Search Results (602)

Background/Objectives: Computer-aided surgical planning (CASP) technologies, including virtual surgical planning (VSP), 3D printed cutting guides, and patient-specific implants, have been increasingly applied to deep circumflex iliac artery (DCIA) free flap reconstruction of maxillofacial defects. Despite growing adoption, no systematic review has specifically evaluated their accuracy and clinical outcomes. This study aimed to comprehensively assess the impact of CASP on reconstruction accuracy, operative efficiency, flap survival, and implant rehabilitation in DCIA flap surgery. Methods: A systematic search of PubMed, Web of Science, and Google Scholar was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Studies reporting CASP-assisted DCIA free flap reconstruction with three or more patients were included. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist and the Cochrane Risk of Bias 2.0 tool for the randomized controlled trial (RCT). Results: Thirty studies (1 RCT, 13 comparative, and 16 non-comparative) involving 844 patients were included. VSP with 3D-printed cutting guides was the most frequently used technology (n = 22). Mean linear deviations between planned and actual outcomes ranged from 0.40 to 4.4 mm, with most studies reporting 0.7–2.7 mm. The sole RCT demonstrated significantly better accuracy (1.3 vs. 5.5 mm, p < 0.001) and shorter reconstruction time (16 vs. 39 min, p < 0.001) with CASP. Flap survival ranged from 90% to 100%. Conclusions: CASP technologies, particularly VSP with 3D-printed cutting guides, appear to improve the accuracy and predictability of DCIA flap reconstruction. However, the evidence base is predominantly retrospective and heterogeneous; prospective multicenter studies with standardized outcome measures are needed before definitive clinical guidelines can be established. Full article

As thoracic surgeons more frequently address smaller lung lesions and perform lung-sparing resections, their objective is to resect an adequate specimen and margin without removing excess healthy lung tissue. Although perioperative lung nodule localization has been in practice for decades, the existing and emerging techniques used for the identification of targeted and occult lesions are more widely utilized today than they were in the past. In this review, we detail the logic behind this increase in use, classify the techniques into preoperative and intraoperative categories, and define the specific modalities available. Where applicable, we review the published data comparing techniques, detailing efficacy and safety. In the preoperative space, we describe standard computed tomography (CT)-guided localization, virtual-assisted lung mapping, electromagnetic navigation bronchoscopy, robotic-assisted bronchoscopy, and novel fiducial markers. In the intraoperative space, we describe classical localization techniques, novel applications of intraoperative cone-beam CT, and fluorescence-guided surgery and intraoperative molecular imaging (IMI). Lastly, we review emerging approaches for intraoperative molecular imaging including a report on agents in early-stage clinical trials and a brief survey of promising preclinical models. With each approach mentioned, we analyze the potential benefits and hazards, and appraise the evidence for (or against) the use of any specific modality. Full article

This systematic review aimed to evaluate the available evidence on methods used to predict mandibular autorotation after maxillary repositioning in orthognathic surgery. A systematic search of PubMed/MEDLINE, Cochrane Library, Scopus, Google Scholar, and EMBASE covering the period from 1970 to 2026 was performed to identify studies reporting on prediction methods for mandibular autorotation after maxillary repositioning. Data on study design, sample size, surgical setting, prediction method, and prediction error were extracted. Because of substantial heterogeneity and incomplete reporting, quantitative synthesis was considered exploratory. Risk of bias was assessed using the ROBINS-I tool. A total of six studies met the inclusion criteria. The available evidence showed marked heterogeneity in study design, outcome definitions, anatomical landmarks, and reporting format. Earlier studies mainly used 2D cephalometric or geometric methods, whereas more recent investigations relied on 3D virtual planning and simulation-based workflows. In the exploratory subgroup meta-analysis, 3D approaches were associated with a lower pooled mean prediction error (0.57 mm, 95% CI: 0.05–1.08) than 2D methods (2.13 mm, 95% CI: 0.65–4.92), although the subgroup difference was not statistically significant (p = 0.2772). Leave-one-out sensitivity analysis showed that the direction of effect consistently favoured 3D methods. Overall, the available evidence suggests that 3D approaches may show lower mandibular autorotation prediction errors than 2D methods; however, this finding should be interpreted cautiously because of the small number of studies, substantial methodological heterogeneity, and the exploratory nature of the quantitative synthesis. Full article

