2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T4fb,Nutcracker syndrome (NCS) refers to symptomatic compression of the left renal vein (LRV), most commonly between the aorta and superior mesenteric artery (anterior nutcracker) or, less frequently, between the aorta and vertebral column in the presence of a retro-aortic LRV (posterior nutcracker). This venous entrapment elevates renal venous pressure and promotes drainage through the gonadal and pelvic venous networks. Clinical manifestations typically include haematuria, left flank or abdominal pain, orthostatic proteinuria, and features of gonadal or pelvic venous congestion such as varicocele. Diagnosis relies on careful clinical evaluation, exclusion of alternative aetiologies, and targeted imaging modalities including Doppler ultrasonography, computed tomography, magnetic resonance angiography, venography, and intravascular ultrasound. Despite increasing recognition of NCS, standardized diagnostic criteria and imaging thresholds remain lacking. Management strategies range from conservative treatment to endovascular interventions and open or laparoscopic surgical procedures. Optimal care requires a multidisciplinary approach involving urology, radiology, nephrology, and vascular surgery to ensure accurate diagnosis and individualized treatment planning.31:T540,ABSTRACT Nutcracker syndrome (NCS) refers to symptomatic compression of the left renal vein (LRV), most commonly between the aorta and superior mesenteric artery (anterior nutcracker) or, less frequently, between the aorta and vertebral column in the presence of a retro-aortic LRV (posterior nutcracker). This venous entrapment elevates renal venous pressure and promotes drainage through the gonadal and pelvic venous networks. Clinical manifestations typically include haematuria, left flank or abdominal pain, orthostatic proteinuria, and features of gonadal or pelvic venous congestion such as varicocele. Diagnosis relies on careful clinical evaluation, exclusion of alternative aetiologies, and targeted imaging modalities including Doppler ultrasonography, computed tomography, magnetic resonance angiography, venography, and intravascular ultrasound. Despite increasing recognition of NCS, standardized diagnostic criteria and imaging thresholds remain lacking. Management strategies range from conservative treatment to endovascular interventions and open or laparoscopic surgical procedures. Optimal care requires a multidisciplinary approach involving urology, radiology, nephrology, and vascular surgery to ensure accurate diagnosis and individualized treatment planning.32:Ta00,The use of robotic-assisted groin hernia repair is increasing rapidly across the US, but evidence regarding its comparative effectiveness to more established laparoscopic or open approaches is limited. To compare the incidence of long-term operative hernia recurrence between robotic-assisted, laparoscopic, and open groin hernia repairs. This retrospective cohort study analyzed groin hernia repairs among Medicare beneficiaries aged 65 years and older from January 2010 to December 2021, with 5-year follow-up, using a population-based analysis of US inpatient and outpatient administrative claims. Data were analyzed between August 2024 and April 2025. Surgical approach: robotic-assisted, laparoscopic, or open groin hernia repair. The main outcome was operative recurrence up to 5 years after initial groin hernia repair. Cox proportional hazards modeling was used to estimate the risk-adjusted cumulative incidence of operative recurrence up to 5 years after the initial procedure, controlling for patient demographics, comorbidities, hernia type (inguinal or femoral), and procedure type (unilateral or bilateral). A total of 199 163 Medicare beneficiaries (mean [SD] age, 72.6 [9.3] years; 29 307 female patients [14.7%]) were included in the study. From January 2010 to December 2021, the proportion of robotic-assisted procedures increased 8.6-fold, from 0.3% to 2.6%. The proportion of open procedures decreased 0.6-fold (84.4% to 51.9%), while laparoscopic procedures increased 3.0-fold (15.3% to 45.5%). Patients undergoing robotic-assisted hernia repair had the highest 5-year risk-adjusted cumulative incidence of operative recurrence (3.78%; 95% CI, 3.76%-3.79%), followed by open (3.37%; 95% CI, 3.36%-3.37%) and laparoscopic (3.21%; 95% CI, 3.21%-3.22%) approaches. Compared to open repairs, the laparoscopic approach was associated with a lower risk of operative recurrence (hazard ratio [HR], 0.75; 95% CI, 0.66-0.86), while there was no difference in risk of operative recurrence between the open and robotic cohorts (HR, 1.29; 95% CI, 0.48-2.10). In this cohort study among Medicare beneficiaries, robotic-assisted groin hernia repair was associated with a higher long-term cumulative incidence of operative recurrence compared to open and laparoscopic approaches. With low operative recurrence rates across all surgical techniques, these findings suggest that alternative measures of clinical value may be necessary to assess the benefits of minimally invasive approaches, particularly as robotic-assisted repair continues to expand.33:Ted3, Importance The use of robotic-assisted groin hernia repair is increasing rapidly across the US, but evidence regarding its comparative effectiveness to more established laparoscopic or open approaches is limited. Objective To compare the incidence of long-term operative hernia recurrence between robotic-assisted, laparoscopic, and open groin hernia repairs. Design, Setting, and Participants This retrospective cohort study analyzed groin hernia repairs among Medicare beneficiaries aged 65 years and older from January 2010 to December 2021, with 5-year follow-up, using a population-based analysis of US inpatient and outpatient administrative claims. Data were analyzed between August 2024 and April 2025. Exposure Surgical approach: robotic-assisted, laparoscopic, or open groin hernia repair. Main Outcomes and Measures The main outcome was operative recurrence up to 5 years after initial groin hernia repair. Cox proportional hazards modeling was used to estimate the risk-adjusted cumulative incidence of operative recurrence up to 5 years after the initial procedure, controlling for patient demographics, comorbidities, hernia type (inguinal or femoral), and procedure type (unilateral or bilateral). Results A total of 199 163 Medicare beneficiaries (mean [SD] age, 72.6 [9.3] years; 29 307 female patients [14.7%]) were included in the study. From January 2010 to December 2021, the proportion of robotic-assisted procedures increased 8.6-fold, from 0.3% to 2.6%. The proportion of open procedures decreased 0.6-fold (84.4% to 51.9%), while laparoscopic procedures increased 3.0-fold (15.3% to 45.5%). Patients undergoing robotic-assisted hernia repair had the highest 5-year risk-adjusted cumulative incidence of operative recurrence (3.78%; 95% CI, 3.76%-3.79%), followed by open (3.37%; 95% CI, 3.36%-3.37%) and laparoscopic (3.21%; 95% CI, 3.21%-3.22%) approaches. Compared to open repairs, the laparoscopic approach was associated with a lower risk of operative recurrence (hazard ratio [HR], 0.75; 95% CI, 0.66-0.86), while there was no difference in risk of operative recurrence between the open and robotic cohorts (HR, 1.29; 95% CI, 0.48-2.10). Conclusions and Relevance In this cohort study among Medicare beneficiaries, robotic-assisted groin hernia repair was associated with a higher long-term cumulative incidence of operative recurrence compared to open and laparoscopic approaches. With low operative recurrence rates across all surgical techniques, these findings suggest that alternative measures of clinical value may be necessary to assess the benefits of minimally invasive approaches, particularly as robotic-assisted repair continues to expand. 