Search Results (56)

Background/Objectives: Intraoperative ultrasound (IOUS) has become an integral component of modern hepatic oncology surgery, providing real-time imaging guidance during liver resections for hepatocellular carcinoma, colorectal liver metastases, and other primary or secondary hepatic malignancies. Despite substantial improvements in preoperative imaging modalities, occult lesions, disappearing metastases after chemotherapy, and complex vascular relationships continue to represent major intraoperative challenges. This structured narrative review aimed to evaluate the contemporary role of IOUS in hepatic oncology surgery, with particular emphasis on contrast-enhanced intraoperative ultrasound (CE-IOUS), minimally invasive liver surgery, navigation-assisted hepatectomy, and emerging artificial intelligence-based technologies. Methods: A structured literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases. Peer-reviewed studies, international guidelines, consensus statements, systematic reviews, and technological reports addressing IOUS applications in liver surgery were analyzed. Particular focus was placed on studies evaluating lesion detection, intraoperative strategy modification, disappearing colorectal liver metastases, parenchymal-sparing hepatectomy, laparoscopic and robotic liver surgery, navigation systems, augmented reality integration, and AI-assisted imaging technologies. Results: Contemporary evidence demonstrates that IOUS continues to significantly influence intraoperative decision-making despite advances in magnetic resonance imaging and multidetector computed tomography. CE-IOUS improves the detection of occult hepatic lesions and residual disease after systemic chemotherapy, particularly in disappearing colorectal liver metastases. IOUS-guided anatomical and parenchymal-sparing resections contribute to the preservation of functional liver parenchyma while maintaining oncologic radicality. In minimally invasive liver surgery, laparoscopic ultrasound remains essential for lesion localization and vascular mapping. Recent developments integrating navigation systems, augmented reality platforms, and AI-assisted image recognition suggest a progressive transition toward digitally integrated precision liver surgery. Conclusions: IOUS remains a cornerstone of modern hepatic oncology surgery and continues to evolve from a localization tool into a comprehensive platform for precision-guided liver resection. The integration of CE-IOUS, navigation technologies, and artificial intelligence may further enhance intraoperative accuracy, oncologic safety, and individualized surgical planning in the future. Full article

Background/Objectives: Anatomical variation of the limb arteries is a recurrent threat to safe surgical and interventional practice, yet it is frequently under-emphasized in modern curricula. Methods: We conducted a systematic review and proportional meta-analysis, following the PRISMA 2020 and Evidence-Based Anatomy methodology, to generate pooled prevalence estimates for the principal limb arterial variants and translate them into an educational framework. Six databases were searched from inception to December 2024; two reviewers independently assessed eligibility and methodological quality (AQUA tool); and proportions were pooled using the Freeman–Tukey double arcsine transformation under DerSimonian–Laird random-effects models. Results: Of 2847 records, 57 studies (23,267 limbs) were included. Pooled prevalence was 11.1% (95% CI 9.2–13.1) for high-origin radial artery, 2.6% (1.9–3.3) for superficial ulnar artery, 12.2% (6.5–19.2) for persistent median artery, 10.4% (9.1–11.9) for popliteal branching variants, and 0.8% (0.3–1.5) for peronea magna. Variation thus affects roughly one in five upper limbs and one in ten lower limbs—common enough to warrant deliberate curricular attention. Conclusions: We propose a four-principle framework (embryological reasoning, clinical-consequence integration, systematic identification, and competency-based assessment) for embedding variation recognition across the surgical training continuum. Full article