The adoption of neoadjuvant immune checkpoint inhibitor (ICI)-based chemoimmunotherapy has fundamentally transformed the operative landscape of resectable non-small cell lung cancer (NSCLC). Surgeons are now routinely confronted with ICI-altered tissue planes characterized by hilar fibrosis, vascular friability, and disrupted lymph node architecture. Simultaneously, robotic-assisted thoracic surgery (RATS) has consolidated its position as the dominant minimally invasive platform for pulmonary resection, accounting for the majority of lobectomies and segmentectomies performed at high-volume centers in 2023. Whether RATS confers specific technical advantages in this increasingly complex operative context remains incompletely characterized. We conducted a structured narrative review of published evidence, synthesizing data from randomized controlled trials, prospective cohorts, national registry analyses, and emerging technology reports addressing RATS in the setting of neoadjuvant ICI-based therapy for NSCLC. A systematic literature search was conducted across PubMed and EMBASE using predefined search terms. Available evidence, though largely retrospective and limited by small sample sizes, consistently demonstrates that RATS after neoadjuvant chemoimmunotherapy is technically feasible and oncologically sound, with R0 resection achievable in virtually all cases. The enhanced three-dimensional visualization, tremor filtration, and instrument degrees of freedom afforded by robotic platforms appear particularly advantageous in the setting of dense hilar adhesions and fragile pulmonary vasculature. Lymph node yield, a recognized robotic advantage, is preserved or enhanced despite post-ICI fibrosis. Pooled conversion rates to thoracotomy, derived from post hoc surgical analyses of ICI trial populations rather than trials designed to measure conversion, are higher than for upfront resection; available retrospective single-center data, including one direct RATS-versus-VATS comparison, suggest lower conversion rates with RATS in experienced hands, though this conclusion requires prospective validation. Emerging platform integrations, including combined robotic bronchoscopy and thoracoscopic surgery, single-port systems, and artificial intelligence-assisted anatomical navigation, are poised to further extend the reach of minimally invasive surgery in this challenging clinical scenario. In experienced centers, RATS appears to offer a technically favorable minimally invasive platform for pulmonary resection after neoadjuvant ICI-based therapy, with potential advantages over VATS in managing immunotherapy-altered anatomy; however, this conclusion is derived from retrospective series and should be interpreted cautiously pending prospective comparative data. Prospective multicenter trials with standardized surgical endpoints are urgently needed. Full article

Patient-specific implants (PSIs) in orthognathic surgery offer optimal intraoperative accuracy. However, evidence regarding their postoperative skeletal stability, specifically comparing distinct fixation designs and segmentation patterns, remains limited. We present a retrospective cohort study that evaluated 64 adult patients undergoing customized maxillary orthognathic surgery between January 2020 and June 2025. The primary predictor variables were fixation design (conventional customized plates vs. minimally invasive plates) and maxillary segmentation (monoblock vs. multisegmental). The outcome variable was 3D skeletal stability, measured as linear displacement between preoperative planning and 6-month postoperative imaging. Non-parametric tests compared displacements and clinical instability rates (defined as ≥2.0 mm). Mann–Whitney tests compared landmark displacements, Fisher’s exact tests compared proportions with ≥2.0 mm displacement, and ORs with 95% CIs were computed (α = 0.05). Analysis of 64 patients revealed that median displacement across landmarks ranged from 0.7 to 4.28 mm and 28.1% exhibited displacement ≥ 2.0 mm, primarily in molar and canine regions. While overall instability rates did not differ significantly between single-segment and multisegmental osteotomies (p = 0.28), multisegmental cases showed significantly higher displacement at the left canine (p = 0.027). Plate design was not associated with skeletal instability (p = 0.88), suggesting that minimally invasive plates provide comparable stability to conventional designs. Customized maxillary plates provide reliable postoperative stability with median displacements within clinically acceptable limits (<2 mm). Minimally invasive PSI designs offer stability comparable to conventional extended designs. However, localized instability in multisegmental cases suggests a need for careful biomechanical management regardless of the fixation method used. Full article

