The Clip-Pulley Maneuver: Atraumatic and Adjustable Retraction in Robotic Liver Resection - Annals of Surgical Oncology Background Precise liver retraction is essential in robotic hepatectomy. Conventional retraction methods using barbed sutures1,2 or hook-needle systems3 are penetrative and traumatic, risking diaphragmatic injury or tension pneumothorax. We developed a nonpenetrating Clip-Pulley Maneuver (CPM) to achieve safe and adjustable retraction. Materials and Methods From February to November 2025, 26 robotic hepatectomies were performed using CPM. A 3-0 polydioxanone monofilament (PDS; Ethicon, Inc., Bridgewater, NJ, USA) was placed on the liver surface at the resection margin. After suture placement, a triangular clip from the Internal Organ Retractor system (Aesculap, Inc., Center Valley, PA, USA) was introduced and the suture passed through its loop. The clip was then positioned on the diaphragm using a dedicated applicator. The suture was exteriorized through the abdominal wall using an Endo Close device (MC Medical Inc., Tokyo, Japan), forming a pulley-like system. The surgeon adjusted the traction force externally, and the assistant could reposition the clips to modify retraction direction. The direction of traction is determined by the spatial relationship between the suture placement on the liver surface and the clip position, rather than by the direction of external pulling. This setup allowed real-time, atraumatic retraction without additional punctures to the diaphragm or peritoneum. In most cases, two clips were sufficient; additional clips may be used for larger anatomical resections. Results There were no CPM-related complications or Clavien–Dindo grade III or higher events. The diaphragm remained intact in all cases. Conclusions CPM offers a safe, effective, and reusable liver retraction method for robotic hepatectomy.

Improved Liver Retraction in Robotic Hepatectomy

by Ashida R, Sugiura T (...) Uesaka K et 4 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article:

BJS Academy Mr. Gareth Owens, MSc. (OXON), MBCS, CITP, discusses his experiences with acute aortic dissection surgery.

❤️‍🩹 Acute aortic dissection surgery: a patient view
➡️ buff.ly/ry9SMLx

Mr. Gareth Owens, MSc. (OXON), MBCS, CITP, discusses his experiences with acute aortic dissection surgery

#surgsky #medsky @bjsurgery.bsky.social @bjsopen.bsky.social

Total Neoadjuvant Therapy Hurts Survival in Rectal Cancer

by Ito K, Jain AJ (...) Chun YS et 5 al. in BMC Surg #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article: www.sciencedirect.com/science/article/pii/S003...

BJS Academy Surgery is a planned trauma with a predictable stress response1. Yet patients are routinely sent to the operating room without preparation for the physiological demands of major surgery.…

When a trial shows “prehabilitation works”… do we actually know what worked?

🏃 Exercise?
🥗 Nutrition?
🧠 Behavioural support?
👩‍⚕️ Supervision level?

The SOS-Prehab checklist, developed by Chelsia Gillis and Julio F Fiore Jr, aims to fix this

🔗https://buff.ly/6GnDLkd

#surgsky @BJSurgery.bsky.social

Efficacy and Safety of Tranexamic Acid in Solid Cancer Surgeries: A Systematic Review and Meta-analysis of Randomized Controlled Trials with GRADE Assessment - Annals of Surgical Oncology Background There is a significant risk of blood loss and transfusion requirements during surgeries for different cancers, raising perioperative morbidity and mortality. The antifibrinolytic drug tranexamic acid (TXA) has been studied to address this issue, but the results remain conflicting. This systematic review and meta-analysis pools all available evidence regarding the use of this medication in cancer surgeries. Patients and Methods The PubMed, Scopus, Web of Science, and Cochrane CENTRAL databases were used for data retrieval until 29 April 2025. Any randomized controlled trial involving surgical patients with cancer who received TXA as the intervention was included. The main addressed outcomes were perioperative blood loss, transfusion requirements, and complications. Study quality and evidence certainty were appraised with the Cochrane RoB 2.0 tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results A total of 16 RCTs with 1830 patients were analyzed. TXA markedly reduced total, intraoperative, and postoperative blood loss compared with control. Hemoglobin changes were also smaller in the TXA group. Intraoperative blood component and perioperative red blood cell transfusions were lower with TXA. TXA was also linked to a modest reduction in operative time. No significant differences were observed between the groups for perioperative complications, reoperation rate, in-hospital or 30-day mortality, and length of hospital stay. GRADE assessments for the outcomes were mainly moderate or low, except for two that had very low certainty. Conclusions TXA appears to statistically improve perioperative outcomes in cancer surgeries while maintaining a favorable safety profile.

