Search Results (31)

Background and Objectives: The optimal timing for surgical intervention in acute aortic valve infective endocarditis (IE) remains debated. Although European guidelines distinguish emergency, urgent, and delayed indications, some centres postpone surgery, concerned that operating before sufficient antibiotic sterilization could increase IE relapse risk. Materials and Methods: This retrospective, observational, multicenter study included patients with acute aortic valve IE. Patients who were not operated, had non-aortic valve IE, or underwent emergency surgery were excluded. Surgery within 7 days of starting targeted antibiotics was classified as “early”; surgery between 7 and 30 days as “late.” Primary outcomes were in-hospital mortality and 30-day permanent pacemaker implantation. Secondary endpoints included reinfection, reoperation for IE relapse, and mid-term survival. Results: A total of 203 patients included: 104 early and 99 late. In-hospital mortality was comparable (early: 16 patients, 15.4%; late: 16 patients, 16.2%; p = 0.90). Permanent pacemaker implantation was higher in the late group (early: 9 patients, 8.7%; late: 18 patients, 18.2%; p = 0.046). Mid-term survival at four years was similar (early: 67.1 ± 5.8%; late: 59.7 ± 8.1%; p = 0.71). Recurrence of IE (early: 5.7%; late: 4.8%; p > 0.9) and reoperation for recurrent IE (early: 5.7%; late: 4.8%; p > 0.9) did not differ. Conclusions: Delaying surgery for acute aortic valve IE does not improve procedural safety, as in-hospital mortality is similar. Early intervention does not increase reinfection or reoperation risk, and may reduce permanent pacemaker implantation, likely by preventing progressive fibrosis of the cardiac conduction system caused by infection and prolonged antibiotic exposure. Full article

Background: Operating rooms generate substantial visual data that is rarely captured systematically. Image-based AI (IBAI) systems using computer vision offer a new approach to real-time perioperative workflow monitoring, but evidence of their impact on surgical case volume remains limited. The aim of this study was to evaluate the association between deployment of an IBAI system and monthly surgical case volume in a high-acuity cardiothoracic operating suite, using synthetic control with difference-in-differences estimation. Methods: We deployed an IBAI system with wall-mounted cameras and a YOLO-based (You Only Look Once) object detection model coupled with a transformer-based event detector in a 15-room cardiothoracic suite at Houston Methodist Hospital (HMH), the tertiary academic hospital of Houston Methodist health system. The deployment was conducted under an IRB-determined quality improvement framework with patient consent for ambient video capture, defined retention limits, and restricted access to recordings. Over a 16-month period spanning 6 months pre-deployment and 10 months post-deployment, the system monitored 5417 surgical cases and automatically detected additional perioperative events including patient entry, draping, and room turnover. Using a synthetic control methodology, we compared post-deployment outcomes at the intervention site against a weighted combination drawn from a pool of 11 Houston Methodist sites that did not yet implement IBAI (116,098 cases across the comparison sites; 121,515 cases in the full analytic dataset). Results: The synthetic control analysis with difference-in-differences estimation showed a statistically significant increase of approximately 25 cases per month (95% CI 8.3 to 41.0; p < 0.01; Bonferroni-adjusted p < 0.05), corresponding to a 7% increase in monthly case volume relative to baseline. Conclusions: Our findings suggest that IBAI can meaningfully improve OR efficiency and support data-driven perioperative management. Future work should evaluate whether case volume gains generalize across other surgical specialties, assess changes in operational outcomes such as turnover time and first-case on-time starts, and examine clinicians’ perceptions of IBAI. Full article

