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BackgroundLaparoscopic skill acquisition involves a steep learning curve and laparoscopic suturing is an exceptionally challenging task. By improving the way feedback is given, trainees can learn these skills more effectively. This study aims to establish the most effective form of structured feedback on laparoscopic suturing skill acquisition in novices, by comparing the effects of expert verbal feedback, video review with expert feedback (video feedback), and video review with self-assessment.MethodsA prospective randomized blinded trial comparing verbal feedback, video feedback, and self-assessment. Novices in laparoscopic surgery were tasked with performing laparoscopic suturing with intracorporeal knot tying. Time was given for practice, and pre- and post-feedback assessments were undertaken. Suturing performance was measured using a task-specific checklist and global ratings. A post-study questionnaire was used to measure participant-perceived confidence, knowledge, and experience levels.ResultsFifty-one participants were randomized and allocated equally into the three groups. Performance in all three groups improved significantly from baseline. Video feedback had the largest improvement margin with checklist and global score improvements of 17.1% (± 9.9%) and 14.7% (± 9.3%), respectively. Performance improvements between groups were statistically significant in the global components (p = 0.004) but not the checklist components (p = 0.186). Global score improvement was significantly better in the video feedback group but was statistically insignificant between the self-assessment and verbal feedback groups. Questionnaire responses demonstrated positive results in confidence, knowledge, and experience levels, across all three study groups, with no differences between the groups (p > 0.05).ConclusionStructured video feedback facilitates reflection and self-directed learning, which improves the ability to develop proficiency in surgical skills. Combining both self-assessment and video feedback may be beneficial over verbal feedback alone due to the advantages of video review. These techniques should therefore be considered for implementation into surgical education curricula.

Amputation has a profound impact on an individual's quality of life (QoL) and functional ability. While socket prostheses are the current first‐line treatment, they often cause socket‐related issues. Bone‐anchored prostheses (BAP) have been introduced to address these problems and improve the amputee experience. This systematic review and meta‐analysis aim to compare the QoL between bone‐anchored and socket prostheses in transfemoral amputees. A systematic review and meta‐analysis were conducted from November 2023 to July 2024, following PRISMA guidelines. Databases including PUBMED, EMBASE, Scopus, Cochrane, and Web of Science were searched. Studies of single‐arm trial design comparing pre‐ and post‐operative outcomes were selected based on specific inclusion and exclusion criteria. Statistical analysis was performed using inverse variance with a random effect model. The primary outcome was QoL, measured using the Questionnaire for Persons with a Transfemoral Amputation (Q‐TFA) and 36‐Item Short Form Survey (SF‐36), and the secondary outcome was mobility, assessed by the 6‐Minute Walk Test (6MWT). Subgroup analyses compared different types of BAP (Press‐fit vs. Screw‐type) on QoL. Thirteen NRCTs with 398 participants were included. Significant improvements in QoL were observed in all Q‐TFA domains and the SF‐36 Physical Component Score (PCS), but not in the SF‐36 Mental Component Score (MCS). Mobility improved significantly as measured by the six‐minute walk test (6MWT). No significant differences in QoL were found between Press‐fit and Screw‐type BAP implants. Overall, BAP significantly improve both QoL and mobility, but study limitations currently restrict their use to individuals with socket‐related complications. As such, it cannot yet be universally recommended as a first‐line intervention.

High-risk patients for hereditary diffuse gastric cancer (HDGC) are commonly offered a prophylactic total gastrectomy (PTG). This includes patients with a germline CDH1 or CTNNA1 mutation and occasionally patients with variants of unknown pathogenicity. Whilst the psychological impact (PI) of curative total gastrectomy (TG) for gastric cancer (GC) has been well documented in the literature, there is a lack of consensus on how PTG affects this group of patients. Hence, this literature review aims to elucidate what is known about the PI of PTG. A narrative review of the literature was carried out using a comprehensive search strategy on Ovid Medline, EMBASE, PubMed, SCOPUS, and Web of Science. After full-text screening, 12 citations were included to investigate the PI of PTG. Domains were classified for themes relating to the PI of PTG. Themes that emerged for the PI of PTG included effects on emotional functioning, anxiety, depression, social life, body image, work and daily life, relationship with food, regret, cancer-related anxiety, and effects on intimate relationships. All domains identified for the PI of PTG are complexly interlinked with the long-term clinical outcomes of PTG. All patients suffer from long-term morbidity, and those who tolerate PTG well, with improving physical symptoms over time, have better psychological outcomes. Alternatively, patients who experience persistent and severe long-term consequences of PTG have poorer psychological outcomes. PTG is an established form of risk reduction, and care should be taken to address the PI of this procedure.

