An electronic search was performed on the Pubmed/MEDLINE and Scopus databases in November 2023 to identify clinical trials that investigated zirconia and titanium implants’ behaviour with a follow-up of at least 5 years. The primary outcome was the implant survival rate—defined as the maintenance of the implant in situ during the period of study. The secondary outcome was the implant success rate, which is associated with the values of the peri-implant variables—the probing depth, marginal bone loss, gingival recession, bleeding on probing, plaque index, and aesthetics scores. Results: A total of 17 articles were selected from the search, resulting in a sample of 364 studies. A total of 15 articles fulfilled the selection criteria. Zirconia implants showed satisfactory results. Due to the lack of data available with follow-up times of more than five years, it is not possible to conclusively describe the benefits of zirconia in comparison with titanium implants. Conclusions: While zirconia implants show promise as a future alternative to metal implants, more research is needed to understand their long-term benefits and peri-implant behaviour. Full article

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition that usually occurs in the elderly. Surgical evacuation of the hematoma with burr holes is considered the standard of care for the treatment of patients with CSDH. However, a high risk of recurrence, up to 34%, after hematoma evacuation has been reported, while the risk factors linked with recurrence have not been studied in depth. In the present study, we set out to identify risk factors of recurrence in patients surgically treated for CSDH. Methods: We retrospectively studied patients with symptomatic CSDH who were treated surgically in our institute during a five-year period. All the patients were treated by single or double burr hole drainage. The data for this study were extracted by the pre-operative and post-operative CT scan of each patient. These data include the sex, the midline shift, the width, and the presence of acute clots and subdural air collection post-operatively. A univariate analysis was performed. A receiver operating characteristic (ROC) analysis was utilized to detect the hematoma’s width more efficiently, differentiating patients that developed recurrence. Results: A total of 222 patients were included in this study. Recurrence occurred in 20 (9.0%) patients. The univariate analysis showed that the presence of acute clots post-operatively are significant factors related with recurrence (OR = 4.01, CI 95% 1.55–10.33, and p = 0.002). There was no significant relationship between the recurrence rate and the hematoma’s width, sex, the midline shifts pre-operatively or post-operatively, the subdural space, and air collection post-operatively. Conclusions: The presence of acute clots in the post-operative CT scan is a potential, previously unexplored, risk factor associated with the recurrence of CSDH. Full article

Background/Objectives: Scalp defect reconstruction often poses a challenge due to the distinct anatomy and limited skin elasticity of the region. Rotational flaps, when properly planned, offer a superior and creative solution for effectively covering most scalp defects. The aim of this study is to present the indications, and versatile use of rotational flaps in scalp reconstructive surgery, guided by an algorithmic approach and exemplified by numerous clinical applications. Methods: An observational cohort study was conducted between 2019 and 2024. The study protocol adhered to the ethical guidelines of the Declaration of Helsinki, was approved by the local ethics committee, and followed the STROBE statement for cohort studies. Results: A total of 152 rotational flaps were performed in 138 patients to reconstruct scalp defects, mostly following skin cancer excision. The defect size ranged from 30 to 96 mm in largest diameter (mean diameter, 52.8 ± 8.8 mm). Postoperative complications occurred in 13 cases (9.4%), and 5 cases (3.6%) required further surgical treatment, due to wound healing problems and/or necrosis. Based on high VAS scores (9.4 + 0.3), the cosmetic outcomes were deemed satisfactory, with excellent color and texture matching. Conclusions: This study underscores the critical role of meticulous surgical planning and technique in achieving optimal outcomes in scalp reconstruction. By combining the principles of tissue biomechanics with the versatility of rotational flaps, surgeons can effectively address a wide range of defects, achieving both functional and esthetic excellence. Full article

Purpose: The objective of this study was to determine the prevalence of exostosis in the Mississippi population. Methods: The patient archives of the UMMC School of Dentistry between January 2018 and May 2021 were examined. Patients with exostosis were included in the study based on the findings from intraoral photographs, full-moth series (FMS), panoramic radiographs, and cone-beam computerized tomography (CBCT) images of the patients. Patients were excluded from the study if they did not have maxillary or mandibular exostosis. In addition, each patient’s age, gender, and ethnic origins, such as Caucasian, African-American, or Asian, were recorded. All data regarding exostosis were evaluated and categorized according to age, gender, and ethnicity. Multiple logistic regression analysis was performed for more detailed statistical analysis. Results: A total of 1242 patients were examined for the presence of maxillary and mandibular tori. In total, 303 patients were diagnosed with maxillary and/or mandibular tori among the Mississippi population, with a prevalence rate of 24.4%. Exostosis was seen more in females (57.4%) compared to males (42.6%). The highest prevalence of exostosis was seen in Caucasians (71.3%), followed by African-Americans (23.8%) and Asians (5%). Conclusions: High prevalence of exostosis was seen in the Mississippi population. Our findings will help clinicians to be more aware of these bony protuberances and, thus, better at diagnosing them. This may specifically help oral surgeons, periodontists, and prosthodontists in pre-prosthodontic surgery and denture fabrication. Full article