34:T794,Inguinal hernia is a common condition in children, and day-case surgery has been widely implemented in pediatric specialty hospitals, benefiting patients and their families. However, overnight hospital stays pose various inconveniences to children and parents. In this study, we aimed to optimize the day-case surgery model for inguinal hernia repair, evaluate the effectiveness and safety of day-case surgery in children with inguinal hernias, and compare the effects of different surgical methods on hospitalization duration and medical cost. A retrospective cohort study was conducted to analyze surgical data from 14,197 children with inguinal hernias admitted from January 2019 to December 2023 using statistical methods, including independent sample t-tests, analysis of variance, and multiple linear regression analysis. The results showed that the day-case surgery model significantly shortened hospitalization duration and reduced medical cost. The hospitalization duration and medical cost in the laparoscopic percutaneous internal ring suturing group were significantly higher than those in the open traditional high ligation of the hernia sac group (P < 0.05). However, the recurrence rate in the laparoscopic percutaneous internal ring suturing group was 0.035%, which was lower than that (0.107%) observed in the open traditional high ligation of the hernia sac group. Laparoscopic percutaneous internal ring suturing aided the detection of hidden hernia at a rate of 49.61%. Day-case surgery offers significant benefits by reducing hospitalization duration and medical cost, whereas laparoscopic percutaneous internal ring suturing is better for detecting hidden hernias and shows excellent performance in reducing recurrence rates. Future research should focus on the promotion and optimization of day-case laparoscopic percutaneous internal ring suturing to enhance the treatment outcomes in pediatric inguinal hernias.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Laparoscopic Surgery: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Laparoscopic Surgery (modality). Clinician-written summaries and actionable practice insights. 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The level of evidence is assigned as 3 (retrospective cohort) despite a prospectively maintained database, due to retrospective outcome analysis and single-surgeon design.","value_numeric":null}],"summaries":{"what_studied":"This study evaluated the safety and outcomes of fundus-first dissection (FFD) as a salvage technique in 159 laparoscopic cholecystectomies (Nassar Difficulty Grades 4–5) where the critical view of safety (CVS) could not be achieved via antegrade dissection, drawn from a single-surgeon prospective database spanning 1992–2022.","key_result":"Zero bile duct injuries occurred in 159 FFD cases. Total cholecystectomy was achieved in 96.9%; subtotal cholecystectomy and open conversion were each required in 3.1%. Adverse outcomes were independently driven by ASA ≥ 3 and Grade 5 difficulty — not the FFD technique itself — and conversions fell 35-fold over three decades.","limitations":"Single-surgeon, single-centre series spanning 30 years limits generalisability; retrospective outcome analysis introduces selection bias; external validation in broader surgical populations has not yet been performed.","practice_takeaway":"When CVS cannot be achieved in a Grade 4–5 laparoscopic cholecystectomy, FFD appears safe in experienced hands — with no bile duct injuries and a 96.9% total cholecystectomy rate. Surgeons should not attribute adverse outcomes to FFD itself; ASA status and anatomical complexity are the key risk drivers."}},{"doi":"10.1186/s13017-026-00696-w","pmid":"42613617","title":"Global practices and attitudes in acute appendicitis management: the PAMAP-W international survey and Delphi consensus study on the WSES appendicitis grading system","journal_title":"World Journal of Emergency Surgery","journal_issn":"1749-7922","published_at":"2026-08-18T00:00:00.000Z","url":"https://doi.org/10.1186/s13017-026-00696-w","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-21T06:28:18.849Z","updated_at":"2026-08-21T06:28:18.849Z","tags":[{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"condition","value":"Acute Appendicitis","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"modality","value":"Antibiotic Therapy","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"sample_size","value":"n=467","value_numeric":467},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"study_design","value":"Cross-Sectional Survey with Delphi Consensus","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"warning","value":"Sample size tag (n=467) reflects survey respondents only; the Delphi panel (up to 50 experts) is a separate, smaller group.","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"warning","value":"The Delphi expert panel size shrank across rounds (50 invited → 37 round 1 → 33 round 2), which may affect the robustness of consensus statements.","value_numeric":null},{"paper_doi":"10.1186/s13017-026-00696-w","tag_type":"warning","value":"The study design combines a survey with a consensus process; the level of evidence (4) reflects expert opinion and practice mapping, not comparative clinical outcomes.","value_numeric":null}],"summaries":{"what_studied":"This international mixed-methods study surveyed 467 surgeons from 64 countries on real-world acute appendicitis management practices (operative approach, stump closure, drainage, antibiotics, follow-up), then used a two-round Delphi consensus with 50 international experts to develop grade-linked management statements aligned with the WSES appendicitis grading system.","key_result":"Laparoscopy was the preferred approach at all severity grades, but increasing disease severity correlated with greater practice variability—especially in stump closure, drainage use, antibiotic duration, and follow-up. Most candidate Delphi statements reached consensus within two rounds (37 experts in round 1, 33 in round 2), yielding a set of grade-linked expert statements for the WSES grading system.","limitations":"Survey completion does not guarantee representative global sampling; Delphi panels shrank from 37 to 33 participants across rounds, risking attrition bias. The study maps practice patterns and expert opinion but does not assess clinical outcomes, reproducibility, or real-world implementation of the resulting statements.","practice_takeaway":"Wide variability persists worldwide in managing complicated appendicitis—particularly around drainage, antibiotic duration, and follow-up—so clinicians should consider adopting the WSES grade-linked framework to improve consistency. This consensus is meant to complement, not replace, formal evidence-based guidelines."