Optimizing adjuvant treatment strategies for non-pancreatic periampullary cancers.

Non-pancreatic periampullary tumors have long been neglected, leading to blurred adjuvant treatment strategies. Recent research, like the ISGACA group's study, is uncovering nuances in chemotherapy efficacy for these diverse cancers. Tailored approaches show promise, with artificial intelligence (AI) aiding in personalized treatment plans.

Study International Multicentric Pancreatic Left Resections (SIMPLR): Does Surgical Approach Matter?

Background: Minimally invasive surgery is increasingly preferred for left-sided pancreatic resections. The SIMPLR study aims to compare open, laparoscopic, and robotic approaches using propensity score matching analysis.

Methods: This study included 258 patients with tumors of the left side of the pancreas who underwent surgery between 2016 and 2020 at three high-volume centers.

The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS).

Objective: To develop and update evidence-based and consensus-based guidelines on laparoscopic and robotic pancreatic surgery.

Summary Background Data: Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines.

Status of Women in Neurosurgery: Results from a National Survey in Italy.

Background: Gender inequity in surgery has increasingly been a matter of debate. Contributions of female neurosurgeons to academic medicine and societies are poorly highlighted. The aim of this study was to evaluate several aspects of the professional and work-life balance of female neurosurgeons in Italy.

Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2).

Introduction: Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM) was a propensity score matched (PSM) study that reported short-term outcomes of patients with CRLM who met the Milan criteria and underwent either open (OLR), laparoscopic (LLR) or robotic liver resection (RLR). This study, designated as SIMMILR-2, reports the long-term outcomes from that initial study, now referred to as SIMMILR-1. Methods: Data regarding neoadjuvant chemotherapeutic (NC) and neoadjuvant biological (NB) treatments received were collected, and Kaplan−Meier curves reporting the 5-year overall (OS) and recurrence-free survival (RFS) for OLR, LLR and RLR were created for patients who presented with synchronous lesions only, as there was insufficient follow-up for patients with metachronous lesions.

Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?-A Systematic Review and Meta-Analysis.

Background: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and laparoscopic liver resection with particular attention to the resection margin status in malignant cases.

The Advances in Computer Vision That Are Enabling More Autonomous Actions in Surgery: A Systematic Review of the Literature.

This is a review focused on advances and current limitations of computer vision (CV) and how CV can help us obtain to more autonomous actions in surgery. It is a follow-up article to one that we previously published in entitled, "Artificial Intelligence Surgery: How Do We Get to Autonomous Actions in Surgery?" As opposed to that article that also discussed issues of machine learning, deep learning and natural language processing, this review will delve deeper into the field of CV. Additionally, non-visual forms of data that can aid computerized robots in the performance of more autonomous actions, such as instrument priors and audio haptics, will also be highlighted.

The LiMAx Test as Selection Criteria in Minimally Invasive Liver Surgery.

Background: Liver failure is a crucial predictor for relevant morbidity and mortality after hepatic surgery. Hence, a good patient selection is mandatory. We use the LiMAx test for patient selection for major or minor liver resections in robotic and laparoscopic liver surgery and share our experience here.

Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM).

(1) Background: Here we report on a retrospective study of an international multicentric cohort after minimally invasive liver resection (SIMMILR) of colorectal liver metastases (CRLM) from six centers. (2) Methods: Resections were divided by the approach used: open liver resection (OLR), laparoscopic liver resection (LLR) and robotic liver resection (RLR). Patients with macrovascular invasion, more than three metastases measuring more than 3 cm or a solitary metastasis more than 5 cm were excluded, and any remaining heterogeneity found was further analyzed after propensity score matching (PSM) to decrease any potential bias.

Knowledge, attitude, and practice of artificial intelligence in emergency and trauma surgery, the ARIES project: an international web-based survey.

Aim: We aimed to evaluate the knowledge, attitude, and practices in the application of AI in the emergency setting among international acute care and emergency surgeons.

Methods: An online questionnaire composed of 30 multiple choice and open-ended questions was sent to the members of the World Society of Emergency Surgery between 29th May and 28th August 2021. The questionnaire was developed by a panel of 11 international experts and approved by the WSES steering committee.

Artificial intelligence in surgery: the emergency surgeon's perspective (the ARIES project).

Artificial Intelligence (AI) has been developed and implemented in healthcare with the valuable potential to reduce health, social, and economic inequities, help actualize universal health coverage, and improve health outcomes on a global scale. The application of AI in emergency surgery settings could improve clinical practice and operating rooms management by promoting consistent, high-quality decision making while preserving the importance of bedside assessment and human intuition as well as respect for human rights and equitable surgical care, but ethical and legal issues are slowing down surgeons' enthusiasm. Emergency surgeons are aware that prioritizing education, increasing the availability of high AI technologies for emergency and trauma surgery, and funding to support research projects that use AI to provide decision support in the operating room are crucial to create an emergency "intelligent" surgery.

Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery.

Background: The implementation of robotics in liver surgery offers several advantages compared to conventional open and laparoscopic techniques. One major advantage is the enhanced degree of freedom at the tip of the robotic tools compared to laparoscopic instruments. This enables excellent vessel control during inflow and outflow dissection of the liver.

Artificial Intelligence Surgery: How Do We Get to Autonomous Actions in Surgery?

Most surgeons are skeptical as to the feasibility of autonomous actions in surgery. Interestingly, many examples of autonomous actions already exist and have been around for years. Since the beginning of this millennium, the field of artificial intelligence (AI) has grown exponentially with the development of machine learning (ML), deep learning (DL), computer vision (CV) and natural language processing (NLP).

Women in Surgery Italia: National Survey Assessing Gender-Related Challenges.

Background: In 2019, women accounted for 46% of surgical residents. Despite the international debate on gender disparities, no literature regarding the experience in Italy is available. The aim of this survey study was to assess satisfaction among female surgeons in Italy, and determine whether they encounter gender-based discrimination.

The use of Permacol® biological mesh for complex abdominal wall repair.

Background: Complex abdominal wall repair (CAWR) remains challenging, especially in contaminated fields where the use of a synthetic mesh is associated with prohibitively complication rates. Consequently, biological mesh has been proposed as an alternative. The aim of our study was to evaluate the safety and efficacy of using Permacol® in patients who had CAWR.

The initiation, standardization and proficiency (ISP) phases of the learning curve for minimally invasive liver resection: comparison of a fellowship-trained surgeon with the pioneers and early adopters.

Background: Using the Ideal Development Exploration Assessment and Long-term study (IDEAL) paradigm, Halls et al. created risk-adjusted cumulative sum (RA-CUSUM) curves concluding that Pioneers (P) and Early Adopters (EA) of minimally invasive (MI) liver resection obtained similar results after fewer cases. In this study, we applied this framework to a MI Hepatic-Pancreatic and Biliary fellowship-trained surgeon (FT) in order to assess where along the curves this generation fell.

The experience of the minimally invasive (MI) fellowship-trained (FT) hepatic-pancreatic and biliary (HPB) surgeon: could the outcome of MI pancreatoduodenectomy for peri-ampullary tumors be better than open?

Background: Although early series focused on benign disease, minimally invasive pancreatoduodenectomy (MIPD) might be particularly suited for malignancy. Unlike their predecessors, fellowship-trained (FT) Hepatic-Pancreatic and Biliary (HPB) surgeons usually have equal skills in approaching peri-ampullary tumors (PT) either openly or via minimally invasive (MI) techniques.

Method: We retrospectively reviewed a MI-HPB-FT surgeon's 10-year experience with PD.