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        <title>Frontiers in Surgery | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/surgery</link>
        <description>RSS Feed for Frontiers in Surgery | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-04-29T20:35:09.666+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1779653</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1779653</link>
        <title><![CDATA[Case Report: Primary giant chondrosarcoma of the manubrium sterni]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Yinghao Zhu</author><author>Yang Lou</author><author>Xianguo Chen</author>
        <description><![CDATA[Chondrosarcoma is one of the most common primary malignant bone tumors in adults, with a predilection for sites such as the pelvis and femur. This article reports a rare case of giant chondrosarcoma originating from the manubrium sterni in a 42-year-old male patient. The patient presented to the outpatient clinic with chest pain accompanied by chest wall swelling. Physical examination revealed a firm mass at the manubrium, and chest CT demonstrated osteolytic destruction of the sternum. Needle biopsy pathology was suggestive of chondrosarcoma. A multidisciplinary team performed a radical resection of the sternal tumor. The postoperative outcome was favorable, with a stable thoracic cage. Histopathological examination confirmed the diagnosis of grade II chondrosarcoma.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1800944</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1800944</link>
        <title><![CDATA[The number of fusion levels as a potential factor influencing long-term complications of anterior controllable antedisplacement fusion: a biomechanical analysis]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Gaole He</author><author>Haopeng Li</author><author>Liang Yan</author><author>Zhongkai Liu</author><author>Teng Lu</author>
        <description><![CDATA[BackgroundAnterior controllable antedisplacement fusion (ACAF) is widely used for cervical ossification of the posterior longitudinal ligament, but long-term complications, such as adjacent segment degeneration (ASD), pseudarthrosis, cage subsidence, and implant failure, remain nonnegligible. This study aimed to explore the influence of the number of fusion levels (NFL) on these complications through finite element (FE) analysis, providing a biomechanical basis for optimizing surgical strategies for ACAF.MethodsThree FE ACAF models (two-level, three-level, and four-level) were established on the basis of a validated C2–T1 cervical spine model. A hybrid loading protocol with a 75 N follower load and physiological moments was applied to simulate physiological motions. Key parameters, including the range of motion (ROM) of the surgical and adjacent segments, disc stress, facet joint force (FJF), endplate stress, and the plate, screw, and screw–bone interface stresses, were compared among the three models.ResultsAn increase in the NFL led to significant increases in the ROM, disc stress, and FJF of adjacent segments, with the upper adjacent segment showing more prominent changes than the lower segment. The ROM of the surgical segment gradually increased with increasing NFL, and the fusion space micromotion correspondingly increased. Endplate stress and implant-related stresses (plate, screw, and screw–bone interface stresses) all tended to increase steadily with increasing NFL, reflecting a continuous increase in the mechanical load at the surgical site and in the adjacent segments.ConclusionsThe NFL is a potential risk factor for long-term complications of ACAF. An increase in the NFL raises the mechanical load in the surgical and adjacent segments, thereby potentially increasing the risks of ASD, pseudarthrosis, cage subsidence, and implant failure.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1777076</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1777076</link>
        <title><![CDATA[Case Report: Spontaneous rupture of an internal thoracic artery aneurysm: a rare life-threatening emergency and Its therapeutic challenges]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Xun Guo</author><author>Zhuohang Liu</author><author>Zheng Liu</author><author>Hongquan Fan</author>
        <description><![CDATA[Internal thoracic artery (ITA) aneurysms are exceedingly rare vascular anomalies that often remain asymptomatic until rupture. Rupture can precipitate acute hemothorax, hemorrhagic shock, and death if not rapidly diagnosed and managed. We report the case of a 42-year-old previously healthy female who presented to the emergency department with sudden-onset chest, abdominal, and back pain. Initial CT imaging elsewhere revealed pleural effusion, a non-specific finding. Upon transfer to our institution, emergency computed tomography angiography (CTA) demonstrated a ruptured left ITA pseudoaneurysm with active contrast extravasation and a large left hemothorax. Emergent transcatheter arterial embolization using microcoils achieved definitive hemostasis. Ultrasound-guided chest tube drainage was subsequently performed. The patient recovered uneventfully and was discharged without complications. This case highlights a critical diagnostic pitfall in emergency medicine—ruptured ITA aneurysm masquerading as simple pleural effusion—and underscores the pivotal role of CTA and endovascular therapy in optimizing outcomes. We also review the literature on etiology, diagnostic challenges, and evolving therapeutic strategies for this rare but fatal condition.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1720182</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1720182</link>