Coronary artery anomalies (CAAs) are a rare but clinically significant group of congenital abnormalities that are associated with myocardial ischaemia, malignant arrhythmias and sudden cardiac death, particularly in young people and athletes. Despite increasing recognition of these conditions and advances in cardiovascular imaging, there are still significant challenges regarding their classification, risk stratification and management, particularly with respect to surgical indications. This review provides a comprehensive overview of the current evidence on the classification, pathophysiology, diagnosis and management of CAAs, with a particular focus on surgical decision-making and contemporary guideline recommendations. A systematic literature search was conducted up to February 2025 using PubMed and Google Scholar. Priority was given to international guidelines, consensus statements, systematic reviews, meta-analyses and large observational studies. CAAs encompass a broad spectrum of anatomical variants and clinical presentations. Among these, anomalies of coronary origin are the most extensively studied. Surgical management is well established for coronary arteries arising from the pulmonary artery, particularly for anomalous left coronary artery from the pulmonary artery (ALCAPA). Substantial advances have also been made in the diagnosis, risk stratification, and treatment of anomalous aortic origin of a coronary artery (AAOCA), which has become a major focus of contemporary guideline recommendations. For patients with AAOCA, surgical correction, including unroofing, coronary reimplantation or coronary artery bypass grafting, is recommended for individuals with symptoms and/or high-risk anatomical features. In contrast, the diagnosis and management of myocardial bridging, coronary artery fistulas, and coronary artery ectasia remain controversial, with considerable variability in the indications for medical, percutaneous, and surgical treatment. The management of CAAs is an evolving field. While there is consensus for a limited number of anomalies, most cases still require individualised decision-making. It is essential to develop standardised diagnostic frameworks, improved risk stratification tools and outcome-based management criteria. A multidisciplinary, evidence-based approach involving cardiologists, cardiac imagers, interventional cardiologists and cardiac surgeons is crucial in order to optimise patient outcomes and reduce the risk of adverse cardiovascular events, including sudden cardiac death. Full article

Background/Objectives: Oculomotor nerve palsy (OMNP) is a clinically significant condition that may represent the earliest manifestation of life-threatening intracranial pathology, particularly aneurysmal compression or neoplasia. Despite its neurosurgical relevance, comprehensive meta-analytic evidence synthesizing OMNP etiologies, clinical presentation, and contemporary diagnostic pathways remains limited. Methods: Following PRISMA 2020 guidelines, MEDLINE, Scopus, and Web of Science were systematically searched for studies reporting quantitative data on OMNP. Pooled prevalence estimates were calculated using random-effects models for causes and symptoms, while a structured narrative synthesis was performed for diagnostic modalities because outcome reporting was heterogeneous and unsuitable for meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute (JBI) risk of bias tool. Results: Twenty-four studies involving 5541 patients were included. Using a multivariate multilevel model to account for within-study dependence, the most common etiological category was vascular disorders (35.62%), followed by idiopathic (16.47%) and neoplastic (12.10%). Head trauma and aneurysms accounted for 11.26% and 10.08% of cases, respectively. Diplopia (60.63%) and ptosis (54.12%) remained the predominant clinical symptoms, while pupil involvement was identified in 40.62% of the pooled population. Diagnostic paradigms have shifted decisively toward non-invasive neuroimaging, with magnetic resonance imaging reported in 66% of included studies and magnetic resonance or computed tomographic angiography increasingly employed to identify surgically relevant vascular lesions. Conclusions: Although vascular disorders represented the most common etiological category, the notable prevalence of aneurysmal and neoplastic causes underscores the importance of prompt high-resolution neuroimaging and early neurosurgical assessment. Early recognition and etiological stratification remain essential to optimize management and prevent irreversible neurological morbidity. Full article

Background/Objectives: Malnutrition is common among women undergoing gynaecologic oncology (GO) surgery and is associated with increased morbidity, prolonged hospitalisation, and reduced survival. Nevertheless, the optimal nutritional screening tools remain uncertain. Methods: We conducted a narrative review of commonly used nutritional screening and assessment tools in surgical GO patients. To highlight practical challenges in accurately identifying at risk individuals, we incorporated findings from our clinical audit. Results: There was a considerable variation between tools. While many tools were associated with adverse outcomes, their clinical value in this population was unclear. The presence of ascites and rapid deterioration in oral intake may contribute to under-recognition of at-risk patients, as illustrated by our audit findings. Emerging strategies including determining body composition from routine pre-operative Computed Tomography (CT) scans, which have shown statistical associations with survival and toxicity in observational studies, but their clinical utility is not yet established. Conclusions: Although several screening tools were statistically associated with adverse outcomes, robust data on their clinical utility are lacking. Current tools may inadequately factor for the specific considerations when screening this group. Consequently, nutritionally vulnerable surgical GO patients requiring nutritional intervention may be missed. As no gold standard currently exists for this population, bespoke, objective approaches and prospective studies are urgently needed to address disease-specific nutritional considerations. Full article