Background: There is a positive relationship between mitochondrial damage in the cell and uptake in technetium Tc 99m monomer methoxy isobutyl isonitrile (^99mTc-MIBI) scintigraphy. Severe mitochondrial dysfunction with cell death occurs in patients with diabetic foot ulcers (DFUs). To decide on the level of amputation, ^99mTc-MIBI scintigraphy should be considered. Methods: Prospectively, 24 patients with DFUs were included in the study. Based on treatment that started with the hospitalization, patients were divided into two groups: those whose DFUs healed and did not need surgical intervention (healed group) and those whose DFUs did not regress despite surgical and medical treatment and who required further surgical intervention (reoperation group). Before surgery, ^99mTc-MIBI scintigraphy was performed. The ^99mTc-MIBI uptake rates of the injured foot relative to the healthy foot were recorded. Deep-tissue culture was taken at surgery. Erythrocyte sedimentation rate, white blood cell count, and C-reactive protein (CRP) and albumin levels were measured. Results: The ^99mTc-MIBI uptake rates of patients with poor prognosis were higher at all times than those of patients who did not require revision surgery. A significant difference was found between these values in the 10 and 30 s rates. The mean ± SD CRP level was 86.04 ± 21.87 mg/dL in the healed group and 144.43 ± 27.54 mg/dL in the reoperation group (p = 0.040). There was a positive correlation between ulcerated foot and healthy foot ^99mTc-MIBI involvement rates at 10 and 30 s and CRP values, and a negative correlation between albumin values. Conclusions: There was a significant relationship between ^99mTc-MIBI involvement rates and poor prognosis and reamputation. The correlation between CRP and albumin levels, which are among the predictive values, and ^99mTc-MIBI uptake confirmed this relationship in DFUs, which are difficult to manage and treat. Full article

Background: Primary thyroid lymphoma (PTL) is a rare malignancy, accounting for less than 5% of thyroid cancers and less than 2% of extranodal lymphomas. It predominantly affects older women and is strongly associated with autoimmune thyroiditis, particularly Hashimoto’s thyroiditis. Diagnosis is often challenging due to non-specific clinical, imaging, and cytological findings, and the role of surgery has progressively shifted from therapeutic to primarily diagnostic. Methods: We conducted a retrospective single-center case series including nine patients treated for PTL between 2015 and 2025 at a tertiary referral endocrine surgery center. An analysis was conducted on clinical presentation, pre-existing thyroid disease, diagnostic work-up, histopathological subtypes, treatment strategies and outcomes. All patients underwent preoperative ultrasound and fine-needle aspiration cytology (FNAC); surgical intervention was performed to confirm cytology results, when cytology was inconclusive or when compressive symptoms were present. Results: The cohort included six females and three males, with a median age of 65.2 years. Four patients had Hashimoto’s thyroiditis and three had multinodular goiter. FNAC was diagnostic or suggestive of lymphoma in three cases only, and surgical biopsy or thyroidectomy for a definitive diagnosis was performed in eight cases. One case started follow-up after cytology and flow cytometry. Histological subtypes were heterogeneous, including diffuse large B-cell lymphoma, Burkitt’s lymphoma, Hodgkin lymphoma, follicular lymphoma, high-grade B-cell lymphoma, and MALT lymphoma. Seven patients received combined chemoimmunotherapy. A complete response was obtained in eight patients, with a minimum follow-up of three years; one patient died of unrelated causes. Conclusions: PTL remains a rare and diagnostically challenging thyroid malignancy. FNAC alone is frequently insufficient, and surgical biopsy retains an important role in cases with high clinical suspicion or compressive symptoms. While surgery has limited therapeutic value, a multidisciplinary approach and timely, tailored treatment are crucial to achieving favorable outcomes. Full article

Background: Cerebral palsy (CP) is the leading cause of permanent physical disability in children. Although hip surveillance is a global standard, spinal surveillance remains inconsistent, often leading to reactive rather than proactive management of neuromuscular scoliosis. This study aims to establish an international consensus on a risk-based spinal surveillance protocol. Methods: A three-round modified Delphi process was conducted in 2024 with 15 international pediatric spine surgeons, identified through purposive sampling. The process adhered to CREDES standards and focused on establishing standards for timing, frequency, and radiographic surveillance. Consensus thresholds were defined a priori as excellent (≥80%) and good (≥73%) agreement. Results: The panel reached excellent consensus (93%) on a “Traffic Light” system based on the Gross Motor Function Classification System (GMFCS) levels. Green Group (Walkers, GMFCS I–II): Clinical surveillance. Amber Group (Poor Walkers, GMFCS III, and asymmetric hemiplegic GMFCS I–II): Annual radiographs starting at ages 3–8. Red Group (Non-Walkers, GMFCS IV–V): Six-monthly radiographs starting at ages 3–5. There was 100% consensus on the mandatory use of sitting radiographs for non-ambulatory patients to prevent masking true pelvic decompensation. Critical referral triggers were identified as a Cobb angle >20°, pelvic obliquity ≥5°, or a progression rate ≥1° per month. Conclusions: The “Traffic Light” protocol helps identify the “window of opportunity” for intervention before reaching the 90° “point of no return,” where surgical risks increase nonlinearly. This proactive approach aims to reduce surgical complications and systemic delays in specialized care. Full article