}},{"doi":"10.1097/xcs.0000000000001959","pmid":"41925196","title":"Longitudinal Incidence and Outcomes of Remnant Cholecystitis after Subtotal Cholecystectomy: An Analysis of 2,682 Patients","journal_title":"Journal of the American College of Surgeons","journal_issn":"1072-7515","published_at":"2026-08-14T00:00:00.000Z","url":"https://doi.org/10.1097/xcs.0000000000001959","source_score":28,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-19T06:28:56.721Z","updated_at":"2026-08-19T06:28:56.721Z","tags":[{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"condition","value":"Acute Cholecystitis","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"condition","value":"Bile Duct Injury","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"condition","value":"Remnant Cholecystitis","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"modality","value":"Open Surgery","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"sample_size","value":"n=2682","value_numeric":2682},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"warning","value":"Only New York and Florida were included; findings may not generalize to other regions or healthcare systems.","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"warning","value":"The impact flag 'safety_signal' was applied specifically for the markedly elevated bile duct injury rate (7.1%) associated with completion cholecystectomy.","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001959","tag_type":"warning","value":"The study uses administrative claims data (HCUP), so remnant cholecystitis diagnoses and bile duct injury events are based on coding rather than direct clinical or operative verification.","value_numeric":null}],"summaries":{"what_studied":"Population-based retrospective cohort study of 2,682 adults who underwent subtotal cholecystectomy (98.7% laparoscopic) for acute cholecystitis from 2012–2021 in New York and Florida, evaluating long-term incidence of remnant cholecystitis and outcomes of completion cholecystectomy.","key_result":"Remnant cholecystitis occurred in 13.3% of patients (median follow-up 2 years); 79.7% of cases arose within 6 months. Only 2.6% (n=70) required completion cholecystectomy, but that procedure was open in 47.1% of cases and carried a 7.1% bile duct injury rate — nearly 8× the 0.9% rate seen with subtotal cholecystectomy itself.","limitations":"Retrospective design using administrative claims data limits ability to confirm diagnosis accuracy or surgical technique details. Study draws from only two states (NY and FL), which may limit generalizability. Median follow-up of 2 years may underestimate long-term remnant cholecystitis risk.","practice_takeaway":"Subtotal cholecystectomy is a durable bailout for the difficult gallbladder, but counsel patients that ~1 in 8 will develop remnant cholecystitis, mostly within 6 months. When completion cholecystectomy is needed, the high rate of open conversion and 7.1% bile duct injury rate strongly support referral to an experienced hepatobiliary center."}},{"doi":"10.1001/jamasurg.2026.3048","pmid":"42525398","title":"Laparoscopic Deskilling—The Hidden Risk of Robotic Dominance","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-07-29T00:00:00.000Z","url":"https://doi.org/10.1001/jamasurg.2026.3048","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-04T18:17:41.532Z","updated_at":"2026-08-04T18:17:41.532Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"condition","value":"Surgical Skill Decay","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"modality","value":"Robotic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"study_design","value":"Viewpoint / Opinion","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"warning","value":"Level of evidence set to 7 (expert opinion) given the Viewpoint format.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"warning","value":"The specific 'strategies to preserve laparoscopic proficiency' mentioned in the abstract are not detailed in the provided text; summary reflects only what is stated in the abstract.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3048","tag_type":"warning","value":"This is an expert Viewpoint with no primary data or patient outcomes — conclusions are opinion-based and cannot be quantitatively evaluated.","value_numeric":null}],"summaries":{"what_studied":"This Viewpoint examines the risk of laparoscopic skill decay ('deskilling') among surgeons as robotic surgery platforms are rapidly adopted, reducing laparoscopic case volumes.","key_result":"The authors argue that falling laparoscopic case volumes driven by robotic dominance pose a hidden but material risk to surgical proficiency, and propose strategies to preserve laparoscopic skills.","limitations":"As a Viewpoint, this piece offers expert opinion without primary data, quantitative outcomes, or a systematic review of evidence on deskilling rates.","practice_takeaway":"Surgical programs and training directors should actively monitor laparoscopic case volumes and implement deliberate practice strategies to prevent skill decay as robotic platforms expand. Maintaining laparoscopic proficiency is critical for situations where robotic systems are unavailable or must be abandoned mid-procedure."}},{"doi":"10.1001/jamasurg.2026.2650","pmid":"42455567","title":"Outcomes and Costs After Robotic vs Laparoscopic Complex Elective Cholecystectomy","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-07-15T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13373735/","source_score":19,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-20T13:35:45.894Z","updated_at":"2026-07-20T13:35:45.894Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"condition","value":"Cholelithiasis","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"condition","value":"Complex Gallbladder Disease","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"modality","value":"Robotic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"sample_size","value":"n=863","value_numeric":863},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"warning","value":"DOI and publication date (2026-07-15) are ahead of today's widely indexed literature; article availability and peer-review status could not be independently verified from the provided text.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"warning","value":"The full text was not accessible; summary is based solely on the abstract and results excerpt. Some subgroup sample sizes (e.g., CEC vs non-CEC breakdown) are not reported, limiting appraisal of statistical power.