Surgical Innovation

Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric procedure. While advancements like staple line reinforcement (SLR) have reduced hemorrhagic complications, bleeding risks persist. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in mitigating bleeding risks in various surgical disciplines, but its efficacy in LSG with SLR remains unexplored. This study aims to evaluate the effect of intraoperative TXA administration on postoperative bleeding outcomes in patients undergoing LSG with oversewing and omentopexy.

This prospective observational cohort study included 233 patients undergoing LSG with oversewing and omentopexy. Patients were divided into 2 groups: 1 received 1 g of TXA intraoperatively, while the other did not. Hemoglobin differences at 24 and 48 hours postoperatively were the primary outcomes. Secondary outcomes included blood transfusion necessity, re-intervention rates, and 30-day surgical complications.

There was no statistically significant difference in hemoglobin changes at 24 hours (TXA group: 0.8 ± 0.7 g/dL, 95% CI: 0.67-0.93; control group: 0.9 ± 0.9 g/dL, 95% CI: 0.74-1.06; P = 0.125) or at 48 hours (TXA group: 1.4 ± 1.5 g/dL, 95% CI: 1.12-1.68; control group: 1.5 ± 1.4 g/dL, 95% CI: 1.25-1.75; P = 0.167) between the groups. No patients required transfusions or re-interventions. Five patients in the control group exhibited hemorrhagic drainage exceeding 150 mL, while none in the TXA group experienced similar complications. Length of hospital stay and operative time were similar between the groups (P = 0.124 and 0.746, respectively).

Tranexamic acid may not significantly impact major bleeding complications following LSG with oversewing and omentopexy but appears to reduce minor hemorrhagic events.

Mesh reinforcement is recommended for ventral hernia repair and can include various materials in different combinations. This study analyzed the mesh materials used and their temporal trends in ventral hernia repair in Denmark over the past 17 years.

This study utilized prospectively collected data from the Danish Ventral Hernia Database, maintained from its inception in 2007 to 2023. The data were cleaned and organized by mesh material. All ventral hernia repairs with mesh were included.

A total of 47,716 operations were included, utilizing many different mesh materials. Polypropylene meshes were used in 62% of the repairs, polyester in 26%, and fully absorbable meshes in 0.7%. Per- and polyfluoroalkyl substances (PFAS)-based meshes were most commonly used from 2007 to 2011 but then experienced a marked decline, followed by a slight increase in 2023. While the use of other absorbable components in semi-absorbable meshes followed a rise-and-fall pattern during the study period, only polylactic acid (PLA) showed a steady increase from 2013 onward.

A wide range of mesh materials and composites have been utilized for ventral hernia repair from 2007 to 2023. Polypropylene-based meshes were most commonly used, followed by polyester. The use of various absorbable composite materials varied considerably over time. The diversity of mesh materials and substantial temporal variations highlight gaps in evidence-based clinical practice and the need for improved regulations. These findings emphasize the importance of developing standardized guidelines for mesh selection in ventral hernia repair.

The aim of this study was to explore the safety and efficacy of retroperitoneal laparoscopic repair of primary lumbar hernia using Self-Gripping mesh.

This retrospective study included 11 patients with primary lumbar hernias who underwent retroperitoneal laparoscopic repair with Self-Gripping mesh from May 2020 to October 2023 in our hospital. Observation indicators were intraoperative measured diameter of hernia ring defect, operation time, length of hospital stay, postoperative follow-up, complications, postoperative visual analogue scale (VAS) score, chronic pain.

The operations were completed successfully in 11 cases. The mean diameter of hernia ring was 2.57 ± 0.49 cm (ranged from 2.0 to 3.0 cm), the mean operation time was 53.31 ± 19.33 min (ranged from 35 to 90 min), the intraoperative blood loss was 3.01 ± 1.43 mL (ranged from 2 to 10 mL), and the mean postoperative hospital stay was 2.43 ± 1.41 days (ranged from 1 to 4 days). The mean postoperative VAS scores at 24 h were 1.10 ± 0.32 (ranged from 1 to 2). All cases were followed up for 21.05 ± 16.73 months (ranged from 3 to 42 months) without seroma, hematoma, incision or mesh infection, recurrence and obvious chronic pain.

Retroperitoneal laparoscopic repair of primary lumbar hernia using Self-Gripping mesh is safe and feasible. Its efficacy in the short term is favorable.

Indocyanine-Green Fluorescence Angiography (ICG-FA) is widely used in reconstructive surgery, providing real-time visualization of flap perfusion. Accurate assessment of perfusion is especially critical in lower extremity reconstructions, where complications like necrosis and venous congestion can lead to poor outcomes, including amputation. Although ICG-FA is commonly available, its interpretation remains subjective and heavily reliant on the surgeon’s experience. These challenges underline the importance of integrating objective, data-driven assessment tools into surgical practice.

As part of a larger, ongoing prospective study, three illustrative cases of lower extremity reconstructions using perforator-based fasciocutaneous flaps were selected. Intraoperative ICG-FA was performed using a surgical microscope with integrated fluorescence imaging. Fluorescence-time-curves (FTCs) were generated using specialized software, and associated quantitative perfusion parameters were compared across three cases: two patients with perfusion-related complications and one patient without complications.