Guidelines have reported that although microwave ablation (MWA) has potential advantages over radiofrequency ablation (RFA), superiority in efficacy and safety remain unclear. Aim of the study is to compare MWA with RFA in the treatment of liver cancer. Meta-analysis was conducted according to the PRISMA guidelines for studies published from 2010 onwards. A random-effects model was used for the meta-analyses. Complete ablation (CA), local tumor progression (LTP), intrahepatic distant recurrence (IDR), and complications were analyzed. Four randomized trials and 11 observational studies with a total of 2,169 patients met the inclusion criteria. Although overall analysis showed no significant difference in LTP between MWA and RFA, subgroup analysis including randomized trials for patients with hepatocellular cancer (HCC) demonstrated statistically decreased rates of LTP in favor of MWA (OR, 0.40; 95% CI, 0.18-0.92; = 0.03). No significant differences were found between the two procedures in CA, IDR, complications, and tumor diameter less or larger than 3 cm. MWA showed promising results and demonstrated better oncological outcomes in terms of LTP compared to RFA in patients with HCC. MWA can be utilized as the ablation method of choice in patients with HCC.

Minimally invasive laparoscopic surgery requires intensive training due to challenges such as loss of haptic feedback and depth perception. Traditional training methods include box trainers (BT), which offer realistic haptic feedback but lack objective performance assessment, and virtual reality (VR) simulators, which provide automated feedback but lack haptic feedback. This review, conducted at the Barts Cancer Institute, Queen Mary University, examines the learning outcomes of VR simulators with haptic feedback compared to BT. A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from December 2023 to April 2024. Research databases, such as PubMed, EMBASE, CINAHL, and Web of Science, were searched for randomized controlled trials (RCTs) comparing VR simulators with haptic feedback to BT in training medical students. Seven RCTs met the inclusion criteria, and four were included in the meta-analysis. The primary outcomes were learning curves and learning effects while secondary outcomes included skill transfer to a surgical environment. The review analysed data from 125 participants across the studies. Results indicated that BTs demonstrated a superior learning curve, with participants achieving proficiency faster than those using VR. Both simulators showed significant learning effects; however, BTs resulted in greater improvements across more performance parameters. Regarding skill transfer to surgical environments, there was no significant difference between the two groups, suggesting both approaches effectively support surgical skill transfer. Overall, BT has a more effective learning curve and marginally better performance in skill acquisition. While VR with haptic feedback offers enhanced realism, it does not fully replicate the natural haptic feedback provided by BT. Further studies are needed to improve VR haptic feedback and its integration into training programs to enhance learning outcomes.

Introduction The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains. Aim of the study To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician. Methods A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I 2 and the QUADAS-2 tool was used to assess bias of the studies. Results This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4–36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8–98.2%) and sensitivity of 86.7% (range 40–99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832–7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries. Conclusion Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases.

