2026-04-01
Yaping Zhang, Jiliang Shen
Laparoscopic hepatobiliary and pancreatic (HBP) surgery necessitates mastery of intricate anatomical relationships and precision-dependent techniques. This review synthesizes advancements in simulation-based training and education modalities— three-dimensional (3D) printing, virtual reality (VR), augmented reality (AR). 3D-printed models provide unparalleled tactile fidelity for patient-specific anatomy replication but lack dynamic physiological responses. VR enables risk-free procedural repetition and AI-driven skill optimization, yet struggles with haptic authenticity. AR bridges preoperative planning and intraoperative execution through real-time holographic navigation but faces challenges in cognitive load management. Future advancements must prioritize hybrid simulation ecosystems integrating biomechanical realism with adaptive virtual interfaces, validated transfer-to-practice metrics, and ethical frameworks for emerging technologies.
DOI: 10.3389/fsurg.2026.17872992026-04-01
Yan Wang, Bin Wang, Fang Qi, Xiangnan Li, Jing Zhang
BackgroundEarly-stage mobilization is a major component of Enhanced Recovery After Surgery (ERAS) for lung cancer surgery.ObjectiveTo investigate the impact of ERAS-based refined nursing on early postoperative activities and recovery.MethodsThis was a retrospective cohort study of 136 patients who received a radical lung cancer operation, with 68 patients assigned to the conventional nursing group and 68 to the ERAS-guided refined nursing group. Early mobilization parameters were time to first ambulation, ambulation distance at 24 h and 48 h, Timed Up and Go (TUG) test, and Barthel Index. Secondary outcomes were recovery parameters, pain, complications, nursing compliance, and patient satisfaction.ResultsPatients in the ERAS group demonstrated significantly earlier ambulation, higher early walking distances, better functional exercise capacity and Barthel Index score than those in the conventional group (P < 0.001). The postoperative recovery was enhanced with earlier gastrointestinal function, reduced duration of drainage and catheterization, and shorter length of stay (LOS, P < 0.001). Significant reductions in postoperative pain and usage of analgesic pump were observed. The incidence of overall postoperative complications was decreased in the ERAS group, especially the pulmonary infection, deep venous thrombosis (DVT) and arrhythmia. Nursing compliance and patient satisfaction were also significantly higher in the ERAS group.ConclusionERAS-based refined nursing was significantly associated with earlier mobilization, faster postoperative recovery, a lower incidence of complications, and improved nursing compliance and patient satisfaction after lung cancer surgery.
DOI: 10.3389/fsurg.2026.17677072026-04-01
Huan Li, Shubin Tan, Mohamed Helmy, Donglei Song, Bin Xu, Wei Wang
ObjectiveTo evaluate whether intraoperative fractional flow reserve (FFR) pressure wire measurements combined with FLOW800 imaging analysis effectively predict postoperative cerebral perfusion abnormalities following superficial temporal artery to middle cerebral artery (STA–MCA) bypass surgery in patients with Moyamoya disease (MMD).MethodsA retrospective analysis was conducted on 26 patients diagnosed with MMD who underwent STA–MCA bypass at our institution between November 2023 and January 2025. Intraoperative graft pressures were assessed using FFR pressure wires. Concurrently, FLOW800 imaging provided quantitative microcirculatory parameters, including delay time (DT), flow velocity, rise time (RT), and fluorescence intensity. Postoperative cerebral perfusion-related complications were documented. ROC analyses were reported with 95% confidence intervals to evaluate the predictive value of intraoperative parameters.ResultsPostoperative cerebral perfusion abnormalities occurred in 9 out of 26 patients (34.6%). Among them, 3 patients (11.5%) had diffusion-weighted MRI (DWI)-confirmed acute ischemic lesions (major complications), whereas the remaining 6 patients experienced transient neurological symptoms that completely resolved within 2 weeks to 1 month without radiographic infarction. A higher pressure gradient across the bypass graft (ΔP) and prolonged rise time (RT) in the proximal recipient artery significantly correlated with postoperative perfusion abnormalities (p 32 mmHg showed a sensitivity of 77.8% and a specificity of 64.7%. The combined predictive capability of ΔP and RT yielded an area under the receiver operating characteristic (ROC) curve (AUC) of 0.82 (95% CI, 0.61–0.99), surpassing the predictive value of either parameter alone (AUC 0.79 for ΔP and 0.79 for RT).ConclusionsIntraoperative monitoring with FFR pressure wire combined with FLOW800 imaging may help identify MMD patients at increased risk of early postoperative cerebral perfusion abnormalities after STA–MCA bypass. The integration of ΔP and RT appears to improve predictive accuracy and may support perioperative risk stratification, although larger prospective studies are required before routine decision-making can be recommended.
