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Bailey & Love's : short practice of surgery
One of the world's pre-eminent medical textbooks, beloved by generations of surgeons both in the UK and in numerous countries overseas, with lifetime sales in excess of one million copies.
BOOK
El Khoury's Textbook of Aortic Valve Repair
The adoption of aortic valve repair is exponentially increasing, and patients and cardiologists are demanding this with more enthusiasm. This is a current subject of great interest, and contemporary results are already present, and more are awaited. The book 'ElKhoury's Textbook of Aortic Valve Repair' describes the whole journey through the set-up of an aortic valve repair program, pertinent investigations, patient selection, different approaches, cardio-pulmonary bypass, re-operations, and its application with combined surgery. This book is directed to all training cardiac surgeons and cardiologists, consultant cardiac surgeons and cardiologists, anaesthetists, intensive care specialists and perfusionists. This is the first book authored exclusively on this subject. The 3 editors (esp Prof. ElKhoury) are leading authorities on this subject in the world and are mentors for many surgical programs. Every chapter is authored by champions in the particular aspect of aortic valve repair surgery. These are mainly from USA and Europe.
eBook
One hundred and fifty-two robotic hepatectomies at a North American hepatobiliary program: Evolution of practice, learning curve, appraisal of outcomes, and cost analysis
Introduction
In North America, the majority of hepatectomies are still performed in traditional open fashion. Robotic hepatectomy may facilitate a minimally invasive approach to liver resection.
Objectives
We report a single-center experience with the wide adaptation of robotic hepatectomy over a 5-year period.
Materials and methods
Retrospective analysis of a prospectively maintained database of all hepatectomies (
n
= 334) was performed at our institution from January 2018 to January 2023. This included 164 open, 18 laparoscopic, and 152 robotic hepatectomies. Propensity score matching (PSM) was used to match open (
n
= 100) to robotic (
n
= 100) hepatectomy cases by demographics and case complexity. Standard statistics were used to compare 90-day outcomes, including textbook outcome after liver surgery (TOLS), and cost. CUSUM curves were used to determine the learning curve for major hepatectomy.
Results
During the study period, laparoscopic hepatectomy was phased out and robotic hepatectomy became the predominant approach. The median IWATE score for the robotic cases was 8 ± 2 and 39% were major hepatectomies. The learning curve for robotic right hepatectomy was 15 cases. When PSM cases were compared, while operative time was longer, blood loss and transfusion, intraoperative incidents, overall and major morbidity, bile leaks, post-hepatectomy liver failure, hypoxia requiring supplemental oxygen, reoperation, ICU utilization, and length of stay were significantly lower in the robotic group. There was no difference in positive margins or 90-day mortality. Robotic hepatectomy was associated with significantly higher TOLS compared to open hepatectomy (85% versus 64%,
p
< 0.001) and on multivariate analysis, only a robotic hepatectomy approach was independently associated with achieving TOLS (OR 3.3, (1.62–6.67) 95% CI)). The lower ICU utilization and length of stay accounted for a significantly lower overall hospital cost for robotic compared to open hepatectomy despite a higher operating room cost.
Conclusion
We describe the successful implementation of robotic hepatectomy at our institution with favorable outcomes and cost.
Graphical abstract
Journal Article
Textbook Outcome: an Ordered Composite Measure for Quality of Bariatric Surgery
IntroductionTextbook outcome (TO) studies have previously shown that a composite measure can provide additional information on the overall quality of surgical care. However, these were binominal outcomes which do not give individual hospitals the required information on how to improve their performance. The aim of this study is to create an ordered TO consisting of multiple outcome parameters for bariatric surgery to assess the extent of hospital variation.MethodsPatients who underwent a primary bariatric procedure in the Netherlands were included for analyses. The outcomes were ordered as mortality, severe postoperative complications, readmission, mild complications and prolonged length of stay (LOS) within 30 days after primary surgery with TO defined as none of these outcomes occurring. Hospitals were identified with a significantly higher or lower observed/expected ratio than expected based on case-mix and the extent of hospital variation was expressed as the median and interquartile range (IQR).ResultsFrom a total of 27,360 patients on average, 88.7% reached TO (range 35.5–96.9%). Two hospitals had less than expected TO due to more prolonged LOS (57.6%) in one hospital and more mild complications in another (17.1%). Hospital variation was much smaller for TO (median OR 0.91 IQR [0.62–1.06]) than for an ordered TO (median POR 0.66 IQR [0.55–0.96]).ConclusionUsing the ordered TO for bariatric surgery, more hospital variation was captured thereby enabling individual hospitals to identify which outcomes and specific groups need improvement. This could attribute to the ongoing effort to improve the quality of the outcome of bariatric surgery.
Journal Article
Beautyscapes
Beautyscapes explores the global phenomenon of international medical travel, focusing on patient-consumers seeking cosmetic surgery outside their home country and on those who enable them to access treatment abroad, including surgeons and facilitators. It documents the journeys of those who travel for treatment abroad, as well as the nature and power relations of the IMT industry. Empirically rich and theoretically sophisticated, Beautyscapes draws on key themes of interest to students and researchers interested in globalisation and mobility to explain the nature and growing popularity of cosmetic surgery tourism. Richly illustrated with ethnographic material and with the voices of those directly involved in cosmetic surgery tourism, Beautyscapes explores cosmetic surgery journeys from Australia and China to East-Asia and from the UK to Europe and North Africa.
eBook
Comparison of textbook outcomes between laparoscopic and open total gastrectomy for gastric cancer
Introduction
While surgery remains an important part of the multimodal treatment of gastric cancer, laparoscopy is increasingly being used in these procedures. The aim of our study is to compare open and laparoscopic total gastrectomy using the concept of ‘textbook outcome’, which has become popular as an important and comprehensive tool in evaluating the quality of surgical treatment.
