Digestive Surgery Research Articles

Feeding interruptions for extubation and other procedures.

The objective of this review is to examine the available evidence concerning feeding interruptions before extubation and other medical procedures in ICUs. We will analyze the physiological mechanisms involved, the potential risks associated with feeding interruptions, as well as the results of recent clinical studies. Additionally, we will explore current practices and recommendations from major professional societies, as well as recent innovations aimed at minimizing feeding interruptions. Fasting before extubation is a common yet heterogeneous practice, varying across ICUs. Although dysphagia is a frequent complication after extubation, its prevalence decreases over time. However, physiologically, fasting before extubation appears ineffective in reducing gastric content or preventing aspiration. The Ambroisie study demonstrated that continuing enteral nutrition up to extubation is not inferior to a 6 h fasting strategy in terms of extubation failure at 7 days. The management of perioperative nutrition in intubated patients is debated. A retrospective study found no significant difference in postoperative respiratory events between patients fasting for at least 6 h and those fasting less or not at all but further prospective randomized studies are needed for definitive conclusions. For abdominal and digestive surgeries, fasting remains necessary to simplify procedures and reduce contamination risks. For invasive ICU procedures, such as catheter placement, the continuation of enteral nutrition appears reasonable. However, for percutaneous tracheotomy, limited evidence suggests no clear benefit from fasting, though the risk of large-volume aspiration during the procedure raises concerns. The approach to nutrition in this context requires further investigation. Fasting before extubation in ICUs is a common practice inherited from anesthesia, aiming to reduce the risk of aspiration. The Ambroisie study demonstrates that continuing enteral nutrition until extubation is not inferior to a 6 h fasting strategy regarding extubation failure at 7 days.

Management strategy of giant inguinoscrotal hernia-a case series of 24 consecutive patients surgically treated over 17years period.

Management of giant inguinoscrotal hernia (GIH) is still a challenging procedure associated with a higher risk of intraabdominal hypertension and abdominal compartment syndrome as a life-threatening condition. The aim of the study was to present our management strategy for GIH. This is a retrospective review of a case series including 24 consecutive patients with 25 GIH who underwent reconstructive surgery from January 2006 to June 2023, at the University Clinic for Digestive Surgery and Hernia Center Zuvela. A combined surgical strategy was applied: the modified Rives repair for groin hernias alone, Rives combined with organ resection to reduce hernia contents, and Rives combined with procedures for abdominal cavity enlargement. A surgical approach was defined based on the patient's general health, the volume of the hernia sac, and perioperative parameters. All patients were male aged between 43 and 82years. Rives was the only procedure in 12 patients. In addition to Rives, omentectomy was performed in four patients and intestinal resection in one. Abdominal cavity enlargement was performed following Rives hernioplasty in 9 patients. The median operative time was 215min (range, 70-720). Surgical complications occurred in seven patients. In-hospital mortality was 12.5%. There was no groin hernia recurrence. Our strategy is a single-stage treatment including modified Rives repair with or without additional procedures for abdominal cavity enlargement or hernia volume reduction, tailored to the individual patient characteristics. The procedure is associated with a higher risk of major morbidity requiring a well-trained intensive care unit team.

Blood Pressure Estimation Using Explainable Deep-Learning Models Based on Photoplethysmography.

Due to their invasiveness, arterial lines are not typically used in routine monitoring, despite their superior responsiveness in hemodynamic monitoring and detecting intraoperative hypotension. To address this issue, noninvasive, continuous arterial pressure monitoring is necessary. We developed a deep-learning model that reconstructs continuous mean arterial pressure (MAP) using the photoplethysmograhy (PPG) signal and compared it to the arterial line gold standard. We analyzed high-frequency PPG signals from 117 patients in neuroradiology and digestive surgery with a median of 2201 (interquartile range [IQR], 788-4775) measurements per patient. We compared models with different combinations of convolutional and recurrent layers using as inputs for our neural network high-frequency PPG and derived features including dicrotic notch relative amplitude, perfusion index, and heart rate. Mean absolute error (MAE) was used as performance metrics. Explainability of the deep-learning model was reconstructed with Grad-CAM, a visualization technique using saliency maps to highlight the parts of an input that are significant for a deep-learning model decision-making process. An MAP baseline model, which consisted only of standard cuff measures, reached an MAE of 6.1 (± 14.5) mm Hg. In contrast, the deep-learning model achieved an MAE of 3.5 (± 4.4) mm Hg on the external test set (a 42.6% improvement). This model also achieved the narrowest confidence intervals and met international standards used within the community (grade A). The saliency map revealed that the deep-learning model primarily extracts information near the dicrotic notch region. Our deep-learning model noninvasively estimates arterial pressure with high accuracy. This model may show potential as a decision-support tool in operating-room settings, particularly in scenarios where invasive blood pressure monitoring is unavailable.