Tranexamic Acid Cuts Blood Loss in Cancer Surgeries

by Soliman A, Azim AAA (...) Qutob IA et 6 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article:

Validation of Textbook Outcome in Gastric Surgery (TOGS) for Primary Gastric Cancer in an Eastern High-Volume Center - Annals of Surgical Oncology Background Textbook Outcome defines the ideal perioperative course after surgery. A specific Textbook Outcome in Gastric Surgery (TOGS) was developed in Western centers; however, its validation among Eastern patients has rarely been investigated. We assessed its achievement in a Korean cohort and identified its predictors. Methods We included adults who underwent curative distal or total gastrectomy for gastric cancer (GC) between 2013 and 2023. TOGS consisted of three surgical criteria (no intraoperative complications, R0 resection, and adequate lymphadenectomy: > 20 nodes in subtotal and > 25 in total gastrectomy) and four postoperative criteria (no re-intervention, no unplanned intensive care unit stay, no unplanned 90-day readmission or mortality). Results Of the 5806 patients with GC enrolled, 4338 (74.7%) achieved the TOGS, with rates of 77.9% for stage I tumors and 68.8% for stages II–III. The TOGS rate declined with age, from 82.3% in patients aged < 40 years to 67.5% in those aged >80 years, with hospital readmission being the strongest negative predictor of its achievement in the elderly. Several factors were independently associated with a higher likelihood of TOGS: early lesions (P = 0.003), female sex (P < 0.001), recent surgery (P = 0.024), distal gastrectomy (P < 0.001), and minimally invasive approach (P < 0.001). Patients with TOGS had shorter hospital stays (P = 0.014) and improved 5-year overall survival (87.6%, vs. 75.6%, P < 0.001), independent of the pathological stage (stage I, P < 0.001; stages II–III, P < 0.001). Conclusions The new definition of TOGS provides valuable insights into the quality of surgical care for patients with GC and has a strong impact on oncological outcomes, including in Eastern patients.

Validation of Textbook Outcome in Gastric Cancer Surgery

by Carbone L, Cho YS (...) Lee HJ et 13 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article:

BJS Academy This video demonstrates the second stage of a planned two-stage repair for an extensive Type II thoracoabdominal aortic aneurysm. The first stage comprised sinotubular junction reconstruction and…

❤️‍🩹 Open Type II thoracoabdominal aortic aneurysm repair: key principles and operative insights
➡️ buff.ly/8yS4KW8

#surgsky #medsky @bjsurgery.bsky.social @bjsopen.bsky.social

BJS Academy Official portrait of President Cleveland by Eastman Johnson (1824-1906) in 1891. Grover Cleveland was the twenty-second president (March 4, 1885 – March 4, 1889) and the twenty-fourth president…

A hidden tumour.
A secret yacht.
A president fighting for political survival.

In 1893, Grover Cleveland underwent a daring and covert operation to remove a suspected cancer—without the public ever knowing.

This is where surgery meets history.
📖 buff.ly/IKe1MsO

#surgsky #medsky #history

Navigating Role Ambiguity in Surgical Education

by Cha JS, Tucker EL, Lauer KV and Smith B in J Am Coll Surg #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article: journals.lww.com/journalacs/abstract/9900...

Figure 4 of the linked paper, "Final anatomical components and modular integration into the neurosurgical simulator."

This 🆕 highly realistic, ethical, and accessible 3D-printed simulator could help replace the use of live rats in microneurosurgical training.

From Amini et al. of @uni-magdeburg.de, in @jnajournal.bsky.social:
doi.org/10.3171/2025...

#MedEd #SurgEd #MedSky #SurgSky #Neurology #Neurosurgery

BJS Academy The nomination window for the 2027 BJS Award is now open. Nominations should be submitted by Friday 26 June 2026 via the BJS Academy website, where further information is available, including the…

🎺 🎉 NOMINATIONS ARE OPEN!
➡️ buff.ly/nblBIe4

Nominate an exceptional individual for the BJS Award:

💫 Celebration of excellence in surgical science.
💫 Recognises a discovery, innovation or scientific study that has changed clinical practice.

⏳ Nominations close 26 June 2026.