DOI: 10.3389/fsurg.2026.17925152026-04-01
Xu Junyan, Zhang Tao
BackgroundRapid classification on Accurate preoperative differentiation between uncomplicated (UCAA) and complicated acute appendicitis (CAA) is essential for guiding treatment but remains challenging. Existing tools, such as clinical scores and common inflammatory markers, lack sufficient accuracy for reliable stratification.MethodsIn this retrospective single-center study, 207 patients with pathologically confirmed appendicitis (52 UCAA, 155 CAA) undergoing laparoscopic appendectomy between June 2024 and September 2025 were analyzed. Multivariate logistic regression and ROC curve analyses were performed.ResultsIndividual AUCs were 0.863 for NLR (cut-off 5.22), 0.803 for SII (cut-off 1292.3), and 0.815 for maximum appendiceal diameter (cut-off 10.5 mm). Their combination achieved a superior AUC of 0.891 (95% CI: 0.840–0.942), with 86.54% sensitivity and 80.65% specificity. NLR and maximum appendiceal diameter were independent predictors of CAA.ConclusionThe combination of NLR, SII, and maximum appendiceal diameter improves preoperative diagnostic accuracy for acute appendicitis over single parameters, potentially aiding individualized treatment planning and reducing diagnostic uncertainty.
DOI: 10.3389/fsurg.2026.17952042026-04-01
Yong Hou, Shijie Zhong, Hongan Chen, Fan Cao, Anshu Xu
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract, and ultra-late recurrence (defined as recurrence occurring ≥10 years postoperatively) is particularly uncommon, especially among patients with inadequate adjuvant targeted therapy. Herein, we report a 64-year-old male patient with jejunal GIST who developed bifocal hepatic metastases 15 years after primary tumor resection. Postoperatively, the patient received only 1 year of adjuvant imatinib (400 mg/day) and remained disease-free for the subsequent 14 years, until liver lesions were incidentally identified during a routine physical examination. Comprehensive imaging studies confirmed two lesions in liver segments S4 (43 mm) and S7 (17 mm), which were consistent with metastatic characteristics. The patient subsequently underwent partial hepatectomy of segments S4 and S7 with intraoperative ultrasound-guided wire localization, achieving R0 resection. Pathological examination of both metastatic lesions revealed spindle cell proliferation, with immunohistochemical staining positive for CD117 (+) and Dog-1 (+), consistent with the typical phenotypic profile of GIST, thus confirming their GIST origin. At the 6-month postoperative follow-up, the patient remained asymptomatic, with no radiological or clinical evidence of tumor recurrence. This case is clinically distinctive owing to its ultra-long recurrence interval and synchronous bifocal hepatic metastasis, thereby offering valuable insights into the long-term natural course of GISTs in the setting of inadequate adjuvant tyrosine kinase inhibitor (TKI) therapy. Furthermore, it underscores the necessity of long-term postoperative surveillance for patients with GIST and highlights the potential role of comprehensive genetic testing in guiding individualized treatment decisions.
DOI: 10.3389/fsurg.2026.17889932026-04-01
Angel Camarasa Perez, Ruwanthi Wijayawardana, Nima Ahmadi, David Lawson Morris
Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy with limited therapeutic options and poor long-term survival, particularly in advanced stages. Complete surgical resection remains the cornerstone of treatment, although recurrence is common and management of metastatic disease is challenging. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown survival benefits in other intraperitoneal malignancies, but its role in ACC remains uncertain due to the rarity of the disease and the scarcity of evidence. We present the case of a 46-year-old woman diagnosed with left-sided ACC in 2012, initially treated with laparoscopic adrenalectomy and adjuvant radiotherapy. Over the following years, she developed multiple peritoneal and hepatic recurrences, managed with repeated cytoreductive surgeries and systemic therapies, including mitotane-based chemotherapy. From 2014 to 2025, the patient underwent four cytoreductive surgeries combined with HIPEC using different intraperitoneal chemotherapy agents, including cisplatin, doxorubicin, and mitomycin C, each achieving complete cytoreduction. The intervals between procedures reached up to three years of disease-free survival, and the patient tolerated all treatments with minimal morbidity. Thirteen years after the initial diagnosis, she remains alive and functionally well following her most recent cytoreductive surgery and HIPEC for bladder and ileocecal recurrence. This case highlights the potential role of iterative cytoreductive surgery combined with HIPEC in achieving long-term survival and disease control in selected patients with recurrent or metastatic ACC. Although limited evidence precludes definitive conclusions, our findings suggest that the integration of HIPEC with surgical management may represent a valuable therapeutic option warranting further investigation in this rare and aggressive malignancy.