Rouvière's Sulcus as a Landmark for a Safe Laparoscopic Cholecystectomy: An Interim Analysis of a Multicenter Cross-sectional Study on the Prevalence and Morphologic Type of Rouvière's Sulcus in the Italian Population.

Laparoscopic cholecystectomy is the gold standard in the treatment of symptomatic gallstones. The large number of gallbladders removed every year is not fully consistent with the excessively high incidence of iatrogenic bile duct injury (IBDI). Several strategies have been suggested to reduce this risk. Among them, the use of extra biliary anatomic structures, such as the Rouvière's sulcus, as a landmark to guide the surgeon during dissection has been proposed as a means to prevent IBDI. The main aim of the present paper is the evaluation of the prevalence of Rouvière's sulcus (RS) and its anatomic variants in a given population. This observational, cross-sectional, and multicenter study has been conducted at the Department of Digestive and Emergency Surgery of the "Azienda Ospedaliera Santa Maria," Terni (Italy), at the Department of Surgical Sciences of the "Azienda Ospedaliera Perugia," Perugia (Italy) and at the Department of Emergency and Trauma Surgery of the "Policlinico Umberto I," Rome (Italy). Intraoperative images of 111 patients undergoing laparoscopic cholecystectomy were analyzed to identify the presence and type of RS, according to the Singh-Prasad classification and the Dahmane classification. RS was present in 93 (83.8%) patients. Singh-Prasad type 1A is present in 48.4% of patients, type 1B in 25.8%, type 2 in 12.9% and type 3 in 12.9%. Dahmane's open type is present in 48.4% of patients and fused type in 51.6%. Due to its high prevalence, RS can be used as an anatomic landmark and probably reduces the incidence of IBDI during laparoscopic cholecystectomy.

Status and Prospects of Robot-Assisted Surgery in the Digestive Surgery

Status and Prospects of Robot-Assisted Surgery in the Digestive Surgery

The Effect of Vitamin D Supplementation on Quality of Life in Stage II-III Colorectal Cancer Patients Undergoing Adjuvant Chemotherapy: A Single-Blind, Randomized Controlled Trial.

Colorectal cancer is the third most common cancer with the second highest mortality worldwide in 2020. Adjuvant chemotherapy is given for stage II-III colorectal cancer. However, there are side effects that decrease the patient's quality of life. Several studies have found that vitamin D could reduce the side effects of chemotherapy, but studies at Hasan Sadikin Hospital have not been done. A study regarding the effect of vitamin D supplementation on the quality of life of stage II-III colorectal cancer patients undergoing adjuvant chemotherapy from May 2022 to April 2023 at Hasan Sadikin Hospital was conducted. A single-blinded, randomized controlled trial (RCT) with consecutive sampling was done at the digestive surgery outpatients. Data was taken from the medical record, history taking, and personal interviews. Quality of life was measured at the first, third, and sixth months after chemotherapy using the validated Indonesian version of the EORTC QLQ-C30 questionnaire. A total of 34 patients received vitamin D and 34 others received placebo. Serum vitamin D levels significantly increased (p < 0.001) in the intervention arm, from a median of 21.34 (5.26-29.95) to 27.92 (13.58-40.49). Meanwhile, it decreased in the placebo arm, from a median of 22.78 (8.3-29.93) to 21.37 (7.45-31.26). The patient's quality of life improved significantly after receiving vitamin D, compared with the placebo group on the third (median of 75.0 vs 45.83) and sixth (median of 83.33 vs 33.33) months after chemotherapy. Vitamin D consumption (10,000 IU/day) could improve the quality of life of colorectal cancer patients undergoing adjuvant chemotherapy.