Background: Enhanced Recovery After Surgery (ERAS) protocols have become integral in improving postoperative outcomes in cesarean deliveries. Variations in protocol adherence and implementation practices can significantly impact maternal and neonatal health across different healthcare systems. Objective: To evaluate the implementation of ERAS protocols in cesarean deliveries across two countries—Croatia and Turkey—and highlight differences in the level of adherence to ERAS recommendations. Design: A comparative clinical review was conducted. The study employed qualitative assessments carried out by medical professionals at two hospitals: one in central Anatolia, Turkey, and the Clinical Hospital “Sveti Duh” in Zagreb, Croatia. Methods: Twenty perioperative ERAS recommendations were evaluated based on implementation levels, rated using a five-point Likert scale (from very low to very high implementation). Qualitative insights were also collected to understand challenges and adaptations in the implementation process. Results: In Croatia, 13 recommendations were implemented at a very high level, compared to 8 in Turkey. Conclusions: Croatia demonstrates higher and more consistent adherence to ERAS protocols compared to Turkey, which faces greater challenges in consistent implementation, particularly in preoperative and postoperative care. Full article

With FDA-approved devices, left atrial appendage (LAA) occlusion has emerged as a well-established and rapidly growing approach to stroke prevention in patients with non-valvular atrial fibrillation. These devices are indicated for use in patients who are at increased risk of stroke and systemic embolism, as determined by CHA₂DS₂-VASc scores, and are suitable for anticoagulation therapy, with an appropriate rationale for seeking a non-pharmacologic alternative. This includes patients who may be unsuitable for long-term anticoagulation due to contra-indications. These devices, generally consisting of a nitinol-framed structure with a circular cross-section, are positioned within the LAA to obstruct the ostium, effectively preventing the thrombus from embolizing the brain. The initial clinical data from pivotal trials and observational registries indicated no strong correlation between peri-device leaks (PDLs) and adverse events. However, recent studies have shown that PDLs are associated with a higher risk of thrombo-embolic events, leading to renewed interest in managing PDLs. This paper reviews the occurrence of PDLs after percutaneous LAA occlusion using current FDA-approved devices, highlighting the need for non-circular occluders to better-accommodate the inherent variability in LAA anatomy. It also compares the benefits and limitations of emerging approaches still under investigation, focusing on addressing PDLs. Full article

Background: Pigmented villonodular synovitis (PVNS) is a rare, proliferative disorder of the synovium that predominantly affects the knee. Traditional treatment involves surgical resection; however, the high recurrence rates have prompted the exploration of alternative, minimally invasive treatments. This case report presents the novel use of genicular artery embolization (GAE) with imipenem/cilastatin as a therapeutic intervention. Case presentation: We present a case of a 52-year-old male with a 5-month history of progressive left-knee pain and swelling. Magnetic resonance imaging (MRI) suggested PVNS, which was confirmed through synovial biopsy. Because of concerns about surgical recovery and recurrence risk, the patient opted for GAE with imipenem/cilastatin over traditional synovectomy. This technique, employing the antibiotic’s anti-angiogenic and anti-inflammatory properties, was administered under local anesthesia without complications. Results: Post-procedural assessments demonstrated rapid and sustained symptom relief. At the 1-month follow-up, the patient’s Visual Analog Scale (VAS) pain score decreased from 7/10 to 3/10, and their Knee Injury and Osteoarthritis Outcome Score (KOOS) and SF-36 health survey scores indicated significant functional improvement. By the 6-month follow-up, the VAS had reached 0/10; the KOOS value reflected near-complete functional recovery; and MRI confirmed reduced synovial hypertrophy and absence of recurrence. No complications were observed. Discussion: GAE with imipenem/cilastatin shows potential as an effective alternative to surgery for PVNS, particularly in patients at risk of surgical complications or recurrence. While the preliminary findings are promising, the limitations include the case’s single-subject design and the need for extended follow-up to determine long-term outcomes and recurrence rates. Further studies comparing GAE with traditional surgical approaches are needed to assess its broader applicability in PVNS management. Conclusion: GAE with imipenem/cilastatin offers a promising, minimally invasive approach for PVNS, providing significant symptom relief and functional recovery with minimal complications. Although long-term studies are needed, this technique could serve as a viable alternative for patients with PVNS, especially those contraindicated for surgery. Full article