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

Thin-slice high-resolution computed tomography (CT) has improved the detection of small pulmonary nodules, increasing the demand for minimally invasive diagnostic and therapeutic resection. While lobectomy with lymph node dissection remains the standard surgical approach for many patients with resectable non-small cell lung cancer, accumulating evidence supports sublobar resection for selected small, peripheral, and ground-glass-dominant lesions when sufficient margins are achievable. In thoracoscopic and robotic surgery, localization of nodules ≤10 mm or lesions located >5 mm from the pleural surface can be challenging, and failure to identify the target may lead to conversion, larger resection than intended, or prolonged operative time. Several localization strategies have been developed, including CT-guided percutaneous wire/coil/dye marking, bronchoscopic dye mapping, and virtual-assisted lung mapping (VAL-MAP), robotic-assisted bronchoscopic dye or fiducial localization, radiofrequency identification microtag systems (Surgical Real-Time FInger Navigation and Detection) that provide real-time depth information, and single-stage intraoperative CT-guided marking and resection in hybrid operating rooms. This review synthesizes representative evidence and published outcome ranges, and compares workflows, marker-to-lesion precision metrics, complication profiles, operational burden, and cost structures. We emphasize the practical contrast between two-stage and single-stage workflows, the access-route differences between transthoracic and transbronchial techniques, and the need to report localization-to-incision “time at risk”. We also present an expert-consensus decision algorithm aimed at facilitating tailored selection of localization strategies for modern minimally invasive thoracic surgery. Full article

Background: Preoperative anxiety and postoperative pain are prevalent and are frequently associated with poor postoperative functional outcomes. Comprehensive postoperative management, including both pharmacological and psychological components, is essential for proper postoperative care and better recovery. While the analgesic effect of traditional non-pharmacological intervention, such as cognitive behavior therapy, has been investigated by other trial studies, the newer innovative methods for delivering psychological interventions for reducing anxiety and pain are extensively being investigated. Virtual reality (VR) has emerged as a novel and promising technology that offers opportunities to mitigate patient perception and cognitive responses, and has been shown to be associated with lower levels of anxiety and pain. The aim of this randomized clinical trial (RCT) is to determine whether delivering the psychological content through virtual reality (VR) along with the standard preoperative and postoperative care results in better anxiety and pain relief outcomes than standard care in patients undergoing spinal surgery. Methods: This study protocol outlines a parallel-group RCT to be conducted in the Department of Neurosurgery at the University Clinical Hospital of Medical University of Lodz. The objective is to assess the efficacy of immersive VR environments in reducing preoperative anxiety and postoperative pain intensity in the following day after surgery. Adult patients (18–70) will be randomly assigned to either (1) standard care before surgery (control group), (2) VR exposure simulating the hospital environment alongside standard care, or (3) VR-based exposure to calming natural landscapes accompanied by soothing background sound along with standard care. In each group, a minimum of 50 patients will be recruited. The primary outcome is the change in preoperative anxiety measured using the State-Trait Anxiety Inventory-State (STAI-S) scale from baseline to immediately after intervention. Secondary outcomes include postoperative pain measured using the Visual Analogue Scale (VAS), postoperative analgesic consumption, patient satisfaction, and VR-related adverse effects. To facilitate a comprehensive understanding of the VR intervention’s impact, the primary outcome will be complemented with measures of the adverse effects, level of immersion, and level of presence in the VR environment. Secondary outcomes of self-reported satisfaction scores and postoperative analgesics from patients’ medical charts will be assessed. Conclusions: This trial will evaluate whether VR-based interventions may reduce preoperative anxiety and postoperative pain in patients undergoing spine surgery. This study may provide evidence supporting the future implementation of VR as a non-pharmacological adjunct in perioperative care. This intervention may hold significant clinical relevance clinically, particularly in patients with high level of preoperative anxiety, by offering an alternative method to pharmacological anxiolytics in the future. Full article

