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Objective Patients with tuberous sclerosis complex (TSC) present with drug‐resistant epilepsy in about 60% of cases, and evaluation for epilepsy surgery may be warranted. Correct delineation of the epileptogenic zone (EZ) among multiple dysplastic lesions on MRI represents a challenging step in pre‐surgical evaluation. Methods Two experienced neuroradiologists evaluated pre‐ and post‐surgical MRIs of 28 epilepsy surgery patients with TSC, assessing characteristics of tubers, cysts, calcifications, and focal cortical dysplasia (FCD)—resembling lesions. Utilizing multiple metrics, we compared MRI features of the EZ—defined as the resected area in TSC patients who achieved seizure‐freedom 2 years after epilepsy surgery—with features of other brain areas. Using combinatorial analysis, we identified combinations of dysplastic features that are most frequently observed in the epileptogenic zone in TSC patients. Results All TSC‐associated dysplastic features were more frequently observed in the EZ than in other brain areas (increased cortical thickness, gray‐white matter blurring, transmantle sign, calcifications, and tubers; Kendal's tau 0.35, 0.25, 0.27, 0.26, and 0.23, respectively; P value <.001 in all). No single feature could reliably and independently indicate the EZ in all patients. Conversely, the EZ was indicated by the presence of the combination of three of the following features: tubers, transmantle sign, increased cortical thickness, calcifications, and the largest FCD‐affected area. Out of these, the largest FCD‐affected area emerged as the most reliable indicator of the EZ, combined either with calcifications or tubers. Significance The epileptogenic zone in TSC patients harbors multiple dysplastic features, consistent with focal cortical dysplasia. A specific combination of these features can indicate the EZ and aid in pre‐surgical MRI evaluation in epilepsy surgery candidates with TSC.

In 2009, the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) conducted an overview about the techniques used for the pre-surgical evaluation and the surgical treatment of epilepsies. The recognition that, in selected cases, surgery can be considered the first-line approach, suggested that the experience gained by the main Italian referral centers should be pooled in order to provide a handy source of reference. In light of the progress made over these past years, some parts of that first report have accordingly been updated. The present revision aims to harmonize the general principles regulating the patient selection and the pre-surgical work-up, as well as to expand the use of epilepsy surgery, that still represents an underutilized resource, regrettably. The objective of this contribution is drawing up a methodological framework within which to integrate the experiences of each group in this complex and dynamic sector of the neurosciences.

Transurethral resection of the prostate (TURP) is a minimally invasive endoscopic procedure that requires experience and skill of the surgeon. To permit surgical training under realistic conditions we report a novel phantom of the human prostate that can be resected with TURP. The phantom mirrors the anatomy and haptic properties of the gland and permits quantitative evaluation of important surgical performance indicators. Mixtures of soft materials are engineered to mimic the physical properties of the human tissue, including the mechanical strength, the electrical and thermal conductivity, and the appearance under an endoscope. Electrocautery resection of the phantom closely resembles the procedure on human tissue. Ultrasound contrast agent was applied to the central zone, which was not detectable by the surgeon during the surgery but showed high contrast when imaged after the surgery, to serve as a label for the quantitative evaluation of the surgery. Quantitative criteria for performance assessment are established and evaluated by automated image analysis. We present the workflow of a surgical simulation on a prostate phantom followed by quantitative evaluation of the surgical performance. Surgery on the phantom is useful for medical training, and enables the development and testing of endoscopic and minimally invasive surgical instruments.

Purpose To identify discrepancies between intraoperative and histological evaluations of the appendix in acute appendicitis and to evaluate the effect on surgical outcome. Methods Data was used from our previous multicentre, prospective, cohort study of patients with suspected acute appendicitis. Appendices were scored during intraoperative and histological evaluation as uncomplicated or complicated appendicitis. Primary outcome was percentage of concordance between intraoperative and histological evaluation. Secondary outcomes were (infectious) postoperative complications, length of hospital stay, hospital re-admission and re-intervention rate, all within 30 days of surgery. Results A total of 1850 patients were included. In 65.7% (1215/1850) of the appendices, the intraoperative evaluation was uncomplicated and in 34.3% (635/1850), complicated appendicitis. Patients with uncomplicated appendicitis had a postoperative course with significantly less postoperative complications (7.2% vs 24.3%), a shorter length of hospital stay (2 vs 5 days) and a lower re-admission (4.2% vs 9.6%) and re-intervention rate (1.1% vs 4.3%) than intraoperative complicated appendicitis ( p  < 0.001). In 93.5% (1136/1215) of the intraoperative uncomplicated patients and in 46.6% (296/635) of the intraoperative complicated patients, there was an agreement with pathology (Kappa 0.45). In 23.9% (81/339) of patients with intraoperative complicated and histological uncomplicated appendicitis, a postoperative complication was observed, which was similar to the postoperative complication rate of complicated appendicitis both on intraoperative and histological evaluation (24.7% (73/296)). Conclusions There is a moderate agreement between a surgeon and pathologist in diagnosing patients with complicated appendicitis. However, the intraoperative diagnosis of complicated appendicitis was significantly associated with postoperative complications. Routine histological evaluation should be preserved for excluding malignancies in suspect appendices.