        <title><![CDATA[Bilateral approach selection in neuroendoscopic surgery for pituitary adenomas and health economic evaluation]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mingjian Li</author><author>Jiahui Liu</author><author>Lianshu Ding</author><author>Jing Xu</author><author>Yanxia Deng</author><author>Pengcheng Wang</author>
        <description><![CDATA[ObjectiveTo investigate the impact of bilateral approach selection in neuroendoscopic transsphenoidal surgery for pituitary adenomas on patient prognosis and to analyze the medical burden on patients from a health economic perspective.MethodsA retrospective analysis was conducted on the data of 197 patients who underwent pituitary adenoma surgery. The patients were divided into two groups based on the surgical approach: the transseptal approach group (n = 108) and the bilateral nostril expanded transsphenoidal approach group (n = 89). The medical burden, clinical efficacy, surgical indicators, hormone levels, and complications were compared between the two groups.ResultsCompared with the bilateral nostril expanded transsphenoidal approach, the transseptal approach was associated with significantly less intraoperative blood loss and shorter operative time (P < 0.05). No significant differences were observed in total medical costs, psychological burden, hormone profiles, or complication rates. Postoperative nasal packing was associated with reduced rates of diabetes insipidus and thyroid-stimulating hormone abnormalities (P < 0.05) and a marginally significant reduction in cerebrospinal fluid rhinorrhea (P = 0.05).ConclusionThe transseptal approach in pituitary adenoma surgery has the advantages of less intraoperative bleeding and shorter surgical duration, which can reduce postoperative anxiety and depression in patients. Postoperative nasal packing may reduce complications, but larger multicenter studies are warranted. Pituitary adenoma patients bear substantial economic and psychological burdens; multidisciplinary collaboration and pharmacoeconomic optimization are needed to reduce overall costs and improve outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1763803</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1763803</link>
        <title><![CDATA[Perioperative machine learning models with SHAP interpretation for predicting adverse outcomes in breast cancer surgery]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yongde Yang</author><author>Jiawei Xu</author><author>Rong Liao</author><author>Yanlin Zhou</author>
        <description><![CDATA[ObjectiveTo investigate the clinical value of a machine learning model constructed using perioperative data for predicting adverse postoperative outcomes in patients undergoing breast cancer surgery, and to identify key decision factors through SHAP interpretability analysis.MethodsPerioperative core indicators and follow-up data from 643 treatment-naïve patients with breast cancer who underwent surgical treatment were retrospectively collected, including 443 cases in the modeling set and 200 cases in the external validation set, derived from two independent medical centers. The modeling set was stratified and split into training and internal validation sets in 7:3 ratio. After screening key variables using univariate analysis in the training set, five predictive models for postoperative adverse prognosis were developed based on Extreme Gradient Boosting (XGBoost), Random Forest (RF), Gradient Boosting Machine (GBM), Support Vector Machine (SVM), and Logistic Regression (LR) algorithms. The model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves (CC), and decision curve analysis (DCA) in both the internal and external validation sets, and the feature contributions of the optimal model were interpreted using the Shapley Additive exPlanations (SHAP) method.ResultsThe predictive model for postoperative adverse prognosis constructed using the XGBoost algorithm demonstrated optimal performance, showing strong discriminatory ability in both the internal (AUC = 0.840) and external (AUC = 0.780) validation sets. In the external validation set, its specificity (0.881) and F1 score (0.514) were higher than those of the other models. In addition, calibration analysis indicated good agreement between the predicted probabilities and actual incidence rates for the XGBoost model, and decision curve analysis demonstrated that it provided the highest clinical net benefit across most threshold ranges. SHAP analysis revealed that the top three variables contributing the most to the XGBoost model's prediction of postoperative adverse prognosis were the systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and age, in descending order.ConclusionThe XGBoost model constructed using perioperative data can effectively predict adverse postoperative outcomes in patients with breast cancer undergoing surgery, outperforming traditional models and other machine learning approaches. The preoperative SII level is the most critical predictive factor.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1816291</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1816291</link>
        <title><![CDATA[Is submuscular drainage mandatory for posterior spinal fusion in adolescent idiopathic scoliosis? A retrospective clinical study]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Duan Wenbo</author><author>Fang Guofang</author><author>Wu Jiachang</author><author>Sang Hongxun</author><author>Cao Lei</author>