Clinical features and risk factors for colorectal gas explosion during digestive endoscopy and surgery: a systematic review.

Colorectal gas explosion (CGE) is an exceptional but potentially fatal complication of digestive endoscopy or surgery. The role played by bowel preparations and endoscopic or surgical devices in the risk of CGE is still unclear. We conducted a systematic review of the literature to identify risk factors for CGE. We conducted a comprehensive literature search of multiple databases from inception to September 16, 2024 including all reports of CGE according to a systematic review protocol preregistered on the PROSPERO database (CRD42023455049). Additionally, we analyzed all trials that measured explosive gas levels after different bowel preparation strategies. Twenty-nine case reports, three case series, and eleven trials were included. Thirty-six cases of CGE were described, 12 surgical and 24 endoscopic. Perforation and death following CGE occurred in 81% and 14% of patients, respectively. The most common bowel preparations taken before CGE were enemas (42%) and oral preparations (31%), while 28% of patients did not undergo any bowel preparation. Bowel preparation was reported as inadequate in most CGE (solid stool in 65% and poor in 11%). The most frequent devices that triggered CGE were argon plasma coagulation during endoscopy (58%) and the electric scalpel during surgical procedures (75%). Published trials showed that adequate bowel preparation, together with endoscopic insufflation and suction, reduces intestinal levels of hydrogen and methane. CGE predominantly occurs in patients undergoing interventional procedures with inadequate bowel preparation. Achieving optimal bowel preparation, together with endoscopic aspiration, washing, and CO2 insufflation practically abolishes potentially explosive gas concentrations.

Scheduled Surgery and Antibiotic Therapy in Catarrhal Acute Appendicitis

&amp;lt;i&amp;gt;Introduction: &amp;lt;/i&amp;gt;Appendicitis is an acute inflammation of the appendix. Appendectomy remains one of the most frequently performed digestive surgeries in the world. The degree of urgency of this surgery and the increasingly proven efficacy of antibiotics still remains a debate. The main objectiveof our study is to compare the therapeutic results of a programmed appendectomy initially treated by antibiotic versus emergency appendectomies performed from the outset in casesof simple acute appendicitis. &amp;lt;i&amp;gt;Patients and method: &amp;lt;/i&amp;gt;Our comparative study was carried out at the Joseph Ravoahangy Andrianavalona University Hospital from 01th August 2021 to 31th July 2022. Group A included simple acute appendicitis patients who underwent emergency surgery, while group B included patients who had been treated with antibiotics for ten days before undergoing surgery. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;Our cohort of 95 patients comprised 70 patients (group A) versus 25 patients (group B). Twenty-three patients (92%) in group B had a Clavien-Dindo I score compared with 74.3% in group A. Parietal infections were 21% (group A) vs 4% (group B). There was no significant difference inpatient outcome between the two groups. &amp;lt;i&amp;gt;Conclusion: &amp;lt;/i&amp;gt;Antibiotic therapy has already proved effective in the treatment of simple acute appendicitisin recent years, and means that emergency surgery can be avoided. However, the timingof surgery remains debatable in fragile patients.

Association of physical activity with health-related quality of life in rectal cancer survivors

Abstract Background Health-related quality of life (HRQoL) in rectal cancer survivors after completion of surgical treatment may be influenced by various factors including physical activity. The purpose of this study was to examine the association between regular exercise and physical and mental health in rectal cancer survivors. Methods People who underwent surgical resection of rectal cancer with temporary ileostomy from 2018 to 2021 were invited to participate. Participants were drawn from the Clinic for Digestive Surgery and the Clinic for Emergency Surgery of the University Clinical Center of Serbia, as well as the nationwide laparoscopic program - LapSerb consortium. Data were collected through interviews in late 2022 and early 2023. The HRQoL was evaluated using the physical composite score (PCS) and mental composite score (MCS) of the Short Form-36 (SF-36) questionnaire. Socio-demographic, clinical and behavioral characteristics including the frequency of exercise were analyzed in multiple linear regression models. Results A total of 134 rectal cancer survivors were tested. Few participants (18.7%) exercised regularly, while most of the study population occasionally (41.8%) or never engaged (39.5%) in physical activity. Rectal cancer survivors who exercised regularly had significantly higher scores of physical (75.5 vs. 62.8, p = 0.019) and mental quality of life (78.9 vs. 63.8, p = 0.008). Regular exercise remained associated with better physical and mental health after the adjustment for demographic, clinical and behavioral characteristics. Conclusions Consistent physical exercise seems to be significant contributor of better physical and mental quality of life in rectal cancer survivors after completion of surgical treatment. Key messages • Physical exercise may help rectal cancer survivors improve their physical and mental health. • Promotion of physcial activity in rectal cancer survivors could optimize recovery after surgery.