Methods
Gastric cancer patients underwent total gastrectomy with curative intent between July 2018 and January 2024 in a single center were included in this retrospective study. Exclusion criteria were emergency surgery, recurrent or metastatic disease, conversion to open, robotic gastrectomy. Patients divided to two groups as open and laparoscopic groups and compared in terms of demographic data, tumor characteristics, operative data and textbook outcome.
Results
A total of 94 patients were enrolled in the study, while the majority of whom were male (73.4%,
n
= 69). Laparoscopic surgery was found longer but there was no significant difference in the incidence of anastomotic leak and other postoperative complications between the two groups. The textbook outcome rate was 50.8% in the open group while 51.5% in the laparoscopic total gastrectomy group (
p
= 0.949). The most significant variables associated with the inability to achieve the textbook outcome were readmissions, reinterventions and postoperative complications.
Conclusion
Achievement of textbook outcomes was found to be similar between the open and laparoscopic groups. Laparoscopic total gastrectomy can be safely preferred taking into account patient status, surgeon expertise and center conditions.
Journal Article
Textbook outcome in low rectal cancer patients undergoing laparoscopic or open surgery: 3-year results from the multicentric LASRE Trial
Purpose
The textbook outcome has emerged as a valuable metric for quality assessment in oncological surgery. However, its application and impact within randomized controlled trials involving patients with low rectal cancer remain underexplored. This study aimed to investigate the incidence and predictors of textbook outcome in patients with low rectal cancer undergoing laparoscopic or open resection.
Methods
This post-hoc analysis included patients from the prospective, multicentric LASRE trial with clinically staged I-III rectal cancer located within 5 cm of the dentate line, tumor diameter < 6 cm, and undergoing radical laparoscopic or open resection. A total of 914 patients were analyzed.
Results
A textbook outcome was achieved in 74.9% of patients, with a higher rate in the laparoscopic group (76.7%) than in the open group (71.2%,
P
= 0.07). Multivariate analysis identified independent predictors of textbook outcome failure, including BMI > 24 kg/m
2
, surgical type (abdominoperineal resection), and operative time > 200 min. Achievement of a textbook outcome was associated with improved disease-free survival (DFS).
Conclusion
Achieving a textbook outcome is significantly associated with improved DFS in patients with low rectal cancer. These findings highlight the importance of optimizing perioperative and intraoperative care to enhance surgical outcomes, particularly within the context of randomized controlled trials.
Trial registration
ClinicalTrials.gov Identifier:
https://clinicaltrials.gov/study/NCT01899547
.
Journal Article
Large Language Models for Intraoperative Decision Support in Plastic Surgery: A Comparison between ChatGPT-4 and Gemini
Background and Objectives: Large language models (LLMs) are emerging as valuable tools in plastic surgery, potentially reducing surgeons’ cognitive loads and improving patients’ outcomes. This study aimed to assess and compare the current state of the two most common and readily available LLMs, Open AI’s ChatGPT-4 and Google’s Gemini Pro (1.0 Pro), in providing intraoperative decision support in plastic and reconstructive surgery procedures. Materials and Methods: We presented each LLM with 32 independent intraoperative scenarios spanning 5 procedures. We utilized a 5-point and a 3-point Likert scale for medical accuracy and relevance, respectively. We determined the readability of the responses using the Flesch–Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) score. Additionally, we measured the models’ response time. We compared the performance using the Mann–Whitney U test and Student’s t-test. Results: ChatGPT-4 significantly outperformed Gemini in providing accurate (3.59 ± 0.84 vs. 3.13 ± 0.83, p-value = 0.022) and relevant (2.28 ± 0.77 vs. 1.88 ± 0.83, p-value = 0.032) responses. Alternatively, Gemini provided more concise and readable responses, with an average FKGL (12.80 ± 1.56) significantly lower than ChatGPT-4′s (15.00 ± 1.89) (p < 0.0001). However, there was no difference in the FRE scores (p = 0.174). Moreover, Gemini’s average response time was significantly faster (8.15 ± 1.42 s) than ChatGPT’-4′s (13.70 ± 2.87 s) (p < 0.0001). Conclusions: Although ChatGPT-4 provided more accurate and relevant responses, both models demonstrated potential as intraoperative tools. Nevertheless, their performance inconsistency across the different procedures underscores the need for further training and optimization to ensure their reliability as intraoperative decision-support tools.
Journal Article
Bodily interventions and intimate labour
How have rapid changes in biotechnologisation, for example around assisted reproductive technologies or (re)constructive surgery, effected those seeking help with fertility treatment or clitoral reconstruction? What is involved for queer people in making a family of their own, or for trans people to access the relevant surgery? This volume argues that contemporary cultures foster bioprecarity by categorizing groups of people in certain ways and/or by denying them access to the treatment they seek or need. Drawing on original empirical data with trans and queer people, but also other minoritised and racialized groups, this volume explores how bodily interventions, their regulation, and the intimate labour the interventions involve, create vulnerabilities.
eBook