Background/Objectives: Patients undergoing metabolic and bariatric surgery (MBS) are at risk of micronutrient deficiencies and gut dysbiosis. Probiotics (such as Lactobacillus, Bifidobacterium) have been proposed as adjunct therapy to optimize postoperative outcomes. This review aimed to evaluate the effect of postoperative probiotic supplementation on anthropometric, metabolic, inflammatory, and micronutrient outcomes in MBS patients. Methods: Nine electronic databases were systematically searched, including PubMed, Web of Science, Cochrane Library, Google Scholar, Popline, Global Health Library, Virtual Health Library, New York Academy of Medicine, and OpenGrey, from inception through October 2024. Only randomized controlled trials (RCTs) were included. The Cochrane Collaboration risk-off-bias tool was used for quality assessment. Meta-analyses were performed using Comprehensive Meta-Analysis software version 2. Fixed-effects or random-effects models based on heterogeneity (I² threshold: 50%) were applied. Mean differences (MD) and 95% confidence intervals (CI) were calculated for all continuous variables. Results: Thirteen RCTs encompassing 666 patients (probiotics group: n = 344; control group: n = 322) were included. Incomplete outcome data represented the most prevalent high-risk domain (23%). Probiotic supplementation was associated with significantly improved serum vitamin D (MD: 25.32 nmol/L, 95% CI: 6.96–43.67, p = 0.007) and vitamin B12 levels (MD: 39.36 pg/mL, 95% CI: 1.88–76.84, p = 0.04). No statistically significant differences were observed in anthropometric outcomes (%EWL, BMI, weight, or waist circumference), lipid profile, glycemic indices, or inflammatory markers (TNF-α, IL-6, CRP). Conclusions: Postoperative probiotic supplementation may significantly improve vitamin D and B12 levels in patients undergoing MBS, suggesting a supportive role in mitigating micronutrient deficiencies. However, these findings should be interpreted with caution due to substantial heterogeneity across studies. Probiotics did not significantly affect weight loss, metabolic parameters, or inflammatory markers. Clinicians may consider probiotics as an adjunct strategy to support micronutrient status in at-risk postoperative patients. Large-scale, strain-specific trials incorporating standardized dietary control and microbiome profiling are warranted. Full article

Background: An aorto-right ventricular fistula (ARVF) secondary to membranous septum rupture is an exceptionally rare complication after surgical aortic valve replacement (SAVR). While sutureless prostheses such as the Perceval valve have gained wide acceptance due to reduced cross-clamp times and procedural simplification, the reported adverse events predominantly include conduction disturbances and paravalvular leaks. Structural septal disruption remains sparsely described. We report a case of an early ARVF after Perceval implantation and review the pathophysiological and procedural mechanisms implicated in septal injury following sutureless and transcatheter aortic valve interventions. Case Description: A 66-year-old woman with severe bicuspid aortic valve stenosis underwent SAVR via a median sternotomy using a Perceval XL prosthesis after meticulous annular decalcification and sizing. Immediate intraoperative transesophageal echocardiography (TEE) confirmed optimal seating without any paravalvular regurgitation. Within 24 h, the patient developed a complete atrioventricular block followed by cardiogenic shock. A repeat TEE revealed a large ARVF with significant left-to-right shunt. Emergent re-exploration identified a membranous septum tear. The Perceval prosthesis was explanted, the defect was closed with a reinforced patch repair, and a 27 mm Inspiris Resilia bioprosthesis was implanted. Peripheral veno-arterial ECMO support was required temporarily. The patient recovered and remained free of prosthetic dysfunction at the two-year follow-up. Discussion: Membranous septum rupture after AVR has an estimated incidence of 0.4–1.5% in TAVR cohorts but is virtually unreported with Perceval valves. The mechanisms are thought to be chronic radial stress from oversized or malpositioned prostheses. Case reports with TAVR devices emphasize oversizing as a risk factor. Predictive factors for septal injury in sutureless AVR mirror those for conduction disturbances: valve oversizing, shallow infra-annular septal length, heavy calcification, and prior valve surgery. Preventive measures, such as strict sizing protocols, the avoidance of balloon dilation, and optimized implantation depth, have reduced conduction complications and may mitigate septal trauma. The treatment choice, whether percutaneous or surgical closure, depends on hemodynamic stability, defect size and anatomy, and operative risk. Conclusions: Early ARVF after Perceval implantation is exceedingly rare but potentially catastrophic. Strict adherence to sizing principles, awareness of septal anatomy, and prompt management, percutaneous in selected stable cases or surgical in acute large defects, are essential to optimize outcomes in sutureless AVR. Full article