Malformations of cortical development such as polymicrogyria can cause medically refractory epilepsy. Epilepsy surgery (hemispherotomy) can be a good treatment option. In recent years, navigated transcranial magnetic stimulation (nTMS), a noninvasive brain mapping technique, has been used to localize the eloquent cortex for presurgical evaluation of patients with epilepsy. In the present case study, neurophysiological markers of the primary motor cortex (M1), including resting motor threshold (rMT), motor evoked potentials (MEPs), and silent period (SP), were assessed in both hands of a right-handed 10-year-old girl with a history of epilepsy and right hemispheric polymicrogyria. Bilateral MEPs with short latencies were elicited from the contralesional side. The average MEP amplitude and the latency for the patient’s paretic and non-paretic hands differed significantly. We conclude that nTMS is a safe and tolerable procedure that can be used for presurgical evaluation in children with intractable epilepsy.

Background Traditionally, surgical success in non-cancer operations, such as elective hernia repair, has been defined by clinical outcomes, including recurrence and complication rates. However, these measures do not capture the primary reason patients seek surgery: relief from symptoms and an improved quality of life. Despite the evident patient-centered goal of non-cancer surgical procedures, research has long prioritized clinical parameters over patient-reported outcomes (PROs). A shift is essential to ensure that surgical success aligns with what truly matters to patients. Main body Current surgical research and practice heavily rely on clinical benchmarks that do not adequately reflect patients’ lived experiences. For non-cancer conditions, where surgery is elective and aims to enhance quality of life, PROs should serve as the primary indicators of success. Studies across various surgical disciplines have revealed discrepancies between clinical outcome measures and patient satisfaction, highlighting the need for validated, standardized PRO instruments. The Danish AFTERHERNIA Project exemplifies efforts to integrate PROs into surgical evaluations, utilizing digital health infrastructure to systematically capture patient experiences. Additionally, condition-specific tools, such as the Abdominal Hernia-Q, demonstrate the growing recognition of patient-centered metrics. However, the widespread implementation of PRO measurement faces challenges, including resource constraints and the need for clinician training. Addressing these barriers is important for redefining success in non-cancer surgical care. Conclusions A paradigm shift in non-cancer surgical evaluation is important. Success should be measured not only by technical outcomes but also by enhancements in patient-reported quality of life and satisfaction. Incorporating PROs into surgical research and practice is both a scientific necessity and an ethical responsibility to ensure that patient needs are addressed. Moving forward, the patient experience must become the foundation for defining surgical success in non-cancer conditions. Ultimately, the primary objective of surgical intervention should be to improve the patient’s health status and overall well-being compared to their preoperative condition.

How clinicians perform pre-surgical psychological evaluations (PSPE) for bariatric surgery remains variable across institutions. Bariatric PSPE guidelines state that self-report measures should be incorporated in the PSPE procedure, yet only 50–60% of PSPEs utilize patient self-report measures. Previous studies describing the presurgical psychological evaluation report a range of measures, however a gold standard in PSPE has yet to be agreed upon. Given this gap in how a presurgical psychological evaluation for bariatric patients is defined, incorporating more objective measures into this process may help clinicians identify specific areas in which a patient is struggling and benefit from additional psychosocial support. The present study proposes the use of the SIPAT, a semi-structured interview initially developed to assess organ transplant candidates, as part of this evaluation. A total of 292 adult patients underwent a pre-surgical psychological evaluation for bariatric surgery between November 2017 and February 2020 at a Midwest medical center. Patient average age was 45.2 (11.3) years and 83.3% were female. At time of analysis, 160 patients received bariatric surgery. Logistic regression and analyses of bivariate associations were conducted in R. The SIPAT exhibited good convergent validity via correlations with analogous scales on the PROMIS 43, and it yielded a small effect size predicting patients who ultimately received surgery. Accordingly, this semi-structured interview may be a useful tool to help differentiate patients for surgical candidacy.