Introduction: Artificial intelligence (AI) and robot-assisted platforms are increasingly influencing cardiothoracic surgery. AI enhances risk prediction, imaging interpretation, and early complication detection, while robotics improves visualization, dexterity, and minimally invasive access. This systematic review evaluates the current evidence supporting these technologies and their implications for clinical practice. Methods: A systematic literature search was conducted across PubMed, Embase, Scopus, Web of Science, and Google Scholar (January 2000–May 2025) following PRISMA 2020 guidelines. After screening and eligibility assessment, 67 studies met predefined inclusion criteria and were incorporated into the qualitative synthesis. Additional high-impact reviews and consensus documents were consulted for contextual interpretation. Results: Machine learning models demonstrated modest but consistent improvements in predictive performance compared with EuroSCORE II and STS scores, particularly in high-risk cohorts. Robot-assisted mitral and coronary procedures showed reduced postoperative pain, blood loss, ICU stay, and recovery time in experienced centers, though early learning phases were associated with longer operative, cross-clamp, and bypass times. AI-enabled intraoperative tools, such as video analysis, workflow recognition, and real-time anatomical segmentation, emerged as promising adjuncts for surgical precision. Structured robotic training programs, especially simulation-based and dual-console pathways, accelerated proficiency acquisition. Conclusions: AI and robotic systems act as augmentative technologies that enhance rather than replace the surgeon’s role. Their safe and effective adoption requires standardized training, transparent AI decision pathways, and clear ethical and medico-legal governance. Full article

Background: Artificial intelligence is emerging as a promising tool in surgical oncology, with growing evidence suggesting potential applications in diagnostic support, intraoperative guidance, and perioperative risk assessment. In gastric cancer surgery, emerging applications range from AI-assisted endoscopic detection to data-driven perioperative risk prediction, while some technological developments, particularly in robotic autonomy, derive from broader surgical or experimental models that may inform future gastric procedures. Methods: A narrative review was conducted following established methodological standards, including the Scale for the Assessment of Narrative Review Articles (SANRA) and the Search–Appraisal–Synthesis–Analysis (SALSA) framework. English-language studies indexed in PubMed, Scopus, Embase, and Web of Science up to October 2025 were included. Evidence was synthesized thematically across five domains: AI-assisted anatomical recognition and lymphadenectomy support, autonomous robotic systems, early cancer detection, perioperative predictive and frailty models, and ethical and regulatory considerations. Results: AI-based computer vision and deep learning algorithms have demonstrated promising capabilities for real-time anatomical recognition, surgical phase classification, and intraoperative guidance, although evidence of direct patient-level benefit remains limited. In diagnostic settings, AI-assisted endoscopy and Raman spectroscopy have been shown to improve early lesion detection and reduce dependence on operator experience. Predictive models, including MySurgeryRisk and AI-driven frailty assessments, may support individualized prehabilitation planning and perioperative risk stratification. Persistent limitations include small and heterogeneous datasets, insufficient external validation, and unresolved concerns related to data privacy, algorithmic interpretability, and medico-legal responsibility. Conclusions: Artificial intelligence is progressively emerging as a promising tool in gastric cancer surgery, integrating automation, advanced analytics, and human clinical reasoning. Its safe and ethical adoption requires robust validation, transparent governance, and continuous surgeon oversight. When developed within human-centered and ethically grounded frameworks, AI can augment, rather than replace, surgical expertise, potentially advancing precision, safety, and equity in oncologic care. Full article