Background/Objectives: Pedicled anterolateral thigh (ALT) flaps have proven their versatility through various applications including in different tissue compositions in locoregional reconstructions. However, they are underutilized compared to their free counterparts. Our aim is to systematically review the studies published on the utilization of pedicled ALT flaps in various anatomical regions. Methods: A search was conducted using the PubMed and Embase databases including the terms: (“pedicled” OR “island”) AND (“ALT” OR “anterolateral thigh flap” OR “lateral circumflex femoral” OR “vastus lateralis” OR “rectus femoris”). Outcomes regarding etiology, location, number and composition of flaps, flap and defect size, tunnel of the pedicle, flap viability and complications were collected. Results: A total number of 133 studies met the inclusion criteria, of which the majority were case series. After excluding the case reports (n = 49), studies included in the review were grouped based on anatomical locations such as abdominal (n = 12), groin (n = 12), perineal–vaginal–vulvar (n = 11), penile (n = 15), trochanteric–ischial–sacrogluteal (n = 8) and multiple (n = 19). Among a total of 1227 flaps, there were 46 partial (3.7%) and 16 total losses (1.3%). Conclusions: The pedicled ALT flap has been gaining popularity in the past decade. The overall flap loss rate is relatively low. However, the level of therapeutic evidence of published studies is not high, and there is a large heterogeneity among methods. There is a need in the literature for comparative studies with larger cohorts. Further studies will help to establish guidelines and possible algorithms that could include pedicled ALT flaps as first-line management options in different anatomical locations. Full article

Background: Proximal phalanx fractures of the hand are common and can significantly impact hand function. Conservative treatments, including splinting and dynamic mobilization, are often used, but their efficacy compared to surgical interventions needs thorough evaluation. Methods: A scoping review was conducted by analyzing studies focused on conservative treatments for proximal phalanx fractures in adults. Inclusion criteria encompassed studies with adult populations, conservative management methods, and clearly reported outcomes. Data from eight selected studies were synthesized to evaluate treatment efficacy, patient outcomes, and complication rates. Results: The review found that conservative treatments, including splinting, buddy taping, and dynamic mobilization, were highly effective for stable, extra-articular proximal phalanx fractures. These methods promoted early functional recovery and had high patient satisfaction rates. Studies comparing conservative and surgical treatments indicated excellent outcomes for both, with fewer complications observed in the surgical groups for unstable fractures. Dynamic and traction splints facilitated significant improvements in total active motion (TAM) and grip strength. Younger patients with transverse fractures showed better outcomes with conservative treatments. Conclusions: Conservative management strategies are effective for stable proximal phalanx fractures, promoting satisfactory functional recovery and minimizing complications. Surgical intervention is recommended for unstable or complex fractures to achieve better functional outcomes. Standardized treatment protocols and long-term follow-up are essential to validate these findings and optimize patient care. Further research with larger sample sizes and standardized outcome measures is needed to establish clear guidelines for the conservative management of proximal phalanx fractures in adults. Full article

Background/Objectives: The porcine mammary anatomy is poorly characterized, and structures are difficult to differentiate macroscopically, unlike human mammary tissue. The objective of this exploratory study was to describe the Yucatan porcine breast tissue morphology and identify the basic differences and similarities to human breast tissue. Methods: Samples from an adult, non-parous female Yucatan pig were prepared utilizing various methods: freezing at −80 °F (−26.67 °C) with a thickness of 0.5 cm/post-fixation in formalin; freezing at −20 °F (−6.67 °C) with a thickness of 0.5 cm/post-fixation in formalin; or formalin fixed and incised at ~0.8 cm. A descriptive comparison of the gross and microscopic images of the porcine breast morphology to the previously described human breast anatomy was performed. Results: As examined grossly, frozen sections allowed narrower serial cross-sectioning and better visualization of the structures and relationships. The mammary glands were poorly demarcated with extensive interspersed adipose tissue throughout the periphery. The mammary tissue appeared grossly as pigmented tissue and extended within ~0.5 cm from the skin surface, ~2.0 cm deep (within ~0.5 cm of the deep muscle layer), and ~6.5 cm laterally (centered on a teat). There were a number of similarities between Yucatan porcine and human breast tissue, yet there were several inherent structural differences. In contrast to human mammary tissue, porcine mammary glands consist of more diffuse acinar tissue, less well demarcated by defined fascial, lamellar, and ligamentous structures. Conclusions: The Yucatan porcine mammary morphology and similarities to the human mammary region allow for the use of this animal model to guide those developing relevant technologies or performing local surgical interventions in the preclinical setting. Full article