#surgsky #medsky

Robot-assisted versus conventional minimally invasive oesophagectomy for oesophageal squamous cell carcinoma (RAMIE): a multicentre, open-label, randomised, phase 3, non-inferiority trial In patients with resectable oesophageal squamous cell carcinoma, robot-assisted oesophagectomy was non-inferior, and seemed superior, to thoracoscopic oesophagectomy in terms of 5-year overall surviva...

🆕 Robot-assisted versus conventional minimally invasive oesophagectomy for oesophageal squamous cell carcinoma (RAMIE): a multicentre, open-label, randomised, phase 3, non-inferiority trial

www.thelancet.com/journals/lan...

#GastroSky #OncSky #SurgSky

🔍WebSurg focus - esophagogastric surgery
➡️ buff.ly/QCsa9VQ

🌐Continuing our partnership with WebSurg (IRCAD), we bring you March's focus of the month🚀

#surgsky #medsky

BJS Academy To mark National Deep Vein Thrombosis (DVT) Awareness Month, we have curated a selection of recent high-impact papers from BJS and BJS Open exploring venous thromboembolism (VTE) in surgical…

🩸 March is Deep Vein Thrombosis (DVT) Awareness Month

Blood clots remain a significant yet often under-recognised risk in surgical patients — with prevention, timing, and patient selection all critical to improving outcomes.

🔍 Read it in full:
buff.ly/biYZWst

#surgsky #medsky

BJS Award A celebration of excellence in surgical science, the BJS Award recognises a discovery, innovation or scientific study that has changed clinical practice. This international accolade will give an…

⁉️Watched the 🥇BJS Award video yet?

The winner will receive:
💥€100,000
💥A medal
💥A diploma
💥Invitation to the Award ceremony
💥Host a BJS Academy webinar

REMINDER:
💥Organisations can nominate
💥Nominations can be made globally

Nominations open 2 April!

Please share ⬇️
buff.ly/EPpMtZ9

#surgsky

Prehospital Whole Blood Transfusion Not Superior in Trauma

by Smith JE, Cardigan R (...) Green L et 22 al. in N Engl J Med #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article: https://www.nejm.org/doi/10.1056/NEJMoa2516043

3D‐Printed Dynamic Heart Model With Left‐Side Anatomy and Integrated Sensor for Edge‐to‐Edge Repair and Regurgitation Reduction This work presents a fully synthetic, 3D-printed dynamic heart model with left-side anatomy featuring sutured mitral valve chordae tendineae analogs, embedded actuators for physiologic wall contracti...

WSU engineers developed a 3D-printed dynamic heart model. Components in the myocardial walls enable it to mimic ventricular contraction & realistic mitral valve motion, supporting minimally invasive #SurgEd.

advanced.onlinelibrary.wiley.com/doi/10.1002/...

#CardioSky #SurgSky #MedEd #MedSky

Preoperative Low-Energy Diets May Reduce Surgical Risks

by McKechnie T, Kuszaj O (...) Bhandari M et 15 al. in Br J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article: academic.oup.com/bjs/advance-article/doi/...

Pre-hospital deaths dominate trauma fatalities in urban systems

by Nijhawan A, Ter Avest E (...) Perkins ZB et 6 al. in Br J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article: academic.oup.com/bjs/advance-article/doi/...

Obesity Linked to Higher Cancer Rates: Significant Implications for Surgery

by Shen S, Brown KA, Green AK and Iyengar NM in JAMA #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article: jamanetwork.com/journals/jama/article-ab...

Gravity Modeling to Predict Patient Choice of Hospital for Pancreaticoduodenectomy - Annals of Surgical Oncology Background Prior studies simulating how regionalization of complex surgeries such as pancreatoduodenectomy (PD) would affect access to care assumed that patients travel to their closest hospital. The validity of this assumption had not been evaluated. Our objectives were to assess the accuracy of a distance-only model in predicting where a patient received PD and determine whether incorporating hospital characteristics improved accuracy. Methods Data on patients undergoing PD from 2016 to 2017 in New York or Florida were obtained from the Statewide Inpatient Databases. We assessed three models: distance alone (model 1), distance and hospital volume (model 2), and distance, hospital volume, rurality, cancer accreditation, medical school affiliation, and centralization taxonomy of the health system (model 3). Model accuracy was determined by comparing the predicted hospital and the actual hospital where the patient received care. Results Among the 2949 included patients, model 1 was accurate for only 16.3%; model 2 was accurate for 32.9%, and model 3 was accurate for 24.3%. Patients who were accurately classified with models 2 or 3 but not 1 were more likely to live in major metropolitan areas (74.7% vs. 61.0%, p < 0.001), more likely to be non-Hispanic white (71.3% vs. 68.3%, p = 0.04), more likely to have private insurance (35.0% vs. 27.8%, p < 0.001), and had lower in-hospital mortality (1.3% vs. 3.3%, p = 0.03). Conclusions Distance-only models were largely inaccurate for predicting where patients received PD. Simulations of patient redistribution should incorporate volume, distance, and additional patient- and provider-level factors.