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2650","tag_type":"warning","value":"The 'impact_flag' of practice_changing is applied cautiously — this is a single-center retrospective study, and findings should ideally be confirmed in a prospective or multi-center design before broad adoption.","value_numeric":null}],"summaries":{"what_studied":"This cohort study compared robotic-assisted vs laparoscopic cholecystectomy in 863 patients at an academic hepatobiliary referral center (August 2018–August 2024), focusing on complex elective cholecystectomy (CEC) defined by prior aborted/partial cholecystectomy, cholecystostomy tube, or history of gallbladder perforation/fistula.","key_result":"In CEC patients, laparoscopic approach was independently associated with 4× higher odds of unplanned endoscopic or percutaneous intervention vs robotic (OR 4.24; 95% CI 1.24–14.52; P=.02). Despite higher OR costs for robotic surgery, total cost of care was equivalent for CEC ($14,309 laparoscopic vs $14,476 robotic), but robotic non-CEC carried significantly higher total costs ($11,416 vs $9,925 laparoscopic).","limitations":"Single academic hepatobiliary referral center limits generalizability. Retrospective cohort design carries inherent selection bias—robotic cases may have been selectively assigned to more experienced surgeons. The absolute number of CEC cases is not broken out, limiting power assessment.","practice_takeaway":"For complex gallbladder disease (prior failed cholecystectomy, cholecystostomy tube, or fistula), consider robotic cholecystectomy to reduce downstream interventions without increasing total cost. Reserve robotic approach for high-complexity cases; in routine (non-CEC) cholecystectomy, laparoscopic surgery remains more cost-effective overall."}},{"doi":"10.1001/jamasurg.2026.2645","pmid":"42455564","title":"Chasing Value in an Evolving Era of Robotic Cholecystectomy","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-07-15T00:00:00.000Z","url":"https://doi.org/10.1001/jamasurg.2026.2645","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-20T13:35:45.641Z","updated_at":"2026-07-20T13:35:45.641Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"condition","value":"Cholelithiasis","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"modality","value":"Robotic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"study_design","value":"Invited Commentary","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"warning","value":"No sample size, sex, or specific outcomes data are present in the available text.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"warning","value":"Study design tagged as 'Invited Commentary'; level of evidence set to 7 (expert opinion) accordingly.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2645","tag_type":"warning","value":"This is a publisher landing/preview page only — full text was not accessible. Summary is based solely on the abstract-level content and commentary excerpt provided. No original data, patient population, outcomes, or statistics are reported in the available text.","value_numeric":null}],"summaries":{"what_studied":"An invited commentary examining the ongoing debate around the clinical value of robotic platforms for cholecystectomy, weighing arguments from skeptics (cost, learning curve, bile duct injury risk, lack of evidence for fewer open conversions) against proponents (precision, complex case capability, ergonomics, lower conversion rates).","limitations":"This is an invited commentary with no original data, patient cohort, or quantitative analysis — conclusions are opinion-based and not drawn from a primary study.","practice_takeaway":"The value of robotic cholecystectomy remains unresolved; clinicians should critically weigh institutional, ergonomic, and patient-centered factors rather than adopt the platform based on marketing or branding alone."}},{"doi":"10.1001/jamasurg.2026.2248","pmid":"42340709","title":"Inferior Mesenteric Artery Ligation Level and Anastomotic Leakage in Low Anterior Resection","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-06-24T00:00:00.000Z","url":"https://doi.org/10.1001/jamasurg.2026.2248","source_score":16,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-27T13:27:32.719Z","updated_at":"2026-06-27T13:27:32.719Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"condition","value":"Anastomotic Leakage","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"condition","value":"Rectal Cancer","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"modality","value":"Minimally Invasive Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"modality","value":"Robotic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"sample_size","value":"n=293","value_numeric":293},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"warning","value":"21 patients were excluded post-randomization (314 randomized, 293 analyzed); reasons for exclusion are not detailed in the abstract, which introduces potential bias.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"warning","value":"The study was powered primarily around anastomotic leakage rates; the observed event rates (~5–6%) are low, raising the possibility of insufficient power to detect a clinically meaningful difference.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.2248","tag_type":"warning","value":"The trial was registered with a South Korean registry (KCT0003523), suggesting a single-country origin that may limit generalizability.","value_numeric":null}],"summaries":{"what_studied":"This multicenter RCT compared high IMA ligation (at the root) vs low IMA ligation (distal to the left colic artery origin) in 293 patients with clinical stage I–III rectal cancer undergoing minimally invasive (laparoscopic or robotic) anterior resection, enrolled July 2019–August 2024, with functional outcomes assessed at 12 months.","key_result":"Symptomatic anastomotic leakage was 4.9% (7/143) with low ligation vs 6.0% (9/150) with high ligation — not significantly different (RR 0.82; 95% CI 0.31–2.13; P = .68). 30-day morbidity (14.0% vs 22.0%; P = .08) and 12-month LARS scores (15.8 vs 17.3; P = .32) were also similar.","limitations":"- Trial may have been underpowered to detect a small but clinically meaningful difference in anastomotic leakage rates.\n- 21 of 314 randomized patients were excluded from the modified ITT analysis, risking selection bias.\n- Single-country trial (South Korea registry) limits generalizability to other practice settings.","practice_takeaway":"Surgeons can choose either high or low IMA ligation in minimally invasive rectal cancer resection without meaningfully changing anastomotic leak risk or long-term bowel function. Low ligation does not need to be routinely favored over high ligation on the basis of leak prevention alone."}},{"doi":"10.1001/jamasurg.2026.1585","pmid":"42201711","title":"Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy in Contemporary Practice","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-05-27T00:00:00.000Z","url":"https://doi.org/10.1001/jamasurg.2026.1585","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-28T13:24:18.658Z","updated_at":"2026-05-28T13:24:18.658Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"condition","value":"Cholecystitis","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"condition","value":"Cholelithiasis","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"modality","value":"Robotic-Assisted Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"study_design","value":"Cohort Study","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"warning","value":"Full text was inaccessible due to a Cloudflare security block on the publisher page. All structured data is derived solely from the abstract. Key results, sample size, specific outcomes, and statistical findings could not be extracted or verified.