Background: Esophagectomy remains a technically demanding oncologic procedure with substantial morbidity, despite ongoing advances in minimally invasive and robotic techniques. Limitations in intraoperative visualization and anatomical recognition contribute to complications such as nerve injury and bleeding. Artificial intelligence (AI)-based intraoperative video analysis has emerged as a potential adjunct to enhance surgical perception and safety, but its application in esophagectomy has not been comprehensively reviewed. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Web of Science were searched without a lower date limit to identify eligible studies published up to January 2026, capturing early and contemporary applications of intraoperative AI in esophagectomy. Human studies involving any surgical approach were included. Data on the AI task, methodology, validation strategy, performance metrics, and reported clinical outcomes was extracted. Risk of bias was assessed using the ROBINS-I tool. Results: Six studies met the inclusion criteria, predominantly evaluating AI-driven analysis of intraoperative video during minimally invasive or robotic esophagectomy. Reported applications included real-time anatomical structure recognition, recurrent laryngeal nerve segmentation, detection of excessive nerve traction, instrument and event recognition, and surgical phase identification. Across studies, AI systems demonstrated performance comparable to expert surgeons for selected tasks and achieved real-time or near–real-time inference. One study reported earlier detection of excessive recurrent laryngeal nerve traction compared to conventional nerve integrity monitoring. However, most studies were retrospective, single-center, and feasibility-focused, with limited external validation and minimal assessment of patient-centered clinical outcomes. Conclusions: Artificial intelligence-based intraoperative analysis in esophagectomy is increasingly achievable and may enhance anatomical recognition, intraoperative risk detection, and procedural awareness. Nevertheless, current evidence remains preliminary, heterogeneous, and largely exploratory. Prospective, multicenter studies with standardized reporting and clinically meaningful outcome evaluation are required before routine implementation. Until such data is available, AI should be regarded as a complementary intraoperative tool rather than a standalone clinical decision-making system. Full article

Background/Objective: Intraoperative frozen section (FS) has long been used in thyroid surgery; however, its routine usefulness has shrunk with high-resolution ultrasound, standardized cytology, and molecular diagnostics. This narrative review synthesizes >20 years of evidence to clarify where FS still adds clinically meaningful value and where it does not. Methods: This study constitutes a narrative review of the contemporary literature spanning more than two decades, integrating prospective and retrospective evidence on FS performance in indeterminate/suspicious cytology (Bethesda III–V), NIFTP recognition, central compartment lymph nodes in papillary thyroid carcinoma (PTC), and prognostic intraoperative markers in medullary thyroid carcinoma (MTC). It also examines how guidelines and emerging technologies influence intraoperative decision-making. Results: FS shows high specificity but limited sensitivity in Bethesda III–IV and Bethesda V cytology, offering minimal incremental diagnostic help in the settings with greatest preoperative uncertainty. FS cannot diagnose NIFTP because definitive classification requires complete capsular examination, incompatible with intraoperative pathology workflows. The most consistent value is FS of central compartment lymph nodes in PTC: it reliably detects macrometastases, enables real-time tailoring of surgical extent, and may reduce staged completion operations. In MTC, intraoperative assessment of desmoplastic stromal reaction appears promising as a prognostic marker; however, it remains investigational and not yet embedded in standard surgical algorithms. Guidelines internationally therefore de-emphasize routine FS. Meanwhile, evolving tools (quantitative imaging, molecular profiling, AI) are reshaping intraoperative decision-support, increasingly positioning FS as one component of a multimodal framework rather than a standalone arbiter. Conclusions: Routine FS is largely unsupported in modern risk-stratified thyroid practice due to the low sensitivity in key cytologic gray zones and inability to diagnose NIFTP. Its selective strength persists most clearly in central neck lymph-node assessment in PTC, where it can directly change intraoperative management. Future operative strategies will likely treat FS as an adjunct—contextualized and amplified by imaging, molecular data, and AI—rather than as a default diagnostic step. Full article