Background/Objectives: Oroantral fistulas (OF) are a challenging complication in oral and maxillofacial surgery, often requiring surgical intervention to restore sinus integrity. The Bichat’s buccal fat pad (BFP) has gained attention as a viable option for OF closure. This study aimed to evaluate the efficacy, safety, and clinical outcomes of BFP advancement for OF treatment. Methods: This prospective study included 20 patients diagnosed with OF. The surgical procedure involved isolation and advancement of the BFP to close the defect. Patients were followed up at 7 days, 45 days, and 6 months postoperatively, with clinical and radiographic assessments. The primary outcome was successful fistula closure at 6 months, while secondary outcomes included complication rates, sinus opacification on CT scans, pain levels, and quality of life improvements. Results: The overall success rate was 85.7%, with complete fistula closure achieved in 18 out of 21 cases (including one bilateral case). Minor complications occurred in 14.3% of cases. CT scans at 6 months showed complete resolution of sinus opacification in 81% of cases. Patients reported significant improvements in pain scores and quality of life. Conclusions: BFP advancement is an effective, safe, and minimally invasive technique for OF closure, offering high success rates and favorable clinical and radiographic outcomes. These findings support the use of BFP as a reliable option for managing OF in oral and maxillofacial surgery. Full article

Regional anesthesia has gained increasing attention in pediatric surgery as a valuable tool for managing perioperative pain and improving surgical outcomes. This narrative review highlights the numerous advantages of regional anesthesia in pediatric populations, including superior pain control, reduced reliance on systemic opioids, fewer anesthetic-related complications, and enhanced recovery profiles. Using ultrasound-guided techniques has further expanded the safety and precision of regional blocks in children. Regional anesthesia also addresses critical concerns about the potential neurotoxicity of general anesthetics in developing brains, offering a safer alternative or complement for specific procedures. Reducing systemic anesthetic and opioid exposure minimizes the risk of adverse effects such as respiratory depression, nausea, and sedation, which are particularly significant in medically fragile or younger patients. Furthermore, regional techniques contribute to faster recovery times, better preservation of neurophysiological monitoring signals during surgery, and attenuation of the stress response. The integration of adjuvants like clonidine, dexmedetomidine, and dexamethasone further enhances the efficacy and duration of regional blocks while improving safety profiles. Despite these benefits, implementing regional anesthesia in pediatric populations requires specialized expertise and an understanding of children’s unique anatomical and physiological differences. This review underscores the growing role of regional anesthesia in modern pediatric perioperative care. It highlights its potential to optimize outcomes, reduce complications, and address emerging concerns about the safety of general anesthesia in children undergoing surgery. Full article

Background: Lung cancer surgery often involves complex decision-making, where accurate and interpretable predictive models are crucial for assessing postoperative risks and optimizing outcomes. This study presents XplainLungSHAP, a novel framework combining SHAP (SHapley Additive exPlanations) and attention mechanisms to enhance both predictive accuracy and transparency. The aim is to support clinicians in preoperative evaluations by identifying and prioritizing key clinical features. Methods: The framework was developed using data from 470 patients undergoing lung cancer surgery. Key clinical features were identified through SHAP, ensuring alignment with medical expertise. These features were dynamically weighted using an attention mechanism in a neural network, enhancing their impact on survival predictions. The model’s performance was evaluated through accuracy, confusion matrices, and ROC analysis, demonstrating its reliability and interpretability. Results: The XplainLungSHAP model achieved an accuracy of 91.49%, outperforming traditional machine learning models. SHAP analysis identified critical predictors, including pulmonary function, comorbidities, and age, while the attention mechanism prioritized these features dynamically. The combined approach ensured high accuracy and offered actionable insights into survival predictions. Conclusions: XplainLungSHAP addresses the limitations of black-box models by integrating explainability with state-of-the-art predictive techniques. This framework provides a transparent and clinically relevant tool for guiding surgical decisions, supporting personalized care, and advancing AI applications in thoracic oncology. Full article