Background/Objectives: Perioperative malnutrition, sarcopenia, and reduced functional reserve are frequent in adults undergoing elective gastrointestinal (GI) surgery and are associated with higher postoperative morbidity and delayed recovery. Enhanced Recovery After Surgery (ERAS) pathways incorporate nutrition-focused elements, but reported effects vary across procedures, protocols, and baseline risk. This review aims to summarize and critically appraise current evidence on perioperative nutritional strategies within ERAS-focused elective GI care, including risk identification, nutritional prehabilitation (oral nutritional supplements and immunonutrition), preoperative carbohydrate loading, early postoperative feeding, and selected microbiome-directed adjuncts. Methods: This narrative literature review was informed by a focused search of PubMed/MEDLINE and Scopus (2010–early 2026), supplemented by targeted screening of relevant clinical practice guidelines and consensus statements (e.g., ESPEN). Evidence was interpreted by hierarchy (guidelines/meta-analyses, randomized trials, observational studies) and discussed with attention to heterogeneity in surgical populations, intervention definitions (composition, timing, duration), and endpoint reporting. Results: Early nutritional risk screening is consistently supported to identify malnutrition and sarcopenia and to trigger tailored optimization plans. Perioperative oral nutritional supplementation, particularly when started preoperatively and continued postoperatively, is frequently associated with improved intake and reduced infectious morbidity in malnourished or at-risk patients, though effect sizes vary. Immunonutrition shows potential benefit in selected high-risk settings but remains formulation- and timing-dependent. Carbohydrate loading is generally endorsed within ERAS and may reduce insulin resistance and improve patient comfort, while impacts on major clinical outcomes are context-dependent. Early oral/enteral feeding is feasible in many elective GI procedures and may accelerate gastrointestinal recovery without increasing major complications when implemented with structured advancement and appropriate patient selection. Probiotics/synbiotics show the most consistent signals in colorectal surgery, with strain-specific effects and important safety boundaries in immunocompromised or critically ill patients. Conclusions: Perioperative nutritional optimization is a core component of elective GI surgical care within ERAS pathways. Benefits are most reproducible in higher-risk patients and when interventions are integrated into high-compliance multidisciplinary programs. Future research should prioritize procedure-specific, risk-stratified trials with standardized interventions and clinically meaningful endpoints. Full article

Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder characterized by motor and phonic tics, often including attention deficit, hyperactivity, and obsessive–compulsive behaviours. The pathophysiology involves the dysfunction of cortico-striato-thalamo-cortical circuits, primarily implicating dopaminergic hyperactivity, but also involving multiple different neurotransmitter systems. Treatment of GTS is complex, highly individualized, and influenced by considerable variability in symptom presentation. Behavioural approaches, such as Habit Reversal Therapy (HRT), play a key role, especially in milder cases. Pharmacological therapy is largely empirical and varies across countries, influenced by drug availability and the perceived risks of certain classes of drugs, particularly dopamine receptor blocking agents. Drug options for managing tics include dopamine receptor antagonists, monoamine depleting agents, and alpha-2 agonists, all of which require close monitoring for metabolic, cardiovascular, and neurological side effects. Botulinum toxin injections represent an effective solution for focal tics that are resistant to systemic treatments. Cannabinoids and antiepileptics have limited efficacy, yet they may still offer relevant therapeutic potential in selected cases. Serotonergic drugs are useful for treating obsessive–compulsive symptoms. For patients with refractory tics, deep brain stimulation (DBS) represents an intervention of last-resort; however, DBS remains off-label and consensus on optimal targets is lacking. This narrative review draws on both the relevant literature and extensive personal clinical experience to explore the complexities of managing GTS, with a focus on evidence-based treatments for tics and associated neuropsychiatric symptoms. A therapeutic algorithm is proposed, emphasizing a “start low, go slow” approach, combining pharmacological interventions with cognitive behavioural and surgical therapies, when needed. We underscore the importance of tailoring treatments to individual patient profiles and symptom variability over time, highlighting the need for further research in GTS management. Full article