Intraoperative clinical assessment appeared satisfactory in all cases, and no changes in surgical management were made based on the subjective interpretation of ICG-FA. In contrast, quantitative analysis of ICG-FA revealed abnormal perfusion patterns in the two flaps that developed complications, identifying perfusion deficits not evident through conventional assessment.

These findings suggest that FTCs derived from ICG-FA data can predict perfusion-related complications. Integrating quantitative ICG-FA analysis into clinical practice may yield a significant advancement in reconstructive surgery, especially in lower extremity reconstructions.

ICG Indocyanine Green in Reconstructive Surgery (ICG-R).

NCT06129669 (https://clinicaltrials.gov/study/NCT06129669?cond=NCT06129669&rank=1).

Laparoscopic transabdominal preperitoneal (TAPP) hernioplasty, a minimally invasive procedure, reduces postoperative pain and recovery time but faces challenges like the “ping-pong effect” (alternating focus between operative field and monitors) and a 1%–2% error rate due to anatomical misidentification, risking complications like vascular injuries.

To develop and validate HernIA, an AI-based system for real-time segmentation of anatomical structures in TAPP, targeting an Intersection over Union (IoU) ≥85% and error reduction ≥50% compared to manual identification.

HernIA employs YOLOv11m-seg, trained on 21 443 annotated laparoscopic images from 45 TAPP procedures at Clinica Colón and Hospital de Campaña Escuela Hogar. Annotation by expert laparoscopists achieved high inter-rater reliability (Cohen’s kappa = 0.87). Validation used 5-fold cross-validation and a 10 800-frame dataset.

HernIA achieved an IoU of 89.4% (±2.1%), Jaccard Index of 81.2%, mAP@50 of 92.3%, and F1 score of 0.94 (confidence threshold ∼0.45). It reduced identification errors by 62% in a simulated TAPP environment (10 800 frames, 24 FPS, 42 ms latency). Clinical validation was limited to one case of bilateral hernia repair.

HernIA enhances surgical precision and training in TAPP, with potential to reduce complications. Multi-center trials are needed to confirm generalizability.

Technological innovations have significantly enhanced the objective assessment of technical skills in minimally invasive surgery, offering substantial potential for proficiency-based training. However, the integration of these innovative tools into surgical education curricula remains limited. This study aims to evaluate the adoption and implementation of data-driven assessment tools within laparoscopic simulation training.

A systematic search of PubMed and Embase was conducted following PRISMA guidelines, identifying studies that employed objective assessments of technical skills in surgical training curricula. Eligible studies utilized data-driven assessment methods as part of structured training programs for surgical residents. A descriptive analysis was performed on the included studies.

From 2814 identified articles, 718 were eligible for full-text screening, and 35 studies met the inclusion criteria. These studies described the implementation of 14 different data-driven tools in laparoscopic skills training. Most tools focused on assessing instrument handling, measuring parameters such as motion speed, path length, and accuracy. Only three studies evaluated tissue handling skills using metrics like knot quality, tissue handling forces, and anastomotic integrity.

The adoption of data-driven tools in laparoscopic simulation training is progressing slowly and exhibits considerable variability. Most technologies emphasize instrument handling, while tools for assessing tissue manipulation and force application are limited. To improve training outcomes, a combination of motion- and force-based assessment tools should be considered, enabling a more comprehensive evaluation of technical skills in minimally invasive surgery.

Laparoscopic surgeons waste time with instrument exchange. This is due to the poor design of existing instrument holders or quivers.

We developed an instrument holder for laparoscopic instruments, energy devices and suction irrigators which correct the design deficiencies of existing quivers.

Following the use of 3D printed prototyping a design was finalised and patented. Initial samples met all design objectives on mock patient testing.

Medsafe registration was achieved in New Zealand in September 2023. In December 2024 a Conformity Assessment Certificate was issued by the Therapeutic Goods Administration (TGA) along with an application for inclusion in the Australian Register of Therapeutic Goods (ARTG). The Surgirack™ can now be supplied in Australia and New Zealand.

The early 20th century saw pioneering work by Frank and Lillian Gilbreth, regarded as the founders of surgical ergonomics, which brought scientific management in surgery and operating rooms. Through time and motion studies, their research helped improve the operative workflow and surgical efficiency.

To document the historical work of Gilbreths in surgical ergonomics, we conducted primary archival research at the Purdue University Archives and Special Collections (West Lafayette, IN), and integrated a collection of secondary sources across various formats and modalities.

We describes the early works of Gilbreths in surgical ergonomics and highlight how their motion research in the operating room evolved to incorporate ergonomics and decrease operative fatigue. The Gilbreths were proponents of promoting the adoption of management practices for operating rooms and standardization in hospital design, equipment, and patient records to improve efficiency in health care delivery. Through analysis of their published and unpublished work, we describe how their ideas are still in widespread use today to eliminate unnecessary motions and foster ergonomics in the operating room and in the field of surgery in general.