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"warning","value":"No sample size was reported in the available abstract text; the sample_size tag has been omitted.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"warning","value":"Sex breakdown of the study population was not mentioned in the abstract; the sex tag has been omitted.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1585","tag_type":"warning","value":"The condition tags (Cholelithiasis, Cholecystitis) are inferred from the surgical context (cholecystectomy) rather than explicitly stated in the abstract.","value_numeric":null}],"summaries":{"what_studied":"This cohort study examined trends in robotic-assisted cholecystectomy (RAC) use among Medicare beneficiaries from 2020 to 2023 and compared risk-adjusted outcomes between RAC and laparoscopic cholecystectomy (LC).","limitations":"Only the abstract was available; full text could not be retrieved due to a security/paywall block. Findings, specific outcome measures, and numerical results are not verifiable from the provided source."}},{"doi":"10.1002/jhbp.70135","pmid":"42186132","title":"Expert Survey on Chyle Leakage After Pancreaticoduodenectomy: The Precision Anatomy for Minimally Invasive Hepato‐Biliary‐Pancreatic Surgery (\n PAM\n ‐\n HBP\n Surgery) Project 2024","journal_title":"Journal of Hepato-Biliary-Pancreatic Sciences","journal_issn":"1868-6974","published_at":"2026-05-25T00:00:00.000Z","url":"https://doi.org/10.1002/jhbp.70135","source_score":6,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-31T13:35:31.239Z","updated_at":"2026-05-31T13:35:31.239Z","tags":[{"paper_doi":"10.1002/jhbp.70135","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"condition","value":"Chyle Leakage","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"condition","value":"Pancreaticoduodenectomy Complications","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"modality","value":"Minimally Invasive Surgery","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"modality","value":"Open Surgery","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"modality","value":"Robotic Surgery","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"sample_size","value":"n=57","value_numeric":57},{"paper_doi":"10.1002/jhbp.70135","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"study_design","value":"Expert Survey","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"warning","value":"Study design is an expert survey, which may overrepresent high-volume centers and may not reflect typical practice.","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"warning","value":"The 'level of evidence' is assigned as 5 (expert opinion) given the survey-based methodology.","value_numeric":null},{"paper_doi":"10.1002/jhbp.70135","tag_type":"warning","value":"The sample of 57 surgeons represents expert opinion only; no patient outcomes or incidence rates are quantified, limiting clinical applicability.","value_numeric":null}],"summaries":{"what_studied":"A structured expert survey of 57 surgeons from 10 countries examined the incidence, anatomical pitfalls, and surgical techniques related to chyle leakage (CL) after pancreaticoduodenectomy (PD), comparing open, laparoscopic, and robotic approaches.","key_result":"Experts reported CL incidence as open ≥ laparoscopic, open > robotic, and laparoscopic = robotic. Three key anatomical risk zones were identified: (i) transverse mesocolon at the ventral SMA/SMV, (ii) meso-jejunum at the dorsal SMA/SMV, and (iii) fusion fascia of Treitz at the ventral IVC. No consensus was reached on the optimal dissection plane at Treitz fascia (21% pancreatic surface, 31% within fascia, 38% IVC-exposing).","limitations":"Survey-based design captures expert opinion rather than objective outcome data; no patient-level data or incidence rates reported; potential selection bias toward high-volume, experienced surgeons.","practice_takeaway":"Focus lymphatic control at three key anatomical zones during PD—transverse mesocolon, meso-jejunum, and Treitz fascia—using energy devices as the preferred modality across all surgical approaches. Robotic PD may carry a lower CL risk than open surgery per expert consensus, though prospective data are lacking."}},{"doi":"10.1093/ckj/sfag124","pmid":"42111894","title":"Nutcracker syndrome in 2026: a nephrologist-oriented diagnosis and management","journal_title":"Clinical Kidney Journal","journal_issn":"2048-8505","published_at":"2026-05-11T00:00:00.000Z","url":"https://doi.org/10.1093/ckj/sfag124","source_score":43,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-04-30","doi":"10.1093/ckj/sfag124","days":"14","issn":"2048-8505","rank":"3","field":"Clinical Medicine","score":"43","category":"Urology & Nephrology","categories":["Urology & Nephrology"],"_categories":["Urology & Nephrology"]},"pubmed":{"doi":"10.1093/ckj/sfag124","title":"Nutcracker syndrome in 2026: a nephrologist-oriented diagnosis and management.","journal":"Clinical kidney journal","methods":"","results":"","abstract":"$30","keywords":["left renal vein compression","nutcracker 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management"],"author":[{"given":"Ernesta","family":"Mačionienė","sequence":"first","affiliation":[{"name":"Center of Nephrology, Vilnius Universty Hospital Santaros Klinikos , Vilnius ,"},{"name":"Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius ,"}]},{"given":"Agnė","family":"Kerpauskienė","sequence":"additional","affiliation":[{"name":"Center of Nephrology, Vilnius Universty Hospital Santaros Klinikos , Vilnius ,"},{"name":"Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius ,"}]},{"given":"Urtė","family":"Žakauskienė","sequence":"additional","affiliation":[{"name":"Center of Nephrology, Vilnius Universty Hospital Santaros Klinikos , Vilnius ,"},{"name":"Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius ,"}]},{"given":"Monika","family":"Vitkauskaitė","sequence":"additional","affiliation":[{"name":"Center of Nephrology, Vilnius Universty Hospital Santaros Klinikos , Vilnius ,"}]},{"given":"Rokas","family":"Girčius","sequence":"additional","affiliation":[{"name":"Vilnius University Hospital Santaros Klinikos, Center of Radiology and Nuclear Medicine , Vilnius ,"}]},{"given":"Marius","family":"Miglinas","sequence":"additional","affiliation":[{"name":"Center of Nephrology, Vilnius Universty Hospital Santaros Klinikos , Vilnius ,"},{"name":"Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius 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Key manifestations include hematuria, left flank/abdominal pain, orthostatic proteinuria, and gonadal/pelvic venous congestion. Management spans conservative care, endovascular intervention, and open or laparoscopic surgery; however, standardized diagnostic criteria and imaging thresholds are still lacking.","limitations":"No standardized diagnostic criteria or validated imaging thresholds exist for NCS. The paper is a narrative review without systematic methods or meta-analysis, limiting the strength of its evidence-based recommendations.","practice_takeaway":"Consider NCS in patients with unexplained hematuria, left flank pain, orthostatic proteinuria, or varicocele — a multidisciplinary team (nephrology, urology, radiology, vascular surgery) is essential for accurate diagnosis and individualized treatment planning. 