Progression of pectus excavatum and carinatum coincides with adolescence, a critical period for identity and self-esteem development. While clinical decision-making and insurance coverage have historically emphasized anatomic severity and cardiopulmonary functioning, increasing evidence suggests that psychosocial burden and quality of life (QoL) impairment represent central components of disease impact. A narrative review was conducted using the PubMed database to synthesize the current literature on the psychological impact of these deformities in adolescents and young adults, including body image distress, social functioning, and mental health effects before and after surgical and non-surgical correction, focusing on validated tools and qualitative studies. Across multiple cohorts, adolescents and young adults with chest wall deformities consistently report impaired body image, reduced self-esteem, social avoidance, and diminished QoL, even in the absence of diagnosable psychiatric disorders. Surgical and non-surgical corrections have positive effects in these domains. Psychological burden, therefore, represents a clinically meaningful component of chest wall deformities and should be considered alongside anatomic and physiologic criteria. Current evidence advocates for the integration of standardized psychosocial screening and support into evaluation and follow-up, which is essential for providing comprehensive, patient-centered care. Greater recognition of psychosocial outcomes may inform advocacy for broader treatment criteria, increasing accessibility among affected individuals. Full article

Background: Rapid and accurate fracture detection is critical in emergency departments (EDs), where high patient volume and time pressure increase the risk of diagnostic error, particularly in radiographic interpretation. Multimodal large language models (LLMs) with image-recognition capability have recently emerged as general-purpose tools for clinical decision support, but their diagnostic performance within routine emergency department imaging workflows in orthopedic trauma remains unclear. Methods: In this retrospective diagnostic accuracy study, we included 1136 consecutive patients referred from the ED to orthopedics between 1 January and 1 June 2025 at a single tertiary center. Given the single-center, retrospective design, the findings should be interpreted as hypothesis-generating and may not be fully generalizable to other institutions. Emergency radiographs and clinical data were processed by a multimodal LLM (2025 version) via an official API using a standardized, deterministic prompt. The model’s outputs (“Fracture present”, “No fracture”, or “Uncertain”) were compared with final diagnoses established by blinded orthopedic specialists, which served as the reference standard. Diagnostic agreement was analyzed using Cohen’s kappa (κ), sensitivity, specificity, accuracy, and 95% confidence intervals (CIs). False-negative (FN) cases were defined as instances where the LLM reported “no acute fracture” but the specialist identified a fracture. The evaluated system is a general-purpose multimodal LLM and was not trained specifically on orthopedic radiographs. Results: Overall, the LLM showed good diagnostic agreement with orthopedic specialists, with concordant results in 808 of 1136 patients (71.1%; κ = 0.634; 95% CI: 68.4–73.7). The model achieved balanced performance with sensitivity of 76.9% and specificity of 66.8%. The highest agreement was observed in knee trauma (91.7%), followed by wrist (78.8%) and hand (69.6%). False-negative cases accounted for 184 patients (16.2% of the total cohort), representing 32.4% of all LLM-negative assessments. Most FN fractures were non-displaced (82.6%), and 17.4% of FN cases required surgical treatment. Ankle and foot regions showed the highest FN rates (30.4% and 17.4%, respectively), reflecting the anatomical and radiographic complexity of these areas. Positive predictive value (PPV) and negative predictive value (NPV) were 69.4% and 74.5%, respectively, with likelihood ratios indicating moderate shifts in post-test probability. Conclusions: In an emergency department-to-orthopedics consultation cohort reflecting routine clinical workflow, a multimodal LLM demonstrated moderate-to-good diagnostic agreement with orthopedic specialists, broadly within the range reported in prior fracture-detection AI studies; however, these comparisons are indirect because model architectures, training strategies, datasets, and endpoints differ across studies. However, its limited ability to detect non-displaced fractures—especially in anatomically complex regions like the ankle and foot—carries direct patient safety implications and confirms that specialist review remains indispensable. At present, such models may be explored as hypothesis-generating triage or decision-support tools, with mandatory specialist confirmation, rather than as standalone diagnostic systems. Prospective, multi-center studies using high-resolution imaging and anatomically optimized algorithms are needed before routine clinical adoption in emergency care. Full article