        <description><![CDATA[ObjectiveThis single-center retrospective analysis was designed to evaluate the outcome of closed-suction wound drainage following posterior spinal fusion with internal instrumentation for mild to moderate adolescent idiopathic scoliosis (AIS).MethodsEighty-six AIS patients undergoing posterior spinal fusion were divided into two cohorts: submuscular closed-suction wound drainage (n = 35) and simple compressed dressing clothes without wound drainage (n = 51). These two cohorts were thoroughly compared in terms of demographic distribution and perioperative blood loss, including hemoglobin and hematocrit levels and blood transfusion volumes. Additionally, the incidence of wound-related problems (pyrexia and wound complications), duration of hospital stay, and lumbar function evaluation (lumbar mobility and SRS-22 questionnaire scores) were annually assessed during at least 5-year follow-up.ResultsThe drainage group had significantly lower hemoglobin (93.73 g/L vs. 99.95 g/L, P = 0.01) and hematocrit levels (27.75% vs. 29.94%, P < 0.01) on the third postoperative day, as well as a significantly higher postoperative blood transfusion volume (40.0 mL vs. 23.5 mL, P = 0.011) compared to the non-drainage group. Furthermore, the duration of hospital stay was significantly longer in the drainage group than in the non-drainage group (10.9 d vs. 8.0 d, P < 0.01). In contrast, the two groups were statistically similar regarding duration of fever (0.9 d vs. 1.2 d, P = 0.268), incidence of wound problems, latest lumbar mobility (42.79° vs. 44.97°, P = 0.586), and scores of function/activity domain (16.74 vs. 16.08, P = 0.285) and pain domain (22.18 vs. 21.48, P = 0.374) in the SRS-22 questionnaire.ConclusionsRoutine closed-suction drainage significantly increased blood loss and hospital stay without obviously improving wound healing or functional outcomes. Utilizing simple compressed dressings without drainage was a clinically superior and resource-efficient alternative for posterior AIS fusion, particularly in uncomplicated primary surgeries for mild to moderate deformities.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1791457</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1791457</link>
        <title><![CDATA[Application of nerve blocks in breast surgery: evolution and prospects from efficacy comparison to multidimensional assessment and precision application]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Cong Deng</author><author>Yongxing Xu</author><author>Maolin Zhong</author><author>Shihong Li</author>
        <description><![CDATA[Postoperative pain represents a significant challenge after breast surgery, emphasizing the need for effective perioperative pain management. Guided by enhanced recovery after surgery (ERAS) principles, multimodal analgesia strategies centered on nerve block have become a prominent clinical research focus. This review comprehensively explores the evolution of nerve block techniques in breast surgery, ranging from the “gold standard” thoracic paravertebral block (TPVB) to newer thoracic fascial plane blocks, including the pectoral nerve blocks (PECS), serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and other innovative approaches. It evaluates the relative benefits and limitations of various techniques regarding analgesic efficacy, opioid-sparing potential, safety, and procedural simplicity. Beyond traditional acute pain management, this review addresses the prevention of chronic post-mastectomy pain syndrome (PMPS), improvements in postoperative recovery quality, and potential effects on oncological outcomes. This review emphasizes the importance of designing individualized precision nerve block strategies based on the surgical scope (e.g., breast-conserving surgery, mastectomy, axillary lymph node dissection, and breast reconstruction) and the distinct features of each technique. No single nerve block technique fits all scenarios; clinical decision-making should focus on selecting the most appropriate approach tailored to the specific patient and procedure. Future research should prioritize high-quality trials for emerging techniques, long-term outcome evaluations, and the development of standardized nerve block protocols to enhance evidence-based practices in this domain.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1779069</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1779069</link>
        <title><![CDATA[Clinical profile, imaging characteristics, and operative outcomes of pediatric cystic echinococcosis in Northern Jordan: a single-center retrospective study]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mohammad Aladaileh</author><author>Saleh A. Ba-Shammakh</author><author>Joud Al Ramadneh</author><author>Yousef Badran</author><author>Musab Al-A’athal</author><author>Almu’atasim Khamees</author><author>Tayseer Al-tawarah</author><author>Anas Aljaiuossi</author><author>Bassem Al Bataineh</author><author>Mohammad AL-Smirat</author>
        <description><![CDATA[BackgroundCystic echinococcosis is a zoonotic parasitic disease with heterogeneous presentation and stage-conscious management. Data describing the clinical profile, imaging pathways, management patterns, and outcomes of pediatric cases in Jordan remain limited.MethodsWe retrospectively reviewed 41 patients (0–13 years) with radiologically confirmed hydatid cysts treated between March 2022 and May 2025. Diagnosis was established using abdominal ultrasound and/or computed tomography (CT), and cysts were staged according to the Gharbi and WHO criteria. Forty patients underwent open cyst deroofing combined with albendazole (15–20 mg/kg/day; one preoperative course and six months post-operatively), whereas one received medical therapy alone. Collected variables included demographics, exposure history, cyst location and stage, operative metrics (duration and blood loss), length of stay, postoperative complications, and recurrence during follow-up (median 12 months).ResultsThe mean age was 9.3 ± 3.1 years; 56% were female, and 76% reported domestic animal contact. Liver involvement was most common (56%), followed by lung (39%); 90% had single-organ disease. Type III cysts predominated (37%). The mean operative time was 105 ± 24 min, and the mean hospital stay was 6 ± 3 days. Postoperative complications occurred in 34% (pneumonia 15% and intra-abdominal collections 10%). Recurrence during follow-up (median 12 months) was 4.9%.No demographic or exposure factors significantly predicted complications or recurrence (p > 0.05).ConclusionsOpen deroofing plus albendazole in Northern Jordanian children was associated with low recurrence and acceptable morbidity. Expanded ultrasound screening, community zoonosis education, and WHO-aligned protocols are needed.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1769996</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1769996</link>