The prevalence of small intestine bacterial overgrowth in irritable bowel syndrome is much higher with lactulose than glucose breath test: Results of a retrospective monocentric study

BackgroundGlucose (GBT) and lactulose (LBT) breath tests have been recommended for the diagnosis of small intestinal bacterial overgrowth (SIBO). LBT may yield a higher prevalence of SIBO diagnosis, because of its limited small bowel absorption, and therefore colonic fermentation. The aim of this retrospective study was to confirm this hypothesis, in irritable bowel syndrome patients (IBS). MethodsAmong a cohort of 995 patients who underwent GBT or LBT, 287 with typical IBS according to Rome IV criteria, without past digestive surgery or significant medical comorbidities, were included. Results155 IBS patients underwent GBT, and 132 LBT (71% women, mean age 45±15, mean BMI: 22.6±4.3 kg/m2). There were no difference between both groups in terms of demographics, IBS type and severity of symptoms. The prevalence of SIBO according to LBT was 47%, versus 4.5% only with GBT (p<0.001). The prevalence of methane values ≥ 10 ppm were similar in both groups (34%). ConclusionLBT is very frequently positive in IBS patients, as compared to GBT. The 2 tests are thus not interchangeable for the diagnosis of SIBO. Furthermore, the positivity of both tests was not correlated with symptoms, which may indicate a poor clinical interest of these tests in IBS.

Causes Of Exercise Intolerance And Their Role In Predicting Response To Prehabilitation In Patients Awaiting Major Digestive Surgery

Causes Of Exercise Intolerance And Their Role In Predicting Response To Prehabilitation In Patients Awaiting Major Digestive Surgery

Precose Post-Operative Complications of Abdominal Surgery at the Communal Medical Center of Ratoma (CMC Ratoma)

&amp;lt;i&amp;gt;Introduction: &amp;lt;/i&amp;gt;Postoperative complications are incidents or accidents that may occur after any surgical intervention. They lead to the aggravation of the previous situation by their morbidity and even their mortality. The objective of this work was to study the early postoperative evolution in the digestive surgery and Maternity departments at the CMC of Ratoma. &amp;lt;i&amp;gt;Methodology&amp;lt;/i&amp;gt;: This was a descriptive prospective study over a period of (6) months from July 01, 2021 to December 31, 2021 carried out in the surgery and maternity departments of the Ratoma municipal center. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: we operated on 403 patients in the surgery and maternity departments of the CMC in Ratoma, of which 50 cases, or 12%, developed early postoperative complications. The age group of 20-30 years was the most affected 22 cases or 44% with an average age of 29.5 years, extremes of 3 years and 85. The female sex was dominant 36 cases or 78% of cases with a sex ratio of 3.5. The majority of patients 26 or 56% were operated on in the maternity ward, where caesarean section was the most performed surgical procedure. Emergencies were represented in 26 cases or 56% of surgical interventions, infection of the surgical site was the most common postoperative complication in 40 cases or 80%. All our suppurated patients benefited from a pus sample for cytobacteriological examination and were treated according to the result of the antibiogram plus local care. 72% of our patients were followed on an outpatient basis. The evolution was favorable in 44 of our patients, i e. 88%, and unfavorable in 6 of our patients, i e. 12%, including ISO, evisceration and death each in 2 cases, i e. a common rate of 4%. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Early postoperative complications were frequent at CMC Ratoma. Surgical site infections were the main early OCC presented by the patients. The management was medical and surgical. The evolution was favorable in most cases, however we recorded a few cases of death.