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Endosc","doi-asserted-by":"publisher"},{"DOI":"10.1245/s10434-015-5062-6","key":"soi260020r27","year":"2016","issue":"7","author":"Leitao","volume":"23","first-page":"2192","unstructured":null,"article-title":"Impact of robotic platforms on surgical approach and costs in the management of morbidly obese patients with newly diagnosed uterine cancer.","journal-title":"Ann Surg Oncol","doi-asserted-by":"publisher"},{"DOI":"10.1001/jamasurg.2024.0016","key":"soi260020r28","year":"2024","issue":"5","author":"Lunardi","volume":"159","first-page":"493","unstructured":null,"article-title":"Robotic technology in emergency general surgery cases in the era of minimally invasive surgery.","journal-title":"JAMA Surg","doi-asserted-by":"publisher"},{"DOI":"10.1097/SLA.0b013e318254f5b9","key":"soi260020r29","year":"2012","issue":"6","author":"Helgstrand","volume":"256","first-page":"955","unstructured":null,"article-title":"Reoperation versus clinical recurrence rate after ventral hernia repair.","journal-title":"Ann Surg","doi-asserted-by":"publisher"},{"DOI":"10.1002/14651858.CD004703.pub3","key":"soi260020r30","year":"2024","issue":"7","author":"Andresen","volume":"7","first-page":null,"unstructured":null,"article-title":"Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair.","journal-title":"Cochrane Database Syst Rev","doi-asserted-by":"publisher"},{"DOI":"10.1371/journal.pone.0054367","key":"soi260020r31","year":"2013","issue":"1","author":"Burcharth","volume":"8","first-page":null,"unstructured":null,"article-title":"Nationwide prevalence of groin hernia repair.","journal-title":"PLoS One","doi-asserted-by":"publisher"},{"DOI":"10.1001/jamanetworkopen.2024.48521","key":"soi260020r32","year":"2024","issue":"12","author":"Loh","volume":"7","first-page":null,"unstructured":null,"article-title":"Learning curves for robotic-assisted ventral hernia repair.","journal-title":"JAMA Netw Open","doi-asserted-by":"publisher"}],"short-title":[],"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["JAMA Surgery"],"reference-count":32,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,4,29]]},"references-count":32,"short-container-title":["JAMA Surg"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1001/jamasurg.2026.1126","is_oa":true,"title":"Surgical Approach and Long-Term Operative Recurrence Following Groin Hernia Repair","updated":"2026-05-04T08:56:22+00:00","published_date":"2026-04-29","best_oa_location":{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13130069/","pmh_id":"oai:pubmedcentral.nih.gov:13130069","url_for_pdf":null,"url_for_landing_page":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13130069/"}}},"created_at":"2026-05-07T22:49:23.106Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"condition","value":"Femoral Hernia","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"condition","value":"Groin Hernia","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"condition","value":"Inguinal Hernia","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"modality","value":"Open Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"modality","value":"Robotic-Assisted Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"sample_size","value":"n=199,163","value_numeric":199163},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"warning","value":"Operative recurrence (requiring reoperation) likely underestimates true clinical recurrence, which includes non-operative cases.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"warning","value":"The robotic vs. open hazard ratio (HR 1.29; 95% CI 0.48–2.10) crosses 1.0 and is not statistically significant, so the higher recurrence rate for robotic repair should be interpreted cautiously — the wide CI reflects the small proportion of robotic cases.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1126","tag_type":"warning","value":"The study population is exclusively Medicare beneficiaries aged ≥65; generalizability to younger or privately insured populations is limited.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study compared 5-year operative hernia recurrence rates among Medicare beneficiaries (≥65 years) undergoing robotic-assisted, laparoscopic, or open groin hernia repair using US administrative claims data from January 2010 to December 2021 (n=199,163).","key_result":"Laparoscopic repair had the lowest 5-year risk-adjusted cumulative recurrence (3.21%), followed by open (3.37%) and robotic-assisted (3.78%). Compared to open, laparoscopic repair reduced recurrence risk (HR 0.75; 95% CI 0.66–0.86), while robotic-assisted showed no statistically significant difference from open (HR 1.29; 95% CI 0.48–2.10). Robotic use grew 8.6-fold (0.3% → 2.6%) from 2010 to 2021.","limitations":"- Administrative claims data cannot capture all clinical nuances (e.g., surgeon experience, hernia complexity, or non-operative recurrences).\n- Study is limited to Medicare beneficiaries aged ≥65, so findings may not generalize to younger patients.\n- Robotic-assisted cases represented a very small proportion of procedures, which may explain the wide confidence interval and statistical non-significance for the robotic vs. open comparison.","practice_takeaway":"Laparoscopic groin hernia repair remains associated with the lowest operative recurrence risk in older adults. Given the rapid growth of robotic-assisted repair and its numerically higher recurrence rate (though not statistically superior to open), surgeons should weigh cost and clinical value carefully before defaulting to robotic approaches for groin hernias."}},{"doi":"10.1001/jamasurg.2025.6865","pmid":"41739485","title":"Contemporary Outcomes of Cholecystectomy","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-02-25T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12936969/","source_score":40,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:49:21.345Z","updated_at":"2026-05-07T22:49:21.345Z","tags":[{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"condition","value":"Biliary Disease","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"condition","value":"Cholelithiasis","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"modality","value":"Robotic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"sample_size","value":"n=516,372","value_numeric":516372},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"warning","value":"Conversion-to-open cases are not described; it is unclear whether converted cases were excluded or included in the minimally invasive cohort.