Background/Objectives: Crohn’s disease (CD) is one of the most frequent causes of short bowel syndrome (SBS), a severe clinical condition with huge morbidity and social costs. SBS occurs when, following intestinal resections, the remaining small bowel in continuity is less than 200 cm in length. Intestinal failure (IF) can complicate SBS when intravenous nutritional or electrolyte supplementation is required to maintain dietary needs. The primary aim of this study was to identify clinical predictive factors of SBS in a cohort of outpatients with CD. Methods: We conducted a prospective, single-center, cohort study enrolling consecutive CD outpatients at a tertiary-level inflammatory bowel disease center. Detailed demographic and clinical features were collected. Significant factors associated with the onset of SBS in the univariate analysis were input into a multivariate logistic regression model to identify independent predictors of SBS. Results: In total, 232 CD patients (52.6% male, median age 49 years [IQR 37–60]) were included: 24.6% of them were smokers; extraintestinal manifestations (EIMs) were present in 21.6% of patients; and 67.7% of patients had at least one intestinal resection (27% of them with more than one surgical intervention). At enrollment, 96.1% of patients were on advanced therapies, and considering the course of the disease, 24.6% of patients were exposed to ≥3 different advanced therapies. A total of 18 patients had SBS and 9 had IF. In univariate analysis, the following variables were statistically associated with the risk of developing SBS: disease duration (p < 0.001), upper gastrointestinal disease localization (L4) (p < 0.001), penetrating behavior (p = 0.023), perianal disease (p = 0.036), length of first intestinal resection (p < 0.001), shorter time elapsing from CD diagnosis to start the first advanced therapy (p < 0.001), and treatment with advanced therapy after first intestinal resection (p < 0.001). In multivariate analysis, disease duration (OR 1.083, 95% C.I. 1.025–1.145, p = 0.005) and L4 (OR 20.079, 95% C.I. 2.473–163.06, p = 0.005) were independently associated with the development of SBS. Conversely, the number of different advanced therapies before the onset of SBS was independently associated with a reduced risk of developing SBS (OR 0.247, 95% C.I. 0.107–0.58, p = 0.001). Conclusions: Our data identifies several clinical features that could possibly predict the development of SBS in CD. Further studies with a larger sample size are needed to confirm our findings. Full article

Background: Advanced sensor insoles and motion capture technology can significantly enhance the monitoring of rehabilitation progress for patients with distal tibial fractures. This study leverages the potential of these innovative tools to provide a more comprehensive assessment of a patient’s gait and weight-bearing capacity following surgical intervention, thereby offering the possibility of improved patient outcomes. Methods: A patient who underwent distal medial tibial plating surgery in August 2023 and subsequently required revision surgery due to implant failure, involving plate removal and the insertion of an intramedullary nail in December 2023, was meticulously monitored over a 12-week period. Initial assessments in November 2023 revealed pain upon full weight-bearing without crutches. Following the revision, precise weekly measurements were taken, starting two days after surgery, which instilled confidence in accurately tracking the patient’s progress from initial crutch-assisted walking to full recovery. The monitoring tools included insoles, hand pads for force absorption of the crutches, and a motion capture system. The patient was accompanied throughout all steps of his daily life. Objectives: The study aimed to evaluate the hypothesis that the approximation and formation of a healthy gait curve are decisive tools for monitoring healing. Specifically, it investigated whether cadence, imbalance factors, and ground reaction forces could be significant indicators of healing status and potential disorders. Results: The gait parameters, cadence, factor of imbalance ground reaction forces, and the temporal progression of kinematic parameters significantly correlate with the patient’s recovery trajectory. These metrics enable the early identification of deviations from expected healing patterns, facilitating timely interventions and underscoring the transformative potential of these technologies in patient care. Conclusions: Integrating sensor insoles and motion capture technology offers a promising approach for monitoring the recovery process in patients with distal tibial fractures. This method provides valuable insights into the patient’s healing status, potentially predicting and addressing healing disorders more effectively. Future studies are recommended to validate these findings in a larger cohort and explore the potential integration of these technologies into clinical practice. Full article

Background: Non-small cell lung cancer (NSCLC) accounts for a significant number of new lung cancer diagnoses each year, which, if identified early, may be surgically removed with curative intent. It is also the most common indication for a sublobar resection due to its equal efficacy in carefully selected patients. From the time of diagnosis to surgery, however, traditionally, there are three separate anesthesia-dependent events: (1) diagnostic bronchoscopy plus lymph node staging, (2) lung nodule marking, and (3) surgical resection. This study evaluated the viability of performing a pulmonary nodule marking and sublobar resection under a single-anesthesia-dependent event at a large community hospital. Methods: The study group was a single-center retrospective cohort of patients, scheduled for same-day marking and sublobar resection and admitted to a large community hospital between 6 January 2023 and 23 May 2023. Prior to arrival, patients had received cardiac surgical clearance, pulmonary function testing, and positron emission tomography to ensure their appropriateness for surgical intervention. Data regarding procedural time, anesthesia time, and hospital length of stay was collected retroactively though the electronic medical record. Results: A total of 12 patients with 16 pulmonary nodules were included. Results demonstrated a mean turnover time of 33 min between completing pulmonary fiducial marking and starting the sublobar resection. The estimated mean total time saved was 231 min. The average hospital length of stay was 1.83 days. Conclusions: Combining pulmonary fiducial marking and sublobar resection within a single-anesthesia-dependent event offers an opportunity to decrease total perioperative time and the time from diagnosis to curative intervention. Full article