Robotic surgery has undergone much development and increased use over the years; it has offered many benefits for the operating surgeon compared to the more restrictive nature of conventional laparoscopic surgery (CLS) which is the current standard of care. However, to the best of our knowledge, no studies have attempted to draw a comparison between the two in terms of the cases required for the learning curve to be achieved. The systematic review was performed at Barts Cancer Institute. A search of Cochrane, PubMed and Embase was made on 15 March 2024. Screening and risk of bias were done by two reviewers. Screening was done via the eligibility criteria by two reviewers. Data collection was done using Excel (Microsoft® Corp., Redmond, USA) and information was double-checked by another reviewer and transferred into a tabulated format. Seventeen studies were included, with the learning curve reported in 14 studies. The cases required to achieve the learning curve for multiport robotic cholecystectomy (MRC) ranged from 16 to 134 and for single-site robotic cholecystectomy (SSRC), it ranged from 10 to over 102 cases. Conventional laparoscopic cholecystectomy (CLC) was from 7 to 200. The improvement in operating times was measured in very different ways and was reported in 10 of the 17 studies. The studies that were available had a high level of heterogeneity making it difficult for comparisons to be made between studies. Several studies included only one surgeon resulting in the sample size of surgeons being too small and vulnerable to bias. As robotic surgery is still relatively novel, higher-quality studies have to be made in order for more conclusive conclusions to be made on the benefits of the learning curve of MRC and SSRC.

Achieve an international consensus on how to recover lost training opportunities. The results of this study will help inform future EAES guidelines about the recovery of surgical training before and after the pandemic. A global survey conducted by our team demonstrated significant disruption in surgical training during the COVID-19 pandemic. This was wide-spread and affected all healthcare systems (whether insurance based or funded by public funds) in all participating countries. Thematic analysis revealed the factors perceived by trainees as barriers to training and gave birth to four-point framework of recovery. These are recommendations that can be easily achieved in any country, with minimal resources. Their implementation, however, relies heavily on the active participation and leadership by trainers. Based on the results of the global trainee survey, the authors would like to conduct a Delphi-style survey, addressed to trainers on this occasion, to establish a pragmatic step-by-step approach to improve training during and after the pandemic. This will be a mixed qualitative and quantitative study. Semi-structured interviews will be performed with laparoscopic trainers. These will be transcribed and thematic analysis will be applied. A questionnaire will then be proposed; this will be based on both the results of the semi structured interviews and of the global trainee survey. The questionnaire will then be validated by the steering committee of this group (achieve consensus of >80%). After validation, the questionnaire will be disseminated to trainers across the globe. Participants will be asked to consent to participate in further cycles of the Delphi process until more than 80% agreement is achieved. This study will result in a pragmatic framework for continuation of surgical training during and after the pandemic (with special focus on minimally invasive surgery training).

This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation. In this prospective randomised trial, novices (n = 40) without laparoscopic experience were recruited and randomised into two groups, which used either traditional rigid needle holders or the FlexDex™. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were recorded, and results were evaluated based on completion times, error rates, and learning curves. The intervention group that used the FlexDex™ completed 10 attempts of the standardised laparoscopic task slower than the control group that used traditional rigid needle holder (415 s versus 267 s taken for the first three attempts and 283 s versus 187 s taken for the last three attempts, respectively). The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). Furthermore, the intervention group demonstrated a higher error rate when compared to the control group (9.3 versus 6.2 errors per individual). When compared to the FlexDex™, the traditional rigid needle holder was observed to be superior in task performance speed, leading to shorter completion times and quicker learning effect, as well as fewer errors. Traditional rigid needle holder leads to faster task completion times and lower error rates when compared with an articulating laparoscopic needle holder in 2D vision.

This narrative review evaluates the role of artificial intelligence (AI) in healthcare, summarizing its historical evolution, current applications across medical and surgical specialties, and implications for allied health professions and biomedical research. We conducted a structured literature search in Ovid MEDLINE (2018-2025) using terms related to AI, machine learning, deep learning, large language models, generative AI, and healthcare applications. Priority was given to peer-reviewed articles providing novel insights, multidisciplinary perspectives, and coverage of underrepresented domains. AI is increasingly applied to diagnostics, surgical navigation, risk prediction, and personalized medicine. It also holds promise in allied health, drug discovery, genomics, and clinical trial optimization. However, adoption remains limited by challenges including bias, interpretability, legal frameworks, and uneven global access. This review highlights underexplored areas such as generative AI and allied health professions, providing an integrated multidisciplinary perspective. With careful regulation, clinician-led design, and global equity considerations, AI can augment healthcare delivery and research. Future work must focus on robust validation, responsible implementation, and expanding education in digital medicine.