Background/Objectives: Among the scientific literature, the significant potential of the application of artificial intelligence (AI) in minimally invasive surgery (MIS) stands out. The aim of this study is to provide a comprehensive review to analyze the scientific literature on AI applications in MIS training, selecting the main applications, limitations, opportunities and challenges in this field of research. Methods/Design: A literature search was conducted in scientific databases. The search was performed with titles or abstracts, using keywords. First, studies unrelated to the topic of study were eliminated. Next, the selection was limited to articles in English. The exclusion criteria for the search were reviews, letters, case reports, industrial articles and conference abstracts. Next, only studies published in the last ten years (2014–2024) were evaluated, with priority given to publications in the last five years (2019–2024) in surgical training in AI and MIS. Finally, the full text was reviewed to add or exclude the study from this review. Results: Of the 54 studies included in this review, 18 studies were related to skills assessment, 30 studies analyzed aspects of surgical training itself, 12 studies were related to learning aspects of surgical planning, 7 studies were based on gesture recognition and 3 studies were based on surgical action recognition to measure surgical performance during MIS training. A brief description of the main AI techniques was included in this review. Conclusions: The application of AI in MIS surgical training is still a developing field of research, which presents great potential for exploring future applications, challenges, opportunities and drawbacks, as well as synergies between the technical and clinical research fields. Full article

It was in 1989 that we first reported on the use of the radial artery (RA) as a secondary arterial graft for coronary artery bypass grafting (CABG). Nevertheless, discrepancies in clinical endpoints between the RA and alternative conduits have been reported in consecutive randomised trials. With over fifty years of accumulated practice in RA bypass grafting, we sought to identify the second-best option for CABG by reviewing the literature. A consistently successful second-best conduit for CABG has been demonstrated using the radial artery. Compared to saphenous vein grafts, the findings indicate improved outcomes and better patency results. Furthermore, it has been demonstrated to be a safe and effective conduit in the territory of the right coronary artery. The lack of available literature and the scarcity of similar case series restrict the application of the gastroepiploic artery. After five decades of utilisation, it can be unequivocally stated that the radial artery is the optimal conduit for coronary bypass surgery following the left internal thoracic artery to the left anterior descending artery. Full article

Background/Objectives: Pressure injuries (PIs) are injuries to the skin and underlying tissue localized over a bony prominence. Surgical complications following the closure of a PI include ulcer recurrence, wound dehiscence, hematomas, and infection, which pose significant morbidity issues to patients. The objective of this study is to characterize the relationship between BMI and early and late wound outcomes following surgical closure through a secondary analysis of a previous study examining the effect of two support surfaces on PI healing. Methods: A single institution study on patients with a stage 3/4 pressure injury admitted for surgical closure was conducted. The subjects were monitored for 14 days post-closure (POD-14) so that an assessment of their early wound status and complications, including moisture, maceration, drainage, dehiscence, epidermolysis, necrosis, and demarcation, could be conducted. Results: In total, 68 patients were included. Out of these, 13% of patients were underweight, 29% were normal-weight, 35% were overweight, and 22% were obese. POD-14 complications occurred in 22% of underweight patients, 15% of normal-weight patients, 38% of overweight patients, and 40% of obese patients. Of all recorded complications, 75% of patients were overweight or obese. Complication rates were not significantly different based on osteomyelitis status. The most common cultures identified in wounds were P. aeruginosa, S. aureus, and E. coli. Negative cultures were found in 22% of closed wounds and 13% of open wounds. Conclusions: Our findings suggest that BMIs may be correlated with early wound status and the incidence of postoperative complications, while it may not be correlated with osteomyelitis status. Future studies should further evaluate the effect of BMIs on pressure injury-associated complications. This may further guide preoperative planning and patient expectations. Full article