Background: Hallux valgus (HV) is one of the most common foot deformities and negatively impacts plantar support. The abductor hallucis (AH) is the most important muscle in the etiopathogenesis of hallux valgus, but the effectiveness of its rehabilitation clashes with the difficulty of identifying the most suitable exercises to activate it. Therefore, the aim of this study was to compare four different therapeutic exercises in the activation of AH in these patients. Methods: In this observational case–control study, 48 patients suffering from hallux valgus of moderate/severe grade, according to traditional radiographic classification and the Manchester scale, were divided into two groups: the case group underwent a monthly rehabilitation protocol for their foot deformity, whereas the control group was only evaluated without any intervention. The exercises were as follows: Toe Spread Out (TSO), Short Foot (SF), Forefoot Adduction (FA), and Flexion of the Metatarsophalanges (FM). Both groups were analyzed at baseline and 1 month later (at the end of rehabilitation for the case group) while performing the four mentioned exercises using a surface electromyograph (sEMG) to record the muscle activity of AH in terms of Root Mean Square (RMS) and Maximum Voluntary Contraction (MVC). Results: FA was the only exercise to determine a statistically significant improvement in AH at the end of the rehabilitation cycle, both in terms of RMS (p = 0.015) and in terms of MVC (p < 0.0001), whereas the other exercises did not produce any change in muscle activity in the comparison between times and groups or in the related interaction. Conclusions: FA seems to be the best exercise to activate and train AH, so rehabilitation programs for patients suffering from hallux valgus should consider this exercise as the starting point for improving plantar support, always considering the specific characteristics of HV. Further studies are needed to deepen the effectiveness of this exercise, with the aim of implementing rehabilitation strategies and rethinking traditional HV therapies, which are currently predominantly surgical. Full article

Objectives: This study aims to describe and analyze the indications and clinical results of total TMJ replacement in participants with degenerative and/or inflammatory joint diseases, defining patient and intervention conditions. Methods: A systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Intervention and reported according to the PRISMA Items update. The search strategy was from 1997 to July 2024 in Pubmed, Embase, Scopus, and Web of Science. A search for gray literature was conducted in the databases Google Scholar and Open Access Theses and Dissertations (OATD), and there were no limitations on the language or study design. We incorporated studies involving human patients over 15 years of age with degenerative and/or inflammatory joint conditions who underwent joint prosthesis replacement, either concurrently or separately from orthognathic surgery, as an initial intervention or after prosthesis installation. Participants with a postoperative follow-up of 12 months or longer were included. A risk of bias analysis was performed for non-randomized studies using the ROBINS-I tool, and GRADE profiler (GRADEpro) software was used to assess the quality of evidence and synthesize the data. Results: All the selected studies performed postoperative follow-up with quantitative and qualitative parameters; 10 performed a follow-up of 2 to 5 years. The indication for joint prosthesis replacement due to system failure was only 4.07%. Concerning diagnoses, 579 presented degenerative and/or inflammatory joint diseases, with osteoarthritis being the most frequent, followed by osteoarthrosis, juvenile idiopathic arthritis, and rheumatoid arthritis. The maximum mouth opening of the participants with TMJ disease presented an average of 24.32 ± 5.8 mm with a range of 18 to 36.4 mm. Of the 579 participants, the studies mention that they presented a soft to liquid diet and pain associated with decreased mandibular functionality. Conclusions: A total of 76.18% of the participants presented a range of moderate to severe pain associated with a decrease in functionality and, after joint replacement, all participants mentioned a decrease in pain or absence of pain, a change in diet by incorporating solid foods, and an increase in opening with an average of 40.74 ± 3.1 mm. Total joint replacement shows favorable long-term results. It is not possible to identify the best time to perform joint replacement surgery, considering the time since diagnosis of the disease, the time since the start of non-surgical treatment, or the number of previous surgeries. Full article