        <title><![CDATA[Research progress on TWEAK/Fn14 signaling in chronic wound healing]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Bo Liu</author><author>Weimin Wu</author><author>Weigang Hu</author><author>Huarong Zheng</author><author>Tianyao Lan</author>
        <description><![CDATA[Chronic wounds are characterized by persistent inflammation and altered microenvironments, exhibiting prolonged healing and difficult repair, presenting significant therapeutic challenges. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK), by binding to its receptor fibroblast growth factor-inducible 14 (Fn14), participates in cellular regulation, wound repair, and inflammatory response processes, playing an important role in chronic wound healing. This review summarizes the pathophysiological mechanisms of chronic wounds, the mechanisms of action of the TWEAK/Fn14 signaling pathway in chronic wound healing, and the latest research progress on its potential as a therapeutic target.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1750755</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1750755</link>
        <title><![CDATA[Anterior vertebrectomy and O-arm navigation for old L5 traumatic fractures with kyphotic deformity: a retrospective case series of clinical and radiological outcomes]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Zhi-da Chen</author><author>Yuan-jie Jiang</author><author>Bin Lin</author><author>Xiao-yang Hu</author><author>Yu-zhe Zeng</author><author>Hui Liu</author><author>Tao-yi Cai</author>
        <description><![CDATA[BackgroundOld L5 traumatic fractures with kyphotic deformity are quite rare and surgical management constitutes a significant challenge. Anterior vertebrectomy and reconstruction with O-arm navigation for old L5 traumatic fractures with kyphotic deformity aim to restore spinal stability, correct deformity, and improve functionality. This study evaluates the efficacy and safety of this approach.MethodsA retrospective case series was conducted on 43 patients with old L5 traumatic fractures and kyphotic deformity who underwent anterior vertebrectomy and reconstruction using O-arm navigation. Data were collected on operation duration, blood loss, radiological and clinical outcomes (VAS, ODI, ASIA, local Cobb angle, and vertebral anterior margin height ratio), Bridwell classification, and complications.ResultsThe mean operation duration was 182.5 ± 32.8 min, with an average blood loss of 570.5 ± 71.4 mL. All patients had regular follow up with an average duration of 27.1 ± 6.8 months. The VAS scores and ODI at 3 months postoperatively and at the final follow-up showed significant improvement compared to preoperative scores (P < 0.05). VAMHR improved significantly from 35.9 ± 5.6% preoperatively to 92.1 ± 2.1% at the final follow-up (P < 0.001). The LCA at the final follow-up 14.4 ± 3.7° showed statistically significant difference compared to preoperative measurements 37.8 ± 2.4°. Preoperative ASIA grades were C in 1 patient, D in 18 patients, and E in 24 patients. And ASIA grades were D in 9 patients and E in 34 patients at the final follow-up. Wilcoxon signed-rank test showed a significant improvement in ASIA grade at the final follow-up compared with preoperative status (P < 0.001). 11 of 43 patients (25.6%) improved by one grade, 32 of 43 patients (74.4%) remained unchanged. 34 patients achieving Bridwell grade I bone fusion. Complications were minimal, with 1 case of intraoperative venous bleeding successfully managed.ConclusionAnterior vertebrectomy and reconstruction using O-arm navigation is an effective and safe approach for treating old L5 traumatic fractures with kyphotic deformity in the medium term follow-up. It offers significant pain relief, functional recovery, and sustained correction of spinal alignment, with low complication rates and high fusion success.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1801458</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1801458</link>
        <title><![CDATA[Case Report: Transrectal contrast-enhanced ultrasonography on preoperative evaluation of rectal neuroendocrine tumors: a 17-case preliminary study]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jigang Jing</author><author>Yuting Wu</author><author>Hua Zhuang</author>
        <description><![CDATA[ObjectiveTo evaluate the feasibility of transrectal ultrasound (TRUS) in the sonographic characterization and preoperative assessment of rectal neuroendocrine neoplasms (NENs).MethodsRetrospective analysis was performed on the transrectal ultrasound manifestations and clinical data of 17 patients with pathologically and immunohistochemically confirmed rectal NENs [8 cases of rectal neuroendocrine tumors [NETs, G1/G2] and 9 cases of rectal neuroendocrine carcinomas [NECs, G3]] between June 2020 and June 2025. These TRUS findings were compared with the ultrasound features of 31 contemporaneous cases of middle- and lower-segment rectal cancer.ResultsAll 8 rectal NETs (G1, G2) showed hypoechoic masses in the rectal mucosal and submucosal layers on TRUS, with clear borders in 8 cases, point-stripe blood flow signals in 7 cases, and round-shaped lymph