Versatile and Tunable Performance of PVA/PAM Tridimensional Hydrogel Models for Tissues and Organs: Augmenting Realism in Advanced Surgical Training.

The increasing complexity and difficulty of surgical procedures have led to a rise in medical errors within clinical settings in recent years. Gastrointestinal diseases, in particular, present significant medical challenges and impose substantial economic burdens, underscoring the urgent need for experiential, high-fidelity gastrointestinal surgical training tools. This study leverages patient-specific computed tomography (CT) and magnetic resonance imaging (MRI) data, combined with 3D printed manufacturing, to develop hydrogel organ models with tunable performance and tissue-mimicking softness. These properties are achieved by regulating the freeze-thaw cycles, cross-linking agents, and the concentration of incorporated antibacterial nanoparticles in DN hydrogels. Through the application of indirect 3D printing and the "sacrificial material method", we successfully fabricate organ tissues such as the stomach, intestines, and blood vessels with high precision. In ex vivo surgical training demonstrations, these tissue-like soft hydrogels provide an effective platform for preoperative simulation and surgical training in digestive surgery, accommodating various surgical procedures and accurately simulating intraoperative bleeding. The development of advanced bionic organ models with specific and tunable characteristics based on DN hydrogels is poised to significantly advance surgical training, medical device testing, and the reform of medical education.

Organization of abdominal emergency surgical care across healthcare services in Senegal: a cross-sectional nationwide survey

IntroductionStudying surgical services and the workforce in sub-Saharan Africa is crucial for enhancing access to quality surgical care in the region. Despite many recommendations to produce evidence based on reliable data on this subject to guide policymakers, there is still a knowledge gap on this topic. The aim of this nationwide survey was to describe the organization of abdominal emergency surgical care across healthcare services in Senegal.MethodologyThis was a cross-sectional nationwide survey. The study period was between October 1st, 2023, and January 20th, 2024. The target population included all registered healthcare facilities in Senegal offering emergency surgical services. A structured questionnaire was designed to gather infrastructure-related data, surgical activities, and human resources.ResultsAll 33 identified healthcare facilities responded to the survey (100%). Emergency abdominal surgery services were available for 96.7% of the surveyed structures. The teams were mainly composed of surgeons and residents (45.2%) or surgeons and medical trainees (48.8%). The average bed capacity of the services was 21.9, with a standard deviation of 13.9. The absence of a dedicated hospitalization section for patients requiring special monitoring was found in 69.6% of the facilities. Operating rooms dedicated to emergency abdominal digestive surgery were present in 54.6% of the services. On average, the services performed 17.6 scheduled surgical interventions with a standard deviation of 11.5 and 29.7 emergency surgical interventions with a standard deviation of 16.8 per month. Morbidity and mortality conferences were not routinely held in the majority of departments (only 27.3%). Professional development programmes were present only in 24.2% of departments. Most of the departments did not have adequate human resources (69.6%). A total of 70 surgeons were identified, resulting in a national ratio of 0.39 general surgeons per 100,000 inhabitants. The strategies employed to address staff shortages included additional working hour by staff (54.5%), temporary workers (30.3%) or the use of trainee doctors or nurses (12.1%).ConclusionThis research shows that significant deficiencies are present in the essential physical and human resources needed to conduct fundamental life-saving surgical procedures. These findings suggest potential areas for improvement in the delivery of emergency surgical care in the region.

Effects of branched-chain amino acids on changes in body composition during the recovery period following tonsillectomy