Aortic stenosis (AS) is the most common valve disease in developed countries, with severe cases traditionally managed through surgical aortic valve replacement (SAVR). More recently, transcatheter aortic valve replacement (TAVR) has been used as a less invasive alternative, especially for patients deemed high-risk for surgery. This review aims to compare SAVR and TAVR by examining the efficacy, patient selection criteria, complications, and evolving guidelines. SAVR is the preferred option for patients at low surgical risk or with anatomical challenges unsuitable for TAVR. It offers well-documented durability and favorable long-term survival. Conversely, TAVR has gained acceptance for intermediate- and high-risk patients, with shorter recovery times and reduced immediate postoperative risks. However, questions surrounding its long-term durability in younger populations persist. Complications differ between the approaches, with TAVR associated with vascular access injuries and arrhythmic events, while SAVR presents risks tied to open surgery. As clinical guidelines evolve, patient age, comorbidities, and life expectancy play critical roles in determining the optimal intervention. This review highlights the need for tailored treatment approaches, given the expanding indications and evolving evidence for both SAVR and TAVR in AS management. Full article

Background: This study evaluated the performance of machine learning models trained on two different datasets of knee X-ray images annotated with Kellgren–Lawrence grades. Methods: Learning curves indicated that one model experienced poor training, characterized by underfitting, while the other model demonstrated effective training with proper convergence. The poorly trained model appeared to perform adequately on its internal test set but failed to generalize to an external dataset, yielding suboptimal results. Results: In contrast, the well-trained model not only performed well on its internal validation but also showed adequate performance when tested on the external dataset. Conclusions: These findings highlight the importance of examining learning curves to assess model training quality and the critical necessity of external testing to evaluate generalizability. Most existing studies lack external validation, raising concerns about the reliability of their reported performance. This study emphasizes that without external testing, models may not perform as expected in real-world clinical settings, potentially impacting clinical decision-making for surgical interventions. The results advocate for the inclusion of external validation in model evaluation and the assessment of model convergence using learning curves to ensure the development of robust and generalizable tools for knee osteoarthritis severity assessment and other applications. Full article

Background: Diversity of gender representation in surgery is known to positively influence patient outcomes and predict career trajectories for female trainees. This study aims to identify the current and recent past state of gender diversity amongst trainees entering Canadian surgical residency programs. Methods: Data were sourced from the Canadian Post-M.D. Education Registry (CAPER) and the Canadian Resident Matching Service (CaRMs) for ten surgical specialties. CAPER data include PGY-1 trainees in all surgical specialties for the academic years 2012–2013 to 2021–2022. CaRMs provided data of total applicants and matched applicants for Canadian Medical Graduates (CMGs) in the match years 2013–2022. Results: From 2012–2022, there were 4011 PGY-1 surgical residents across Canada (50.4% female, 49.6% male). The surgical specialties with the most female representation were obstetrics/gynecology (82.1–91.9%), general surgery (40.2–70.7%), and plastic surgery (33.3–55.6%). The surgical specialties with the least female representation were neurosurgery (18.7–35.3%), urology (11.8–42%), and orthopedic surgery (17.5–38.5%). The number of female applicants to surgical programs has increased since 2013 and outnumbers male applicants each subsequent year. The match rate to surgical programs for female applicants has varied by year, with the highest being 63.9% in 2014 and the lowest in 2018 at 48.8%. Conclusions: Our study shows promising trends that reflect increased representation of female trainees. However, while the number of female trainees in general surgery and obstetrics/gynecology programs matches and even exceeds Canadian demographic proportions, this is not true for most other surgical specialties. This calls for continued efforts to improve and retain gender equity across surgical specialties in Canada. Full article

Background/Objectives: Myocardial revascularization surgery (MR) is routinely performed in hospitals. However, there is a lack of an algorithm in the scientific literature aimed at predicting intraoperative parameters, such as total surgery time (TST) and cardiopulmonary bypass time (CBT), based on preoperative MR parameters. Therefore, the objective of the present study is to apply a complex network model to predict parameters associated with TST and CBT. Methods: Retrospective data from 124 patients who underwent MR, including medical history, vital signs, and laboratory/biochemical tests, were used, with 30 patients contributing to the construction of the network. Three complex networks were created to study the targets (TST and CBT). The Eigenvector metric was employed to investigate the parameters most relevant to these targets. Results: Regardless of the target, parameters derived from the blood gas analysis followed by erythrogram displayed greater relevance according to the eigenvector metric. However, for TST, the most prominent parameter was Red Blood Cells, while, for CBT, Diastolic Blood Pressure emerged as the most important variable. Conclusion: The targeted complex network model revealed that pulmonary, hemodynamic, and perfusion factors are relevant to the intraoperative parameters of MR. The networks also demonstrated that, although the targets show significant correlation with each other (TST and CBT-r = 0.76; p = 0.000), the importance of the parameters in the networks does not follow the same order. This reiterates the strength of the network in revealing specific information when a particular target is selected. Full article