nodes with a short diameter > 5 mm in 3 cases; contrast-enhanced ultrasound (CEUS) was performed in 6 cases, showing inhomogeneous hyperenhancement in 2 cases and homogeneous isoenhancement in 4 cases. Among the 9 rectal NECs (G3), 8 presented with localized irregular thickening of the rectal wall, 7 invaded perirectal tissues or organs, all lesions were hypoechoic or heteroechoic with muscularis propria infiltration, and 4 cases had enlarged local lymph nodes. Compared with rectal cancer, the distribution of T stage (T1 vs. T2–4) differed significantly (P = 0.016), whereas no significant differences were noted in gender, age, distance from the lower margin of the lesion to the intersphincteric sulcus, lesion length, lesion thickness, or N stage (all P > 0.05). The overall concordance rate between ultrasonographic staging and surgical pathological staging was 70.6% (12/17) for all rectal NENs, with 87.5% (7/8) for NETs and 55.6% (5/9) for NECs. A limitation of this retrospective feasibility study is its relatively small sample size (n = 17), which needs further verification in future multi-center large-sample studies.ConclusionsRectal NETs exhibit characteristic TRUS manifestations and require differentiation from polyps, adenocarcinomas, and inflammatory lesions. Transrectal contrast-enhanced ultrasonography (TR-CEUS), though not widely adopted, is feasible for the preoperative assessment of rectal NENs and may be valuable for follow-up after endoscopic resection to monitor recurrence.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1734148</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1734148</link>
        <title><![CDATA[A Delphi consensus report of the Italian society of thoracic surgery on influencing factors, use of a bleeding scale, and management of bleeding in thoracic surgery]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Domenico Galetta</author><author>Federico Rea</author><author>Stefano Margaritora</author><author>Agostini Vanessa</author><author>Francesco Facciolo</author><author>Franca Melfi</author><author>Gianluca Guggino</author><author>Roberto Crisci</author><author>Collaborators and Participating Institutions </author>
        <description><![CDATA[IntroductionWe report the results of a national consensus paper among Italian thoracic surgeons obtained through a Delphi process, on the bleeding in thoracic surgery (BTS) evaluating influencing factors, use of a validated intraoperative bleeding scale (VIBeS), its management and helping improving practice.MethodsA panel of 20 statements (a total of 39 issues) was developed and, after initial validation by six experts, was electronically sent to 60 Italian thoracic surgeons. Participants were asked to score each statement on a 5-point Likert scale and the agreement was scored for evaluating the consensus (>66%).ResultsOverall, a total of 49 (82%) participants scored the proposed statements. The consensus was reached in 35/39 issues (89.7%). Responders agreed (>90%) that medical (comorbidities, anticoagulant or antiplatelet therapies) and surgical factors (pleural adhesions, procedures on parietal pleura and chest wall resection) influenced BTS. Use of VIBeS has gained broad positive acceptance (>90%). Effects of BTS have achieved a broad positive consensus both for intraoperative and post-operative ones (surgeon stress, overall costs, length of operation, postoperative complications) (>73%). Modality of reduction and management of BTS (use of appropriate hemostatic products according to the coagulation status and VIBeS) has obtained a broad positive consensus.ConclusionsThe expert panel of Italian thoracic surgeons reached an agreement on the majority of issues of Delphi survey (factors, effects and management of BTS). The use of a VIBeS is recommended. In the absence of prospective and randomized studies on management of BTS, this document may be useful for reducing practice variation among thoracic surgeons facing intraoperative bleeding.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1735378</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1735378</link>
        <title><![CDATA[Pioneering semi-rigid stability: navigating the female pelvis for enhanced precision in binocular vision guidance]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Tieyuan Sun</author><author>Linna Wei</author><author>Pan Hu</author><author>Xiaolong You</author><author>Lubin Liu</author><author>Mingbo Liu</author>
        <description><![CDATA[PurposeTo overcome the surface marker drift issue in semi-rigid pelvic structures and establish a foundation for the binocular vision navigation targeting semi-rigid anatomical structures within the human body.MethodsThe study was conducted at Chongqing health center for women and children form April to June 2024. Surface markers were placed on 20 volunteers with semi-rigid pelvic anatomy. Respiratory and movement-induced displacement data were collected pre- and post-activity. A hybrid approach integrating a loss function and respiratory compensation algorithm was developed for spatial registration correction.ResultsAfter correction through spatial registration using a mathematical model, the drift range of semi-rigid body surface markers was 0.86 ± 0.11 mm. Specifically, the body surface drift ranges for the left anterior superior iliac spine marker were 0.79 ± 0.12 mm, for the right anterior superior iliac spine marker were 0.85 ± 0.14 mm, and for the pubic symphysis marker were 0.96 ± 0.25 mm. The stability around the umbilicus was relatively poor, with an error range of 1.71 ± 0.91 mm. Among the four markers, three have achieved positioning accuracy meeting the millimeter-level requirements for spatial registration in the current field of medical navigation surgery. The performance complies with the mandated sub-4-millimeter Target Registration Error (TRE) for optical tracking devices in surgical navigation applications.ConclusionsThe first successful mitigation of surface marker drift issues by a mathematical compensation algorithm enabling binocular vision navigation in pelvic floor surgerys, and lays a foundation for future semi-rigid anatomical structure navigations.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1801218</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1801218</link>