In recent years, Transcranial Color Doppler (TCCD) has gained increasing recognition as a non-invasive neuromonitoring tool. However, there remains a strong tendency to view arterial TCCD as the ‘stethoscope for the brain,’ while the assessment of cerebral venous flow is still underrepresented in clinical protocols. This review aims to explore the emerging role of venous TCCD, particularly when combined with Internal Jugular Vein (IJV) ultrasound, in evaluating cerebral venous outflow in both critically ill and surgical patients. We conducted a narrative review of e-Pub articles from PubMed, MEDLINE, and Scopus, on the pathophysiological factors that impair cerebral venous drainage and their clinical implications in surgical and critical care settings. Based on this evidence, we developed two procedural algorithms that integrate established knowledge of cerebral venous hemodynamics with common clinical conditions affecting venous outflow, including internal jugular central venous catheter placement, mechanical ventilation, and pneumoperitoneum. The algorithms emphasize systematic monitoring of cerebral venous drainage, including assessment of internal jugular vein morphology and Rosenthal’s vein flow, to guide procedural optimization and minimize potential neurological complications. They were informed by validated frameworks, such as the RaCeVa protocol, and are illustrated through two representative clinical case scenarios. Cerebral venous congestion can be induced by multiple established risk factors, including mechanical ventilation, cardiovascular disease, elevated intra-abdominal pressure, the Trendelenburg position, and central venous catheterization. In selected patients, real-time venous TCCD monitoring, combined with IJV assessment, allows early detection of cerebral venous outflow impairment and guides timely hemodynamic and procedural adjustments in both surgical settings and critical care contexts. Venous TCCD neuromonitoring may help prevent intracranial hypertension and its consequent neurological complications. It can guide clinical decisions during procedures that may compromise cerebral venous drainage, such as mechanical ventilation, the placement of large-bore central venous catheters, or laparoscopic and robot-assisted surgeries. Further studies are warranted to validate this strategy and better define its role in specific high-risk clinical scenarios. Full article

Background: Effective preoperative patient counseling is essential to shared decision-making. In thyroid surgery, patient communication can be complicated by the complex anatomy and variable surgical approaches, which may not be fully conveyed through conventional verbal explanations or schematic drawings. Virtual three-dimensional (3D) thyroid models may provide an intuitive tool to enhance patient comprehension. Methods: We conducted a randomized controlled trial at Peking Union Medical College Hospital with 94 newly-diagnosed thyroid cancer patients scheduled for thyroidectomy. Participants were assigned to either the control group (n = 47), which received preoperative drawing-based counseling, or the intervention group (n = 47), which utilized a virtual 3D model for communication. The Thyroid Navigator app, developed by Kuma Hospital, was used to provide dynamic 3D representation of the thyroid gland, surrounding structures, and potential surgical procedures. After standardized preoperative consultations, patients were surveyed to assess their understanding in pertinent anatomy and postoperative complications. Results: Patients in the 3D model group demonstrated similar correct response rates in lesion localization (p = 0.536) or parathyroid gland recognition (p = 0.071), but significantly higher accuracy in identifying the recurrent laryngeal nerve and the extent of lymph node dissection compared with the control group (p < 0.05). Moreover, comprehension of the causes of major postoperative complications—including hoarseness (recurrent laryngeal nerve injury, p = 0.004), hypocalcemia (parathyroid gland impairment, p = 0.015), and bleeding (inadequate hemostasis, p = 0.008)—was significantly improved in the 3D model group. Conclusions: Use of a virtual 3D thyroid model significantly improves patient comprehension of thyroid anatomy, surgical procedures, and potential complications, thereby enhancing clinician–patient communication. Virtual 3D models represent a practical and cost-effective supplement to conventional counseling in thyroid surgery, offering clear benefits in patient education and shared decision-making. Full article