Background: Postoperative infection following anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication that can compromise patient outcomes, leading to prolonged recovery, graft failure, and knee dysfunction. Although infection rates are reported to be less than 2%, it remains essential to implement strategies to reduce infection risk and improve surgical outcomes. Methods: This review explores current evidence on the prevention of infections in ACLR, emphasizing the importance of timely antibiotic prophylaxis and vancomycin presoaking of grafts, which has been associated with a substantial reduction in infection rates. Results: Empirical antibiotic therapy should be started immediately after joint aspiration when infection is suspected. Treatment must prioritize culture-specific antibiotic regimens to optimize patient outcomes. Surgical intervention with arthroscopic debridement and irrigation needs to occur as soon as the diagnosis of infection is made. Often, this is performed with a focus on retaining the graft in order to preserve knee stability, if possible. Careful intraoperative management, along with the aid of infectious disease specialists, is paramount to help optimize outcomes following infection after ACLR. Conclusions: This review emphasizes the need for treatment protocols and highlights areas for future research to establish clear guidelines on infection after ACLR, especially with decisions of graft retention versus removal. Full article

Background and Clinical Significance: Femoral neck fracture frequently occurs in the elderly population but may also present in patients diagnosed with primary cancer or bone metastases. A pathological, oligosymptomatic fracture associated with epithelioid haemangioendothelioma (EHE), a rare endothelial cell-derived sarcoma, is uncommon. Case Presentation: A 44-year-old patient underwent biopsy procedures three times (2010, 2012, 2013) for a focal lesion of the left ischium, none confirming its malignant nature. The last biopsy revealed a neoplastic tissue with features of discrete dysplasia. The lesion did not undergo medical follow-up for seven consecutive years. In August 2020, the patient presented with right lower limb pain. A CT scan, PET/CT scan, and biopsy confirmed EHE with spindle/sarcomatous features. In November 2020, chemotherapy (5xADIC) started (PET/CT confirmed a partial response). After its completion in July 2021, bone progression occurred and sirolimus-based therapy was started. After 3 months, a small liver metastasis was visualized on PET/CT, which did not result in the termination of treatment. In December 2021, pamidronate-based antiresorptive therapy was started. Liver metastasis remained stable in follow-up CT scans. Due to pelvic and spinal lesions, the patient was assisted by elbow crutches and underwent radiotherapy, remaining professionally active. The patient did not report any trauma, but in August 2023, a subsequent CT scan revealed a subcapital fracture of the left femoral neck in the fusion phase. Due to pelvic changes and the stable nature of the fracture, surgical treatment was abandoned. Conclusions: An oligosymptomatic femoral neck fracture, not requiring medical intervention is considered a rare complication of bone cancer. Full article

Background: The gold standard treatment of acute cholecystitis is early laparoscopic cholecystectomy (LC), as indicated in the Tokyo Guidelines (TG). However, the definition of “early” is still unclear. In 2013, TG suggested surgical intervention within 72 h from the onset of the symptoms; however, according to the 2018 revision, LC must be performed as soon as possible, regardless of symptom onset. Therefore, the optimal timing for surgery is still debated. In order to avoid any complications, surgeons need to know all the surgical strategies for safety in case of a difficult cholecystectomy. Methods and Materials: Starting from January 2023 at Cittiglio Hospital (Italy), the following strategies were implemented: LC within 72 h from the onset of symptoms, systematic intraoperative use of indocyanine green fluorescence cholangiography, systematic identification of the Critical View of Safety (CVS), and subtotal cholecystectomy when the CVS was impossible to identify. We retrospectively analyzed a cohort of patients who underwent LC in our surgical department, subdividing them into two groups: Group 1 (G1) included patients operated on in 2022, and Group 2 (G2) included patients operated on in 2023. End points were length of stay and in-hospital postoperative complications, with particular interest in biliary duct injury. Results: Overall, 210 LC have been performed (97 in G1 and 113 in G2). After the introduction of the new safety strategy, the median length of stay (3 days in G1 vs. 2 in G2), BDI rate (2 in G1 vs. 0 in G2), and conversion rate to open procedure (5 in G1 vs. 1 in G2) were decreased. Conclusions: Our data are promising, highlighting that LC with the standardization of new safety strategies, especially in case of acute cholecystitis, immediately improves surgical outcomes in terms of length of stay and complications. Full article