        <title><![CDATA[A decision tree model suggests a strong interaction effect between tumor size and a close surgical margin on the prognosis of limb salvage surgery in high-grade osteosarcoma]]></title>
        <pubdate>2026-04-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yingying Shi</author><author>Lan Wei</author><author>Qiyuan Bao</author><author>Junxiang Wen</author><author>Zhusheng Zhang</author><author>Zhuochao Liu</author><author>Qi Liu</author><author>Jie Chen</author><author>Xiaoqing Yang</author>
        <description><![CDATA[PurposeThe effect of a close surgical margin (CSM) due to the preservation of vital structures in limb salvage surgery (LSS) for high-grade osteosarcoma (OS) is still controversial. This article aimed to study the prognosis of LSS with a close peri-neurovascular margin (PNM).MethodsWe retrospectively reviewed 196 cases that underwent LSS from January 2010 to December 2015 at our institution, of which 88 involved high-grade extremity osteosarcoma with a potential risk of an “inadequate” wide margin (<15 mm) according to the Enneking classification system. Data on surgical and tumor-related factors were collected together with the width of the PNM. Survival analysis and machine learning (ML) algorithms with cross-validation were used to construct the prognostic model for oncological outcomes after LSS.ResultsPNM was associated with a higher local recurrence (LR) rate, while greater tumor size was a risk factor for metastasis and overall survival in the multivariate Cox regression model. Using ML algorithms, a decision tree (DT) model was constructed, indicating that a closer PNM was significantly correlated with higher LR-free survival only when the tumor size was less, but not greater, than 31.6% of the limb (with a significant interaction effect). Interestingly, a conventional survival analysis and receiver operating characteristic plot confirmed the robust interaction effect of PNM and tumor size on not only LR, but also metastasis and overall survival, with an even larger effect size than that of each factor alone.ConclusionThe prognostic effect of CSM in high-grade osteosarcoma is dependent on the tumor size. We found that a close PNM (< 2.4 mm) in LSS due to the preservation of critical structures is a risk factor for LR and survival in patients with small-sized osteosarcomas. For a large-sized tumor, the prognosis is unsatisfactory regardless of the state of the CSM. Further studies are needed to explore the mechanisms underlying such heterogeneity in LSS.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1738809</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1738809</link>
        <title><![CDATA[Case Report: Patient-specific 3D-printed preoperative simulation for tailored resection and reconstruction in complex vertebral tumors: a case of giant recurrent chondrosarcoma at the cervicothoracic junction]]></title>
        <pubdate>2026-04-24T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>M. De Robertis</author><author>P. P. Cotrufo</author><author>N. Khaled Mansour</author><author>P. Oliva</author><author>C. Cappelli</author><author>E. Stucchi</author><author>A. Baram</author><author>G. Capo</author><author>U. Cariboni</author><author>G. Mercante</author><author>M. Fornari</author><author>F. Pessina</author><author>C. Brembilla</author>
        <description><![CDATA[IntroductionThree-dimensional (3D) printing is a rapidly evolving technology that is transforming various fields and its application in surgery, particularly in spinal procedures, has seen substantial growth in the last 10 years. It enables the production of highly accurate, patient-specific custom implants and anatomical models, enhancing preoperative surgical planning and intraoperative decision-making. This article describes the workflow adopted to produce a 3D-printed model of the cervical column of a patient affected by a recurrent giant cervical chondrosarcoma, focusing on its application in the presurgical resection and reconstruction planning.Methods and resultsWe present the case of a 67-year-old female patient with recurrent clear cell chondrosarcoma of the cervical spine. After multidisciplinary discussion, a two-stage (posterior and anterior stage) intentional Enneking inappropriate subtotal resection, followed by adjuvant proton beam therapy (PBT), was planned. One week before the second surgical stage, a surgical simulation was performed on a 3D-printed model. For the 3D virtual modeling, contrast-enhanced CT images of the cervicothoracic spine were obtained for the segmentation of the different anatomical structures. A PolyJet J850 Digital Anatomy® (Stratasys, USA) printer was used due to its ability to assign different materials to each structure, closely mimicking real tissue properties. Surgery was completed without complications, with neurological improvement from American Spinal Injury Association (ASIA) C to D. Adequate decompression and stable reconstruction were achieved. Adjuvant PBT was delivered postoperatively. At the 6-month follow-up, imaging demonstrated good local control and early fusion, and the patient was pain-free and functionally independent.Discussion and conclusionThe creation of patient-specific, 1:1 scale 3D-printed anatomical models is a crucial tool in the improvement of preoperative planning, providing crucial tactile and visual insights for complex spinal tumor resection and reconstruction, thereby improving surgical precision and safety.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1740978</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1740978</link>