PurposeIn recent decades studies have examined body weight changes following tonsillectomy. In nutrition science, the focus has shifted from body mass index to body composition analysis. However, no studies have explored body composition changes post-tonsillectomy. In oncology and digestive surgeries, the potential benefits of branched-chain amino acids (BCAAs) have been investigated; however, their effects on pharyngeal surgery remain unknown. Therefore, the aim of the present study was to investigate the body composition changes after tonsillectomy and to explore the potential benefits of branched-chain amino acids.MethodsThis prospective interventional controlled study enrolled 48 patients who were randomly assigned to a control group (CG) and an experimental group (EG). These groups were further divided into active and inactive subgroups on the basis of their activity levels. The EG consumed 2 × 4 mg of BCAA daily. Body composition was measured using bioimpedance (InBody 270) on the day of surgery and again on days 7 and 21 postoperatively.ResultsBoth groups experienced similar weight loss; however, significant differences in body composition emerged. The CG showed significant muscle mass loss (from 30,29 to 28,51 kg), whereas active EG members maintained muscle mass (from 35,33 to 35,40 kg); inactive EG members increased muscle mass (from 26,70 to 27,56 kg) and reduced body fat percentage (from 31.94% to 29.87%). The general health status (InBody score) remained stable or improved in the EG (from 75,13 to 75,96); however, it decreased in the CG (from 75,42 to 72,67).ConclusionThe negative effects of tonsillectomy on body composition are mitigated by BCAA supplementation.

Rationality of Empirical Antibiotic Usage among Digestive Surgery Inpatients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia: Gyssens Criteria Analysis

Background: Many empirical antibiotics are prescribed unnecessarily, contributing to the rise in the incidence of antibiotic resistance. Preventing infection of surgical sites is one of the most frequent purposes of empirical antibiotic usage. Therefore, this study aimed to analyze the rationality of empirical antibiotic usage among digestive surgery inpatients based on the Gyssens criteria and clinical features outcomes. Methods: A descriptive method was used with a cross-sectional design. Data was collected from medical records of patients underwent digestive surgery and had received empirical antibiotic therapy post-surgery from July to September 2021 at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Subsequently, the data was analyzed using the Gyssens method to qualitatively assess the rationality of antibiotic use based on specific criteria, classified from rational (category 0) to various levels of irrational use (categories I-VI). Clinical outcomes were evaluated by assessing leukocyte count, clinical symptoms of fever, and the appearance of surgical site infection before and after administration of empirical antibiotics. Results: In total, 70 empirical antibiotic prescriptions were obtained from 42 patients, with only 40% of patients using rational antibiotics, whereas 60% of antibiotics were used inappropriately (category I-VI). Clinical evaluation showed no fever, edema, or erythema and reduced leukocytosis and exudate/pus post-therapy. Conclusions: Inappropriate empirical antibiotic prescription for digestive surgery inpatients at Dr. Hasan Sadikin General Hospital based on the Gyssens criteria is high. Nonetheless, clinical outcomes showed improvements in infection-related parameters. These results emphasize the importance of stricter adherence to antibiotic stewardship and regular evaluation of empirical antibiotic practices to optimize usage and patient outcomes.

Preoperative frailty and postoperative complications after non-cardiac surgery: a systematic review.

Many tools have been used to assess frailty in the perioperative setting. However, no single scale has been shown to be the most effective in predicting postoperative complications. We evaluated the relationship between several frailty scales and the occurrence of complications following different non-cardiac surgeries. This systematic review was registered in PROSPERO (CRD42023473401). The search strategy included PubMed, Google Scholar, and Embase, covering manuscripts published from January 2000 to July 2023. We included prospective and retrospective studies that evaluated frailty using specific scales and tracked patients postoperatively. Studies on cardiac, neurosurgical, and thoracic surgery were excluded because of the impact of underlying diseases on patients' functional status. Narrative reviews, conference abstracts, and articles lacking a comprehensive definition of frailty were excluded. Of the 2204 articles identified, 145 were included in the review: 7 on non-cardiac surgery, 36 on general and digestive surgery, 19 on urology, 22 on vascular surgery, 36 on spinal surgery, and 25 on orthopedic/trauma surgery. The reviewed manuscripts confirmed that various frailty scales had been used to predict postoperative complications, mortality, and hospital stay across these surgical disciplines. Despite differences among surgical populations, preoperative frailty assessment consistently predicts postoperative outcomes in non-cardiac surgeries.

Skill progress during a dedicated societal robotic surgery training curriculum including several robotic surgery platforms.