DOI: 10.3389/fsurg.2026.17252722026-04-01
Ruomeng Yang, Zhen Song, Jian Wang, Linxi Xia, Hongwei Liang
BackgroundsAbdominoplasty constitutes a principal aesthetic procedure in plastic surgery, with relevance for postpartum women presenting with abdominal wall laxity. Nowadays, an increasing number of patients are undergoing abdominoplasty not merely to address a protruding abdominal appearance, but to pursue a waist-to-hip ratio that approaches an athletic physique.ObjectiveThis study aims to assess the clinical efficacy of combining abdominoplasty with liposuction within this patient population.MethodsThis retrospective study analyzed 160 postpartum women with BMI (22.1 ± 0.7 kg/m2) undergoing combined abdominoplasty and circumferential liposuction. Surgical steps included preoperative marking, tumescent liposuction of flanks, hip rolls, and upper abdomen, followed by abdominoplasty with rectus plication, progressive tension sutures, and meticulous umbilicoplasty. Outcomes were assessed via anthropometric measurements and Visual aid scoring questionnaire.ResultsWaist circumference significantly reduced from 90.9 cm to 80.4 cm postoperatively. Complications included seroma (3 cases), umbilical wound dehiscence (3 cases), and abdominal wound dehiscence (4 cases), all managed successfully. Patient satisfaction significantly improved postoperatively.ConclusionsCombined abdominoplasty and circumferential liposuction are safe and effective for abdominal contouring, achieving significant waistline refinement and high patient satisfaction. The integrated approach addresses both aesthetic and functional concerns with an acceptable complication profile.
DOI: 10.3389/fsurg.2026.17938842026-03-31
Min Chang Kang, Hayeon Lee, Haewon Lee, Hak-Jae Lee, Kyungwon Lee, Nam-Ryong Choi, Jay Jung, Eunhae Um, Hyunwoo Sun
BackgroundComputed tomography (CT) plays a vital role in diagnosing suspected gastrointestinal perforation (GIP), particularly in the presence of pneumoperitoneum and intra-abdominal fluid. Nevertheless, these radiologic findings do not invariably correspond to bowel perforation, and negative surgical exploration may occur. We conducted this study to characterize the clinical features and outcomes of patients who underwent emergency surgery for suspected GIP but had no perforation.MethodsWe retrospectively reviewed consecutive non-trauma patients who underwent emergency surgical exploration during 2021–2025 for CT-confirmed pneumoperitoneum with fluid collection. Among 1,024 emergency surgical explorations (excluding appendectomies), 11 (1.1%) were classified as negative explorations, of which five cases without pneumoperitoneum were excluded, leaving six patients for analysis. We evaluated their clinical characteristics, laboratory findings, operative details, and 90-day outcomes.ResultsThe median age of the patients was 67.5 years [interquartile range (IQR): 58–77], and three patients (50%) were men. All patients presented with abdominal pain, with a median symptom duration of 84 h (IQR: 72–148). The median white blood cell count was 13.2 × 109/L (IQR: 8.7–17.7), and the median C-reactive protein level was 23.6 mg/dL (IQR: 19.8–29.7). Final diagnoses included primary peritonitis (n = 1), sealed duodenal microperforation (n = 1), peritoneal abscess secondary to urinary tract infection (n = 2), severe oophoritis (n = 1), and soft tissue infection related to Fournier's gangrene (n = 1). The median intensive care unit (ICU) and hospital lengths of stay were 16 (IQR: 6–39) and 28.5 (IQR: 18–78) days, respectively. One patient died within 90 days (16%).ConclusionPneumoperitoneum with fluid collection on CT does not invariably indicate bowel perforation. In clinically stable patients with prolonged symptoms, a brief period of careful observation and reassessment may be appropriate. These findings underscore the importance of integrating radiologic features with clinical judgment to guide surgical decision-making.
DOI: 10.3389/fsurg.2026.17394712026-03-31
Hao Chen, Ya Sun, Fei Gao, Bo Wang, Weiwei Hua
Giant cell tumor of bone (GCT) is a borderline primary bone tumor characterized by locally aggressive behavior, for which surgical management is the mainstay of treatment. Reports on GCT involving the proximal femur remain relatively limited. Achieving complete lesion removal while preserving hip joint function continues to represent a clinical challenge. A 25-year-old man presented with right hip pain. Imaging examinations revealed an occupying lesion in the proximal region of the right femur. The patient underwent lesion curettage and inactivation assisted by hip arthroscopy, followed by bone defect reconstruction using a combination of artificial bone and autologous bone grafting. This case suggests that arthroscopy-assisted lesion curettage combined with bone grafting may facilitate local tumor control while preserving hip joint function, and may serve as a reference for the management of similar cases.
DOI: 10.3389/fsurg.2026.17741222026-03-31
Jianxin Hu, Yiyang Lu, Guochen Zhu
Primary mucoepidermoid carcinoma of the middle ear is a rare malignancy. We report a case of 58-year-old woman who presented with purulent discharge from the left ear for seven months, followed by bloody otorrhea for one month. She was diagnosed with mucoepidermoid carcinoma of the middle ear after mastoidectomy. Then, she received x-ray radiation therapy (total dose: 3,000 cGy). However, nine months later, she underwent a comprehensive surgical intervention, including subtotal temporal bone resection, partial parotidectomy, and neck dissection, due to local tumor recurrence. The patient succumbed to tumor recurrence two years after the second surgery.
DOI: 10.3389/fsurg.2026.1779650