        <title><![CDATA[Comparison of surgical approaches for pectus excavatum in children and adolescents: a single-center retrospective study]]></title>
        <pubdate>2026-04-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Sirui Ding</author><author>Xiaolong Chen</author><author>Tienan Feng</author><author>Xuequn Huang</author><author>Li Shen</author><author>Haifa Hong</author>
        <description><![CDATA[ObjectiveThis study aimed to compare the clinical utility of two modified Nuss procedures in children and adolescents with pectus excavatum (PE), including single-incision modified Nuss and modified Nuss with non-flipping bar. It sought to delineate patient selection patterns, assess perioperative parameters, postoperative recovery, complication rates, and short/intermediate-term efficacy of the two approaches, thereby providing evidence-based guidance for individualized surgical selection.MethodsA single-center retrospective cohort study was conducted on pediatric and adolescent PE patients who underwent surgical correction at Shanghai Children's Hospital between January 2015 and December 2022. Patients were categorized by the intended operative strategy: single-incision modified Nuss (single working incision with optional thoracoscopy through the same incision) versus modified Nuss with a pre-shaped non-flipping bar (advanced without intraoperative 180° turnover). A total of 171 patients were included (140 single-incision; 31 non-flipping bar). Demographic data, clinical characteristics, surgical parameters, and postoperative outcomes were collected.ResultsRegarding surgical parameters, the non-flipping bar group had longer median operative time, more incisions, and lower screw fixation rate. Postoperatively, the non-flipping bar group showed a higher median Haller index, but this difference had limited clinical significance. No significant differences were noted in overall complication rates, postoperative recovery indicators, or surgical efficacy. After PSM, no statistical difference in therapeutic efficacy was found between the two groups.ConclusionBoth the single-incision modified Nuss procedure and the modified Nuss procedure with non-flipping bar are effective and safe for PE in children and adolescents, with comparable therapeutic efficacy. Surgical selection should be tailored to patient age and deformity characteristics.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1814772</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1814772</link>
        <title><![CDATA[Analysis of the clinical effect of dexmedetomidine hydrochloride for sedation before cosmetic suturing of emergency facial trauma in children]]></title>
        <pubdate>2026-04-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Wenbin Gao</author><author>Xianpu Song</author><author>Yanhua Feng</author><author>Chuo Liu</author>
        <description><![CDATA[ObjectiveTo explore the clinical efficacy and safety of dexmedetomidine hydrochloride for preoperative sedation in children undergoing emergency facial trauma cosmetic suturing.MethodsA total of 200 children with facial trauma admitted to the Emergency Surgery Department of our hospital from January to June 2025 were retrospectively enrolled and assigned to two groups for different sedation interventions. The study group received preoperative intranasal dexmedetomidine hydrochloride spray, while the control group received routine comfort care. The UMSS Sedation Scale was used to assess sedation level objectively, and rescue dosing protocols were implemented for sedation failure. Statistical analyses were performed using SPSS 30.0 software, with a two-tailed P-value ≤ 0.05 and 95% confidence intervals (CIs) considered statistically significant.ResultsA total of 100 cases were included in both the study group and the control group, with no baseline differences between the two groups (P > 0.05). The sedation failure rate in the study group was 8.0% (8/100), and all 8 cases achieved effective sedation after rescue dosing with one additional spray (15μg for 10.7–19.4 kg, 25 μg for 19.4–28.0 kg) intranasal dexmedetomidine hydrochloride; no sedation failure was observed in the control group. No serious adverse reactions were observed in either group. Preoperative and intraoperative cooperation in the study group was significantly better than that in the control group, and the incidence of agitation was significantly lower (P < 0.01), 95%CI: 0.0–0.2. No serious adverse reactions were observed in either group. Preoperative heart rate, respiratory rate, oxygen saturation, and mean arterial pressure were comparable between the two groups (P > 0.05). Intraoperatively, the study group maintained more stable vital signs, with significantly lower heart rate and mean arterial pressure than the control group (P < 0.05), 95%CI for heart rate: 8.2–15.7; 95%CI for mean arterial pressure: 5.1–10.3, all within normal physiological ranges.ConclusionPreoperative intranasal dexmedetomidine hydrochloride is an effective and safe regimen for improving intraoperative cooperation, stabilizing vital signs, reducing agitation, and enhancing cosmetic suture quality and family satisfaction in children with emergency facial trauma.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1794712</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1794712</link>
        <title><![CDATA[Lateral rectus abdominis approach fixation of a high-energy both-column acetabular fracture after total hip arthroplasty with retention of a stable acetabular cup: a case report]]></title>