Migraine is a prevalent and disabling neurological disorder with multifactorial origins and complex clinical manifestations. While pharmacologic therapies remain the cornerstone of management, a growing body of evidence highlights the role of extracranial peripheral nerve compression as a significant contributor to migraine pathophysiology in selected patients. This recognition has expanded the therapeutic role of plastic surgery, offering anatomically targeted interventions that complement or surpass traditional medical approaches for refractory cases. From a plastic surgeon’s perspective, optimal migraine care begins with accurate identification of clinical patterns, trigger-site mapping, and the judicious use of diagnostic tools such as nerve blocks and botulinum toxin. Surgical decompression techniques, including endoscopic and open approaches, address compression of the supraorbital, supratrochlear, zygomaticotemporal, greater and lesser occipital, auriculotemporal, and intranasal contact-point trigger sites. Adjunctive strategies such as autologous fat grafting further enhance outcomes by providing neuroprotective cushioning and modulating local inflammation through adipose-derived stem cell activity. Recent advances, including neuromodulation technologies, next-generation biologics, and innovations in surgical visualization, underscore the ongoing shift toward precision-based, mechanism-driven therapy. As understanding of migraine heterogeneity deepens, the integration of surgical expertise with modern neuroscience offers a comprehensive and personalized therapeutic framework. Plastic surgeons, equipped with detailed knowledge of peripheral nerve anatomy and minimally invasive techniques, play an increasingly pivotal role in the multidisciplinary management of refractory migraine. Full article

Background: The radial artery (RA) is one of the terminal branches of the brachial artery, extending along the lateral forearm, crossing the anatomical snuffbox, and contributing to the palmar arches. Anatomical variations in the RA are of great clinical relevance due to their implications in procedures such as transradial catheterization, arterial cannulation, and bypass grafting. These variants may alter the course, branching pattern, or origin of the vessel, potentially increasing procedural complexity and the risk of iatrogenic injury. In critically ill patients and in surgical or interventional settings, accurate identification of RA anatomy is essential. The objective of this study was to systematically identify and describe RA variants reported in the scientific literature and to analyze their clinical relevance. Methods: A systematic search was conducted across six electronic databases: Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Latin American and Caribbean Literature in Health Sciences (LILACS), covering publications up to July 2025. Eligible studies included anatomical, radiological, and surgical investigations reporting RA variants. Study quality was evaluated using the Assessment of Quality in Anatomical Studies (AQUA) tool. Quantitative synthesis was performed using a random-effects model to estimate the pooled prevalence of RA variants and subgroup differences. Twenty-three studies met the inclusion criteria, and eleven were included in the meta-analysis, encompassing a total of 6320 participants. Results: Radial artery variants were categorized into three main types: variations in origin, course, and branching pattern. The pooled global prevalence of RA variants was 12% (95% CI: 6–18%), with substantial heterogeneity (I² = 97.7%). Higher prevalence was found in imaging-based studies (14%) compared with donor-based studies (12%). Sex-based subgroup analysis revealed a higher prevalence in females (18%; CI: 9–28%) compared with males (3%; CI: 3–4%), with moderate heterogeneity (I² = 61.3%). Regionally, European populations demonstrated a higher prevalence (20%) than Asian populations (11%), both showing high heterogeneity (I² > 98%). Notably, only one study from the Americas and none from Africa or Oceania were identified, representing a major geographical limitation in the available data. The findings of this study highlight the considerable variability in RA anatomy across populations. Such variations hold significant clinical importance, particularly in the context of transradial interventions, arterial cannulation, and reconstructive procedures where vascular integrity is critical. The high degree of heterogeneity observed may reflect differences in population genetics, sample size, and imaging or dissection methodologies. The limited representation of certain regions underscores the need for further anatomical and radiological studies to obtain a more comprehensive understanding of global RA variability. Preoperative or pre-procedural imaging using Doppler ultrasonography or computed tomography angiography is recommended to identify anomalous patterns and minimize iatrogenic complications. Conclusions: Radial artery variants are frequent and diverse. Their recognition is fundamental for the safety and success of invasive and surgical procedures in the upper limb. A standardized approach to vascular evaluation, particularly through preoperative imaging, is essential to improve procedural outcomes and reduce the risk of arterial injury in clinical practice. Full article