Robot-assisted procedures are increasingly common, and several systems are available for thoraco-abdominal surgery. Specific structured training is necessary, while access to these systems is still limited. This study aimed to assess surgeons' skill progress during consecutive training days of a curriculum with exposure to different robotic systems. This prospective observational study enrolled 47 surgeons with anonymized analysis of SimNow™ simulator performance scores and dedicated questionnaires after written consent. The primary outcome was the overall score, based on economy of motion, time to complete the exercise, and penalty for errors. Course participants in 2022-2023 had chosen 2 full hands-on days on Da Vinci® consoles with either virtual reality (VR) simulation training using the SimNow (n = 21, 44.7%) or digestive surgery procedures with a live animal model (n = 26, 55.3%). In all participants, training on Da Vinci® systems included console functions and principles of docking, camera, and instrument use for console and procedural training. They additionally had access to introductory dry-lab and VR simulator exercises on the Versius, HugoTMRAS, and Dexter systems and to VR exercises on the ROBOTiS simulator. The participants (16F/31M, median age 40years, range 29-58) from various surgical specialties (general/visceral/vascular) had no (n = 35, 74.5%) or little (n = 12, 25.5%) robotic experience including bedside assistance only and 20 (42.6%) had robotic simulator experience. The demographic variables fully completed by 44/47 participants (93.6%) and choice of module had no significant impact on the primary outcome. The considerable performance improvement from days 1 to 2 was exemplified by a significantly increased economy of motion and decreased amount of excessive force. Robotic surgical training is increasingly complex with several systems on the market. Within a dedicated robotic surgery curriculum and based on integrated performance metrics, a significant improvement of skill levels was observed in a relatively short period of time.

Impact of the thresholds of surgical volume on mortality in oncological digestive surgery: A French National Cohort

ObjectiveTo report the 90-day mortality benefit associated with the implementation of the new regulatory reform on oncological surgical digestive authorizations. Summary background dataNew thresholds in digestive cancer surgery were applied in 2023, accrediting centers for major interventions. No evidence has been provided to support their justification. MethodsAny French adult operated for digestive cancer from January 1, 2019 to December 31, 2021 was included from the PMSI. A 90-day mortality logistic regression was performed by adjusting by age, sex, Charlson score, Frailty index, hospital-volume (<5 or ≥5 interventions/year), emergency intervention, specialty. Results143,582 patients were identified. Of these, 64,268 underwent surgery of one of the subspecialties subject to the new thresholds (stomach N = 8283, liver N = 18,668, pancreas N = 11,220, esophagus N = 3704, rectum N = 22,393).4808 (7.5 %) patients underwent surgery in low-volume centers, distributed as follows: stomach 1757/8283 (22.94 %), liver 970/18,668 (5.19 %), pancreas 895/11,220 (7.98 %), esophagus 672/3704 (18.14 %) and rectum 514/22,393 (2.29 %).In univariate analysis, the 90-day mortality rate was significantly lower in high-volume centers, for all subspecialties, gastric: 127/1757 (7.23 %) vs 330/6526 (5.06 %), p = 0.0004, hepatic: 64/970 (6.6 %) vs 824/17,698 (4.66 %), p = 0.006, pancreatic: 74/895 (8, 27 %) vs 608/10,325 (5.89 %), p = 0.004, esophageal: 58/672 (8.63 %) vs 195/3032 (6.43 %), p = 0.04, rectal 26/514 (5.06 %) vs 639/21,879 (2.92 %), p = 0.005.The multivariate analysis, showed a mortality reduction for high-volume centers: OR = 0.78 CI95[0.71–0.87], p < 0.001. ConclusionThe recent implementation of regulatory decrees appears to be justified. The enforcement of these hospital volume thresholds is likely to contribute to a reduction in postoperative mortality following digestive cancer surgery.

Smart Operating Room in Digestive Surgery: A Narrative Review.

The introduction of new technologies in current digestive surgical practice is progressively reshaping the operating room, defining the fourth surgical revolution. The implementation of black boxes and control towers aims at streamlining workflow and reducing surgical error by early identification and analysis, while augmented reality and artificial intelligence augment surgeons' perceptual and technical skills by superimposing three-dimensional models to real-time surgical images. Moreover, the operating room architecture is transitioning toward an integrated digital environment to improve efficiency and, ultimately, patients' outcomes. This narrative review describes the most recent evidence regarding the role of these technologies in transforming the current digestive surgical practice, underlining their potential benefits and drawbacks in terms of efficiency and patients' outcomes, as an attempt to foresee the digestive surgical practice of tomorrow.