        <pubdate>2026-04-23T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Xiangyu Zong</author><author>Qicai Li</author><author>Chunpu Li</author><author>Hongtao Ge</author><author>Xuemei Yang</author><author>Yingze Zhang</author><author>Tianrui Wang</author>
        <description><![CDATA[BackgroundAcetabular fractures are intra-articular injuries with complex anatomy and demanding reduction requirements. Traumatic periprosthetic acetabular fractures after total hip arthroplasty (THA) are rare and particularly challenging because treatment must simultaneously address fracture stability and acetabular component stability.Case presentationA 72-year-old woman sustained a high-energy road-traffic injury from an outside vehicle 10 years after left THA. Computed tomography (CT) demonstrated a comminuted both-column acetabular fracture with medial displacement of the quadrilateral surface and compromised periacetabular bone continuity, raising concern for cup instability. Open reduction and internal fixation (ORIF) was performed in the supine position through a lateral rectus abdominis approach (LRAA). Intraoperative direct visualization and fluoroscopy confirmed a well-fixed, osseointegrated acetabular cup, which was therefore retained. The anterior and posterior columns and quadrilateral surface were reconstructed using two contoured reconstruction plates, with careful screw trajectory planning to avoid the cup.ConclusionFor traumatic periprosthetic both-column acetabular fractures after THA, intraoperative assessment of acetabular component stability is pivotal. When the cup is stable, LRAA can provide direct intrapelvic exposure enabling anatomic reduction and robust buttress fixation of the quadrilateral surface while avoiding revision arthroplasty.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1787138</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1787138</link>
        <title><![CDATA[A gastrointestinal stromal tumour in the distal ileum—a rare presentation in Saudia Arabia: case report]]></title>
        <pubdate>2026-04-23T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Mohammad Shawir</author><author>Mohammad Abdulkarim</author><author>Mohammed Elnibras</author><author>Haneen Brnawi</author><author>Marei Al amari</author><author>Roaa Ghazi Khan</author><author>Elsadig Shiekedien</author><author>Yazeed Al Jabri</author>
        <description><![CDATA[IntroductionGastrointestinal stromal tumours (GIST) are an extremely rare case in Saudi Arabia. These tumours arise from the smooth muscle cells of Cajal in the interstitium, a key component of Gastrointestinal tract (GIT) mesenchymal tissue.Case reportA 31-year-old male arrived at our emergency department with central abdominal pain, nausea, vomiting, and absolute constipation persisting for four days. Upon examination, he exhibited hypotension, tachycardia, and tenderness in the central abdomen. The provisional working diagnosis based on the abdomen computed tomogram (CT) indicated a pelvic tumour to the right of the lower midline. Contrast CT suggested a distal ileum inflammatory mass vs. a tumour. Operative results verified a tumour at the distal ileum accompanied by a dilated, obstructed volvulus in the small bowel. A histoinmunohistochemical analysis showed the presence of a gastrointestinal stromal tumour (GIST), demonstrating diffuse positivity for CD117 (Ckit), focal positivity for CD34, and negative results for S100 and desmin.ConclusionIt is critical to avoid tumour rupture during surgical resection, as this may result in tumour implantation or recurrence. Because the tumour was fragile and fragmented during dissection, a positive outcome may not be possible; consequently, our case requires strict surveillance and CT follow-up. The operating surgeon and histopathologist must agree on labelling specimens before sending them to the lab. Furthermore, research must investigate epidemiological issues, therapeutic methods, and follow-up procedures in Saudi Arabia. Guidelines for managing and following up on these cases should be developed based on the agreed-upon processes.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1778083</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1778083</link>
        <title><![CDATA[Ileal hybrid schwannoma/perineurioma presenting with gastrointestinal bleeding: a case report]]></title>
        <pubdate>2026-04-23T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Shiyu Pan</author><author>Changxi Chen</author><author>Gun Chen</author><author>Jiande Gong</author><author>Xianhao Ying</author><author>Hongliang Li</author>
        <description><![CDATA[Hybrid schwannoma/perineurioma (HSP) is a rare benign peripheral nerve sheath tumor. Its occurrence in the gastrointestinal tract with associated bleeding is exceptionally uncommon. Definitive diagnosis relies critically on a complete surgical specimens and comprehensive immunohistochemical analysis. Complete surgical removal is the preferred treatment method and is associated with a favorable prognosis. We report the case of a 19-year-old male admitted with recurrent hematochezia without obvious cause. Small bowel endoscopy revealed an ulcerated, space-occupying lesion located approximately 120 cm from the ileocecal valve in the ileum. Initial biopsy was limited by a small tissue sample, rendering diagnosis challenging. Following laparoscopic resection of the small bowel lesion, pathological examination confirmed the diagnosis of ileal hybrid schwannoma/perineurioma. The patient recovered well postoperatively. Through this case, we aim to explore the clinicopathological characteristics, diagnostic approach, and therapeutic strategies for HSP, thereby enhancing awareness of this rare entity.]]></description>
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