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"warning","value":"Study population is exclusively Medicare fee-for-service beneficiaries (mean age ~75), so results may not apply to younger or non-Medicare patients undergoing cholecystectomy.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6865","tag_type":"warning","value":"The paper does not separately report outcomes for laparoscopic vs. robotic subgroups, so modality-specific trends cannot be inferred.","value_numeric":null}],"summaries":{"what_studied":"This cohort study examined trends in postoperative outcomes following inpatient minimally invasive (laparoscopic or robotic) cholecystectomy among 516,372 Medicare fee-for-service beneficiaries (mean age 74.8 years; 52.4% female) from 2011 to 2021, using risk-adjusted multivariable regression.","key_result":"Despite rising patient complexity and unplanned admissions (78.8% → 90.1%), risk-adjusted overall complications fell from 21.5% to 16.5% and serious complications from 12.3% to 7.0%; bile duct injury dropped from 0.19% to 0.12% and transfusion from 5.47% to 1.87% — but percutaneous drainage rates nearly doubled (1.32% → 2.91%), all P < .001.","limitations":"- Findings are limited to Medicare fee-for-service beneficiaries (older adults), limiting generalizability to younger or privately insured populations.\n- Claims-based data cannot capture surgeon-level factors, hospital volume, or granular clinical details that may explain outcome trends.\n- The rising use of percutaneous drainage is noted but its clinical drivers (evolving practice vs. complication patterns) remain unclear from claims alone.","practice_takeaway":"Surgeons can be reassured that minimally invasive cholecystectomy outcomes have meaningfully improved over the past decade, even as patients arrive sicker and more urgently. The rise in post-op percutaneous drainage warrants monitoring to determine whether it reflects a deliberate practice shift or an emerging quality signal."}},{"doi":"10.1001/jamasurg.2025.6726","pmid":"41706492","title":"Long-Term Outcomes After Laparoscopic vs Open Adhesiolysis for Small Bowel Obstruction","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-02-18T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12917750/","source_score":98,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:49:20.736Z","updated_at":"2026-05-07T22:49:20.736Z","tags":[{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"condition","value":"Adhesive Small Bowel Obstruction","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"condition","value":"Small Bowel Obstruction","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"modality","value":"Open Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"sample_size","value":"n=100","value_numeric":100},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"warning","value":"Mean patient age was 69.2 years with 65% female; results may not apply equally to younger or predominantly male cohorts.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"warning","value":"The 5-year per-protocol denominators (31–32 per group) are notably smaller than the randomized groups (49–51), suggesting substantial attrition; the paper does not fully detail reasons for loss to follow-up, which may affect long-term result reliability.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.6726","tag_type":"warning","value":"The trial was conducted exclusively in Finland and Italy, which may limit generalizability to other healthcare settings or patient populations.","value_numeric":null}],"summaries":{"what_studied":"The LASSO RCT compared laparoscopic vs open adhesiolysis in 100 patients with adhesive small bowel obstruction (SBO) not resolving conservatively, across 8 hospitals in Finland and Italy (July 2013–April 2018), reporting 5-year outcomes including SBO recurrence, incisional hernia, and quality of life.","key_result":"No significant differences at 5 years: SBO recurrence in 9.7% (open) vs 12.5% (laparoscopic) (OR 1.33; 95% CI 0.27–6.51; P >.99); incisional hernia in 6.1% vs 6.3% (OR 1.03; P >.99); SF-36 scores 73.2 vs 67.1 (P = .23); GIQLI scores 118 vs 119 (P = .54).","limitations":"- Small sample (n=100) limits power to detect meaningful long-term differences.\n- Open-label design with potential for performance and detection bias.\n- High dropout/loss to follow-up implied by smaller per-protocol denominators (31–32 patients per group at 5 years vs 49–51 at enrollment).","practice_takeaway":"Laparoscopy for adhesive SBO offers short-term recovery benefits but does not reduce recurrence, incisional hernia, or improve quality of life at 5 years compared to open surgery. Surgeons can choose approach based on patient factors and operative expertise without concern for inferior long-term outcomes with either technique."}},{"doi":"10.1016/j.fertnstert.2026.01.016","pmid":"41617042","title":"Laparoscopic abdominal cerclage at 15 weeks of gestation after trachelectomy: a step-by-step surgical video","journal_title":"Fertility and Sterility","journal_issn":"0015-0282","published_at":"2026-01-29T00:00:00.000Z","url":"https://doi.org/10.1016/j.fertnstert.2026.01.016","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-23T13:24:45.260Z","updated_at":"2026-05-23T13:24:45.260Z","tags":[{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"condition","value":"Cervical Cancer","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"condition","value":"Cervical Insufficiency","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"condition","value":"Pregnancy After Trachelectomy","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"modality","value":"Laparoscopic Surgery","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"study_design","value":"Video Case Report","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"warning","value":"Delivery at 36 weeks after premature rupture of membranes may reflect a procedure-related or cervical insufficiency-related complication, but causality cannot be determined from this report.","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"warning","value":"Single case report — no statistical conclusions can be drawn; findings reflect one procedure at a specialized tertiary center.","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.01.016","tag_type":"warning","value":"The study design is a surgical video article; level of evidence is the lowest tier (expert opinion/case report).","value_numeric":null}],"summaries":{"what_studied":"This video article demonstrates a four-step laparoscopic abdominal cerclage technique performed at 15 weeks of gestation in a 37-year-old woman (G2P0) with a history of radical trachelectomy for early-stage cervical cancer, a short cervix (17 mm), and insufficient cervical tissue for vaginal cerclage after IVF.","key_result":"The patient delivered a healthy infant via cesarean section at 36 weeks following premature rupture of membranes; the cerclage was retained for future pregnancies.","limitations":"Single-patient case report; no comparative data or control group; generalizability is limited to highly selected post-trachelectomy patients at a specialized tertiary center.","practice_takeaway":"In post-trachelectomy patients with insufficient cervical tissue for vaginal cerclage, laparoscopic abdominal cerclage during the second trimester appears feasible and may be considered at centers with minimally invasive gynecologic surgery expertise. The Hasson entry technique and Roder knot fixation are key technical steps to ensure safe suture placement medial to the uterine arteries at the isthmus."