New Models for Predicting Hospital Choice in Pancreatic Surgery

by Ross-Driscoll K, Huber S (...) Ellis RJ et 5 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article:

Retroperitoneal-First Laparoscopic Approach (Retlap) for Bile Duct Resection in Pancreaticobiliary Maljunction (PBM): A Novel and Reasonable Approach to Intrapancreatic Bile Duct - Annals of Surgical Oncology Background Pancreaticobiliary maljunction (PBM) is a congenital anomaly in which the pancreatic and bile ducts join outside the duodenal wall.1,2 Reflux of pancreatic juice induces chronic inflammation and epithelial regeneration, promoting carcinogenesis. Biliary dilation increases the risk of cholangiocarcinoma, and prophylactic resection of the extrahepatic bile duct and gallbladder is recommended even for asymptomatic patients.3,4 To prevent postoperative carcinogenesis, the intrapancreatic bile duct should be transected just above the pancreatobiliary junction. The authors describe a novel dorsal approach to the pancreatic head using the retroperitoneal-first laparoscopic approach (Retlap).5–7 Methods A 73-year-old woman under follow-up evaluation for choledocholithiasis-associated cholangitis was found to have a gallbladder tumor. Evaluation showed PBM with biliary dilation. Computed tomography exhibited wall-thickening of the gallbladder fundus. Magnetic resonance cholangiopancreatography demonstrated a common bile duct diameter of 13 mm and a common channel length of 12 mm, whereas endoscopic retrograde cholangiopancreatography measured both as 15 mm. Biliary amylase was elevated. The preoperative diagnosis was gallbladder carcinoma with PBM and biliary dilation. After an explanation of the procedure and her informed consent, the woman underwent extrahepatic bile duct and gallbladder resection with lymphadenectomy using Retlap. Results The operative time was 480 min, including 210 min for Retlap, with 40 mL blood loss. The postoperative course was uneventful, and she was discharged on postoperative day 14. Pathology confirmed gallbladder carcinoma with single-node metastasis. At this writing, after adjuvant chemotherapy, the woman has remained recurrence-free 3 years. Conclusion Although additional trocars and steps are required, Retlap for PBM may enable safe bile duct transection just above the pancreatobiliary junction and facilitate lymphadenectomy, providing excellent visualization and stable maneuverability.

Novel Laparoscopic Method for Bile Duct Resection in PBM

by Karasuyama T, Kiguchi G (...) Takeyama O et 2 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article:

Fluorescence Lymphography Using Indocyanine Green During Esophagectomy for Cancer to Prevent Chyle Leakage: A Propensity Score Matched Analysis - Annals of Surgical Oncology Background This study evaluated the efficacy of intraoperative fluorescent lymphography with indocyanine green (ICG) to reduce the incidence of chyle leakage post-esophagectomy. Methods This prospective observational cohort study was conducted among patients who underwent fluorescence lymphography during esophagectomy for cancer between May 2022 and August 2023 at a single tertiary referral center. After 1:3 propensity score matching, the results were compared between 59 patients who underwent fluorescence lymphography (ICG group) and a historical cohort who did not (non-ICG group). The primary outcome was the incidence of postoperative chyle leakage. Results The study included 59 patients in the ICG group and 177 non-ICG controls. ICG was ultrasound guided bilaterally injected into inguinal lymph nodes in 26 patients (44%), the small bowel mesentery in 30 patients (51%), and both sites in three patients (5%). Thoracic duct visualization was successful in 85%. Fluorescence lymphography influenced intraoperative management in 21 patients (36%), with placement of additional clips. The incidence of chyle leakage was 17% (10/59) in the ICG group and 10% (18/177) in the non-ICG group (p = 0.163). All patients with chyle leakage in the ICG group were treated conservatively versus two re-interventions in the non-ICG group (p=0.271). Conclusions Real-time ICG fluorescence lymphography is a promising tool for the intraoperative detection and management of chyle leakage during esophagectomy, although no reduction in chyle leakage was demonstrated. Further studies are required to elucidate the efficacy of fluorescence lymphography with ICG in reducing the incidence of postoperative chyle leakage.