Background The surgical evaluation of pediatric liver tumors is challenging, especially in difficult cases that require precise surgery. Three-dimensional visualization (3D) based on two-dimensional CT (2D) has been widely used. However, virtual surgical simulation (VS), which can provide more procedural details for specific patients, is worthy of further exploration. Methods Six pediatric liver tumor patients with the surgical difficulty increasing sequentially were selected. Recruited pediatric surgeons (15 junior and 15 senior) guided professional technicians in performing surgical evaluation using 2D, 3D, and VS sequentially. The patient-specific VS based on 3D can be constructed within the clinically permissible time window to meet clinical needs. Results For objective analysis, the scores in 3D Group and VS Group were significantly higher than those in 2D Group ( P  < 0.0001), and there was also a statistically significant difference between 3D Group and VS Group ( P  < 0.0001). As the difficulty increased, the 3D Group and VS Group consistently maintained higher scores. The scores of Junior Group using 2D were significantly lower than those of Senior Group ( P  < 0.0001), but there was no significant statistical difference in the scores of using 3D and VS. For subjective assessment, the scores of 3D Group and VS Group were significantly higher than those of 2D Group ( P  < 0.0001). VS was more aligned with clinical reality compared to 3D. Conclusion 3D and VS offer significant advantages in surgical evaluation compared with 2D, particularly for difficult cases and junior surgeons. The novel perspective and realistic experience provided by VS have attracted attention, and future research will further validate its potential clinical value in preoperative rehearsals and advanced training.

Purpose To describe the construction and use of a percutaneous pelvic fixation model, evaluate its translational validity among fellowship-trained orthopedic trauma surgeons, and investigate the importance of specific criteria for effective competency-based assessment of pelvic fixation techniques. Methods Five orthopedic trauma surgeons were asked to place percutaneous wires on a pelvic fixation model, including anterior column (antegrade/retrograde), posterior column (antegrade/retrograde), supra-acetabular, transsacral, and iliosacral. Evaluation criteria included successful wire placement, redirections, cortical breaches, procedure duration, radiation exposure, and quality of fluoroscopic views. Following completion, participants were provided a survey to rate the model. Results There were no differences between approaches on successful screw placement, wire redirections, or fluoroscopic quality. Antegrade approaches to the anterior and posterior columns took longer ( p  = 0.008) and used more radiation ( p  = 0.02). There was also a trend toward more cortical breaches with the antegrade anterior column approach ( p  = 0.07). Median ratings among surgeons were 4 out of 5 for their overall impression and its accuracy in tactile response, positioning constraints, and fluoroscopic projections. Learning parameters considered most important to the progression of trainees (most to least important) were successful screw placement, corridor breaches, wire redirections, quality of fluoroscopic views, radiation exposure, and procedure duration. Conclusion In being affordable, accessible, and realistic, this percutaneous pelvic fixation model represents an opportunity to advance orthopedic surgery education globally. Future research is needed to validate the findings of this pilot study and to expand upon how trainees should be evaluated within simulations and the operating room to optimize skill progression.

Given the anatomical variability among patients and the intricate geometry of the hand, the shape and size of the skin flap have traditionally relied heavily on the surgeon’s experience and subjective judgment. This dependence can lead to inconsistent and sometimes suboptimal results, particularly in complex cases such as web reconstruction in syndactyly surgery. Finite element analysis (FEA) provides a quantitative method to simulate and optimize skin flap design during surgery. However, existing FEA studies in this field are scattered across a wide range of seemingly unrelated topics. To address this, we present a comprehensive review focused on the application of FEA in skin flap design since 2000, with attention to all aspects of preprocessing and postprocessing. The primary objective is to evaluate the potential of FEA to generate patient-specific models by integrating individualized anatomical and biomechanical data while identifying key advancements, analyzing methodological challenges, exploring emerging technologies, and outlining future research directions. A critical finding is that the mechanical modeling of skin remains a major limitation in current FEA applications. To address this, future studies should focus on the development and refinement of non-invasive techniques for acquiring patient-specific skin properties. We also recommend several additional research directions based on our findings. These include exploring techniques to unfold 3D wound surfaces into 2D representations, which can improve mesh quality and computational efficiency; validating FEA simulations through large-scale, multicenter clinical studies to ensure robustness and generalizability; developing real-time AR/MR systems that integrate simulation or optimization results into surgical workflows; and creating AI-powered platforms that learn from clinical data to provide adaptive and personalized flap design recommendations. These findings offer a pathway to bridge the gap between simulation and clinical practice, ultimately aiming to improve surgical outcomes.