}},{"doi":"10.1186/s12887-025-06362-5","pmid":"41462164","title":"Evaluation of the feasibility and clinical benefits of day-case laparoscopic percutaneous internal ring suturing for pediatric inguinal hernia in a single institution","journal_title":"BMC Pediatrics","journal_issn":"1471-2431","published_at":"2025-12-30T00:00:00.000Z","url":"https://doi.org/10.1186/s12887-025-06362-5","source_score":19,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-01-04","doi":"10.1186/s12887-025-06362-5","days":"7","issn":"1471-2431","rank":"2","field":"Clinical Medicine","score":"19","category":"Pediatrics","categories":["Pediatrics"],"_categories":["Pediatrics"]},"pubmed":{"doi":"10.1186/s12887-025-06362-5","title":"Evaluation of the feasibility and clinical benefits of day-case laparoscopic percutaneous internal ring suturing for pediatric inguinal hernia in a single institution.","journal":"BMC pediatrics","methods":"","results":"The results showed that the day-case surgery model significantly shortened hospitalization duration and reduced medical cost. The hospitalization duration and medical cost in the laparoscopic percutaneous internal ring suturing group were significantly higher than those in the open traditional high ligation of the hernia sac group (P < 0.05). However, the recurrence rate in the laparoscopic percutaneous internal ring suturing group was 0.035%, which was lower than that (0.107%) observed in the open traditional high ligation of the hernia sac group. Laparoscopic percutaneous internal ring suturing aided the detection of hidden hernia at a rate of 49.61%.","abstract":"$34","keywords":["Children","Day-case surgery","Inguinal hernia","Laparoscopy"],"pubmed_id":"41462164","conclusions":"","publication_date":"2025-12-30T00:00:00"},"crossref":{"DOI":"10.1186/s12887-025-06362-5","URL":"https://doi.org/10.1186/s12887-025-06362-5","ISSN":["1471-2431"],"link":[{"URL":"https://link.springer.com/content/pdf/10.1186/s12887-025-06362-5.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://link.springer.com/article/10.1186/s12887-025-06362-5","content-type":"text/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https://link.springer.com/content/pdf/10.1186/s12887-025-06362-5.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":"1","score":1,"title":["Evaluation of the feasibility and clinical benefits of day-case laparoscopic percutaneous internal ring suturing for pediatric inguinal hernia in a single institution"],"author":[{"given":"Yiyao","family":"Bao","sequence":"first","affiliation":[]},{"given":"Duote","family":"Cai","sequence":"additional","affiliation":[]},{"given":"Shoujiang","family":"Huang","sequence":"additional","affiliation":[]},{"given":"Zhigang","family":"Gao","sequence":"additional","affiliation":[]}],"funder":[{"name":"The Zhejiang Provincial Medical and Health Science and Technology Program","award":["Grant No. 2023KY828"],"award-info":[{"award-number":["Grant No. 2023KY828"]}]}],"issued":{"date-parts":[[2025,12,29]]},"member":"297","prefix":"10.1186","source":"Crossref","volume":"25","created":{"date-time":"2025-12-29T16:19:01Z","timestamp":1767025141000,"date-parts":[[2025,12,29]]},"indexed":{"date-time":"2025-12-29T16:23:11Z","timestamp":1767025391141,"date-parts":[[2025,12,29]]},"license":[{"URL":"https://creativecommons.org/licenses/by-nc-nd/4.0","start":{"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000,"date-parts":[[2025,12,29]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://creativecommons.org/licenses/by-nc-nd/4.0","start":{"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000,"date-parts":[[2025,12,29]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://link.springer.com/10.1186/s12887-025-06362-5"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"ArticleHistory","label":"Article History"},"label":"Received","order":1,"value":"22 September 2025"},{"name":"accepted","group":{"name":"ArticleHistory","label":"Article History"},"label":"Accepted","order":2,"value":"3 November 2025"},{"name":"first_online","group":{"name":"ArticleHistory","label":"Article History"},"label":"First Online","order":3,"value":"29 December 2025"},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"},"order":1},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"},"order":2,"value":"This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and adheres to the principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the Children’s Hospital affiliated with the Zhejiang University School of Medicine (Hangzhou, China; approval number: 2024-IRB-0303-P-01). Owing to the retrospective nature of this study and its minimal risk, the need for patient consent was waived."},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"},"order":3,"value":"Not applicable."},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"},"order":4,"value":"The authors declare no competing interests."}],"deposited":{"date-time":"2025-12-29T16:19:03Z","timestamp":1767025143000,"date-parts":[[2025,12,29]]},"issn-type":[{"type":"electronic","value":"1471-2431"}],"published":{"date-parts":[[2025,12,29]]},"publisher":"Springer Science and Business Media LLC","reference":[{"DOI":"10.1308/rcsann.2024.0058","key":"6362_CR1","year":"2024","issue":null,"author":"S Kılıç","volume":"106","first-page":"718","unstructured":"Kılıç S. Comparison of long-term outcomes of laparoscopic percutaneous internal ring suturing and classic open approach for inguinal hernia repair in children. 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Recurrence was 4/11,386 (0.035%) after LPIRS vs 3/2,811 (0.107%) after open, and LPIRS detected contralateral occult hernia in 5,204/10,127 (49.61%).","limitations":"Retrospective, single-institution design with parental selection of surgical approach and imbalanced groups (age, sex, bilateral hernia rates), risking selection confounding. The recurrence difference was based on very low event counts and was not statistically significant.","practice_takeaway":"A structured day-case pathway for pediatric inguinal hernia can cut hospital time and costs. LPIRS offers high detection of contralateral occult hernia and very low recurrence in this cohort but at higher cost and slightly longer stay than open repair."}}],"initialOffset":15,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Laparoscopic Surgery"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Laparoscopic Surgery"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Laparoscopic Surgery"}}}]]

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