Fluorescence Lymphography in Esophagectomy Shows No Chyle Leakage Benefit

by Henckens SPG, van der Aa DC (...) Gisbertz SS et 4 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article:

🚨 UPCOMING | BJS Academy Virtual Journal Club
➡️https://buff.ly/GTT8WTE

LIVE event featuring two trainee presentations and expert-led discussion exploring surgeon wellbeing and resilience, based on research published in BJS and BJS Open.

🗓 Thursday, 2 April ⏰ 18:00 GMT

#Surgsky #medsky

2027 BJS Award 💥 RULE REMINDER

🩺 Nominations CAN be made in any area of surgery.
🌎️ Nominations and nominees CAN be from anywhere in the world

Have someone in mind? Read up on all the guidelines before the nomination window opens on 2 April: buff.ly/EPpMtZ9

#surgsky #medsky

BJS Academy The BJS Academy is delighted to present a special webinar featuring Professor James Shapiro, recipient of the 2025 BJS Award. Learn more about his career and his ground-breaking achievements and the…

🆕 Webinar - BJS Award 2025 winner, Professor James Shapiro
➡️ buff.ly/OHGZTST

Enjoy a special webinar featuring Professor James Shapiro, recipient of the 2025 BJS Award.

❓️Has the 2025 Award winner inspired you to nominate for the 2027 BJS Award ? The nomination window opens 2 April.

#surgsky

AI-Driven Marker Improves Outcomes for Pancreatic Cancer Nonproducers

by Thalji SZ, Aldakkak M (...) Kothari AN et 18 al. in JAMA Surg #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article: jamanetwork.com/journals/jamasurgery/art...

Occult Nodal Disease in Gallbladder Cancer: An International Multi-institutional Analysis and Preoperative Risk Stratification - Annals of Surgical Oncology Introduction Accurate preoperative nodal staging remains challenging in gallbladder cancer (GBC), and a substantial proportion of patients presumed to be clinically node-negative have nodal metastasis at surgery. This study aimed to quantify the burden of occult nodal disease (OND)—defined as pathologic node-positive disease among clinically node-negative patients—and to identify preoperative factors associated with OND. Methods Patients who underwent upfront curative-intent resection with regional lymphadenectomy for GBC were identified from an international multi-institutional database. Among patients staged as clinically node-negative (cN0) on preoperative imaging, multivariable logistic regression was used to identify preoperative predictors of OND. CA19-9 and the systemic immune-inflammation index (SII) were log-transformed for modeling purposes. Results Among 187 patients, 142 (75.9%) were classified as cN0 preoperatively, among whom 47 (33.1%) had OND on final pathology. On multivariable analysis, higher ln(SII) (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.05–2.86), higher ln(CA19-9) (OR 1.30, 95% CI 1.12–1.53), and preoperative jaundice (OR 3.68, 95% CI 1.21–11.76) were independently associated with OND. The observed OND rate increased stepwise with the number of elevated preoperative markers (SII > 890.2, CA19-9 > 37 U/mL, and jaundice): 17.1% with 0 markers, 44.8% with 1 marker, and 73.6% with 2–3 markers. Conclusions OND was present in approximately one-third of clinically node-negative GBC patients undergoing lymphadenectomy. Preoperative jaundice, elevated CA19-9, and elevated SII independently predicted OND and provided simple risk stratification. Incorporating these readily available markers into preoperative assessment may improve risk enrichment for OND and help guide additional staging and treatment sequencing.

Occult Nodal Disease in Gallbladder Cancer: Critical Insights

by Kawashima J, Yuza K (...) Pawlik TM et 9 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article:

High Variation in Expert Assessment of Peritoneal Malignancy

by Bhatt A, Sharma V (...) Glehen O et 42 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article: link.springer.com/article/10.1245/s10434-0...

Improved Technique for Chronic Anal Fissures

by Liu R, Li J (...) Zhong S et 3 al. in Dis Colon Rectum #Surgery #SurgSky #GeneralSurgery #MedSky

🪡 read our summary here
📖 read the article: journals.lww.com/dcrjournal/abstract/9900...