Background/Objectives: Transsphenoidal surgery has become the gold standard for the treatment of sellar and parasellar lesions, but it remains associated with significant anatomical challenges and the risk of intraoperative complications. The limitations of conventional imaging in depicting the complex three-dimensional anatomy of the skull base have led to a growing interest in virtual (VR) and augmented reality (AR) technologies, which offer enhanced spatial visualization, preoperative simulation, and image-guided intraoperative navigation. This systematic review aims to evaluate the current evidence on the role of virtual and augmented reality in transsphenoidal surgical interventions, with a focus on their impact on preoperative planning, intraoperative orientation, surgical outcomes, and neurosurgical training. Methods: A systematic literature search was conducted in accordance with PRISMA 2020 guidelines across PubMed, Scopus, and Web of Science for the period 2015–2025. MeSH terms and free-text keywords related to transsphenoidal surgery, sphenoid sinus anatomy, and VR/AR technologies were combined using Boolean operators. Risk of bias was assessed using RoB 2.0 for RCTs; methodological quality was assessed using the Newcastle–Ottawa Scale for observational studies and AMSTAR 2 for systematic reviews. Clinical, morphometric, and experimental studies evaluating VR/AR applications were included. Data were extracted using a standardized protocol and synthesized through qualitative analysis, with subgroup analysis by technology type (VR vs. AR) and clinical application domain. Results: A total of 218 publications were identified, of which 52 met the inclusion criteria (clinical studies n = 12, simulation and technology studies n = 30, morphological studies n = 10). VR-based three-dimensional reconstructions were consistently associated with improved preoperative spatial orientation and anatomical landmark recognition. AR systems demonstrated a meaningful contribution to intraoperative navigation, with reported reductions in time to target and improved visualization of critical neurovascular structures. VR platforms showed high effectiveness in surgical training, with shorter learning curves and improved technical performance. However, the majority of included studies were small observational cohorts, simulation studies, or expert overviews, with substantial heterogeneity in methodology, technology platforms, and outcome measures, precluding quantitative meta-analysis. Conclusions: Virtual and augmented reality represent clinically promising adjuncts to transsphenoidal surgery, with demonstrated benefits in preoperative planning, intraoperative navigation, and surgical training. These conclusions should be interpreted in the context of a predominantly early-phase and heterogeneous evidence base. Standardized protocols, larger prospective studies, and randomized trials are needed before the integration of VR/AR with navigation systems and artificial intelligence can be established as a routine component of personalized transsphenoidal surgery. Full article

Adrenal tumors are increasingly diagnosed due to widespread use of cross-sectional imaging and an aging population, making adrenalectomy a progressively more common surgical procedure. Over the past three decades, adrenal surgery has undergone a paradigm shift from open adrenalectomy to minimally invasive (MI) techniques, with laparoscopic adrenalectomy becoming the standard approach for most benign and selected malignant adrenal tumors. More recently, retroperitoneoscopic and robotic approaches have expanded the armamentarium available to adrenal surgeons, allowing for tailored, patient-specific surgical strategies. This review summarizes current evidence on MI adrenalectomy techniques, including transperitoneal and retroperitoneal laparoscopic approaches, hand-assisted adrenalectomy, and robotic adrenalectomy, with particular emphasis on their role in pheochromocytoma and adrenocortical carcinoma. In addition, evolving ancillary technologies such as laparoscopic ultrasound, indocyanine green fluorescence imaging, artificial intelligence, and virtual and augmented reality are reviewed, highlighting their potential to enhance intraoperative decision-making, safety, and surgical precision. Current controversies, including the role of preoperative alpha-blockade, partial versus total adrenalectomy in hereditary pheochromocytoma, the oncologic adequacy of MI surgery for adrenocortical carcinoma, and the selective use of lymph node dissection, are discussed. Available evidence supports MI adrenalectomy as a safe and effective approach in carefully selected patients when performed by experienced surgeons in high-volume centers. Technological innovations continue to refine surgical planning, execution, and training, suggesting that the future of adrenal surgery will increasingly rely on precision-guided, personalized, and data-driven strategies. This review offers a timely and comprehensive synthesis of the evolving landscape of MI adrenalectomy, uniquely integrating current evidence across the full spectrum of surgical techniques with a critical appraisal of emerging ancillary technologies while addressing unresolved clinical controversies relevant to contemporary surgical practice. Full article

Background: Transcatheter mitral valve implantation (TMVI) represents an evolving therapeutic strategy for patients with severe mitral valve disease who are at high or prohibitive risk for conventional surgery. Since the first human implantation in 2012, multiple dedicated and adapted devices have entered clinical investigation, yet only one dedicated system—the Tendyne prosthesis (Abbott Structural)—holds regulatory approval. This systematic review evaluates the current landscape of available and emerging TMVI devices, examines the clinical outcome data, discusses key indications and limitations, analyses the role of computed tomography (CT) in predicting left ventricular outflow tract (LVOT) obstruction caused by the unopposed anterior mitral leaflet, and compares TMVI outcomes with conventional surgical mitral valve replacement (SMVR) in the specific context of severe mitral annular calcification (MAC). Methods: A systematic search of PubMed, EMBASE, Cochrane Central, and Web of Science was performed for studies published from January 2010 to March 2025 reporting outcomes of TMVI in native valve disease, valve-in-valve (ViV), valve-in-ring (ViR), or valve-in-MAC (ViMAC) procedures. Studies reporting CT-based LVOT planning, neo-LVOT quantification, and LVOT obstruction outcomes were specifically sought. Meta-analyses comparing TMVI with redo surgical mitral valve replacement were included. A total of 63 studies (n > 12,000 patients across all subgroups) were included in the qualitative synthesis; 28 studies were included in the quantitative synthesis. Results: Nine dedicated TMVI devices are currently under clinical investigation, with only Tendyne holding CE Mark and FDA approval. In ViV/ViR cohorts, TMVI was associated with significantly lower in-hospital mortality (OR 0.72, 95% CI 0.57–0.92; p = 0.008) and 30-day mortality (OR 0.49; p = 0.04) compared with redo SMVR, with no significant difference at one year (OR 1.03; p = 0.91). In ViMAC cohorts, 30-day mortality ranged from 14 to 24%, which was substantially higher than in the ViV outcomes. CT-based virtual simulation of the neo-LVOT area—the residual outflow tract created by anterior mitral leaflet displacement—is the most validated predictor of LVOT obstruction, with a threshold of ≤1.7 cm² yielding 96% sensitivity and 92% specificity. The LAMPOON technique (laceration of the anterior mitral leaflet to prevent outflow obstruction) has expanded the eligibility for patients who were previously excluded due to LVOT risk. Surgical MVR in severe MAC carries a median 30-day mortality of 6.3% (range 0–27.3%), while ViMAC TMVI with dedicated devices yields 6.8% 30-day mortality, without a definitive randomised comparison. Conclusions: TMVI offers a viable alternative to redo surgery in high-risk patients with failed bioprostheses or rings. In severe MAC, both surgical and transcatheter approaches carry significant risk; patient selection, CT-guided LVOT planning, and use of dedicated devices are critical to optimising outcomes. The ongoing SUMMIT randomised controlled trial will provide the first high-quality comparative data. Future developments in transseptal delivery and LVOT-safe device architectures are expected to broaden the eligible population. Full article

Computer-assisted surgical simulation (CASS) in craniomaxillofacial (CMF) surgery is traditionally performed using a computer interface (CI) with a two-dimensional monitor, while the adoption of immersive virtual reality (VR) remains limited. This study examined how low-dose (LD) and high-dose (HD) cone beam computed tomography (CBCT) imaging modes influence image quality and usability across both CI and VR environments. Five CMF radiologists rated CBCT views and 3D-segmented models on a 0–4 Likert scale, and intra- and interobserver agreement was calculated. VR usability was further assessed using the NASA Task Load Index and follow-up interviews. LD imaging performed comparably to HD in both interfaces, with slightly higher scores for CBCT views in LD mode. For 3D models, HD scored marginally higher in CI, whereas LD performed slightly better in VR. Observer agreement ranged from fair to excellent, and VR demonstrated reliability like CI. NASA-TLX results indicated reductions in mental and temporal demand, along with decreased effort and frustration during VR use, suggesting diminishing cognitive and emotional strain over time. In this pilot study, the findings suggest that LD CBCT may be feasible for selected CMF CASS applications and that VR offers an immersive and user-friendly alternative without compromising diagnostic reliability, supporting its potential role in future surgical planning. Full article

Background: Enhanced Recovery After Surgery (ERAS) pathways depend on nursing-led safety behaviours such as early mobilisation, opioid-sparing analgesia, device minimisation, and reliable discharge teaching to prevent immobility-related, opioid-related, and device-related harms. However, pre-licensure medical–surgical preparation inconsistently embeds these competencies, leaving ERAS delivery and patient-safety vulnerable to variation. Objective: To develop an evidence-informed, practice-development framework that translates ERAS principles into measurable nursing competencies and management priorities explicitly linked to patient-safety, quality improvement, and harm reduction in acute surgical care. Methods: This practice-development framework paper used a narrative literature review of ERAS guidelines, AACN Essentials, and published simulation reports (MEDLINE, CINAHL, Embase, Scopus, ERIC) to identify recurring competencies and scenario features. These were inductively organised and mapped to patient-safety priorities to derive a four-domain framework. Findings: Identified simulations emphasised early mobilisation and multimodal analgesia; nutrition, fluid stewardship, device minimisation, and ERAS-focused patient education were less represented. High-fidelity and virtual formats improved knowledge and confidence but rarely reported patient-level outcomes. These gaps informed a four-domain framework: (1) ERAS clinical pillars and priority nursing competencies; (2) scenario and modality design (including a worked POD-1 colorectal case); (3) assessment and feedback strategies anchored by the Lasater Clinical Judgement Rubric; and (4) implementation tools for nurse managers and ERAS leads to integrate simulation into orientation and quality dashboards. The framework conceptually links competencies to safety-relevant endpoints including opioid-related adverse events, immobility-related complications, device-related harms, and discharge-education reliability. Conclusions: ERAS-aligned simulation may offer a feasible, scalable patient-safety and practice-development strategy for aligning pre-licensure preparation with nursing-management priorities for harm reduction. The framework provides a conceptual model that warrants empirical evaluation. It maps ERAS pillars to nursing competencies, operationalises these through a reusable colorectal scenario, and links simulation-derived competencies to unit-level recovery and safety agendas. Full article