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Henry Norman Bethune was a prominent Canadian thoracic surgeon who came to fame during the 1930s. After being made a Fellow of the Royal College of Surgeons of Edinburgh, Bethune became head of thoracic surgery in a hospital in Cartierville, Canada. During this time, he pioneered surgical techniques, published research findings, and invented surgical instruments. Not content with being only a physician, innovator, and humanitarian, Bethune also found himself in medical services on the frontlines of wars in both Spain and China. In Spain, Bethune emphasized the need for prompt blood transfusions and developed mobile blood transfusion services. After the start of the Second Sino-Japanese War, Bethune traveled to China and quickly organized a mobile operating unit. Following discussions with Chinese leaders, Bethune performed surgeries on the frontlines of conflict in northern China, where his exceptional loyalty to duty became famous throughout the region. Although he met his end at an early age due to septicemia in 1939, his medical legacy carries on in multiple countries and serves to inspire a future generation of medical practitioners.

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Introduction Surgeons-in-training (SIT) perform laparoscopic cholecystectomy (LC); however, it is challenging to complete the procedure safely in difficult cases. We present a surgical technique during difficult LC, which we named the hanging strap method. Methods We retrospectively compared the perioperative outcomes between patients undergoing difficult LC with the hanging strap method (HANGS, n = 34), and patients undergoing difficult LC without the hanging strap method (non-HANGS, n = 56) from 2022 and 2024. Difficult LC was defined as cases classified as more than grade II cholecystitis by the Tokyo Guidelines 18 and cases when LC was undergoing over five days after the onset of cholecystitis. Results The proportion of SIT with post-graduate year (PGY) ≤ 7 was significantly higher in the HANGS group than in the non-HANGS group (82.4% vs. 33.9%, P < 0.001). The overall rate of bile duct injury (BDI), postoperative bile leakage and operative mortality were zero in the whole cohort. There were no significant differences between the HANGS and non-HANGS groups in background characteristics, operative time (122 min vs. 132 min, P = 0.830) and surgical blood loss (14 mL vs. 24 mL, P = 0.533). Conclusions Our findings suggested that the hanging strap method is safe and easy to use for difficult LC. We recommend that the current method be selected as one of the surgical techniques for SIT when performing difficult LC.

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BACKGROUND: Operative notes represent the critical record of a surgical procedure, encompassing comprehensive details encountered throughout the operation. Recognizing the importance of comprehensive documentation, the Royal College of Surgeons (RCS) developed the Good Surgical Practice guidelines, which emphasize accurately recording every procedure and specifying the necessary parameters for each operative note. These guidelines help maintain high standards of surgical care and patient safety. METHODS: A retrospective review of 88 orthopaedic surgery operative notes for fracture neck of femurs was conducted at Gezira Centre for Orthopedic Surgery and Traumatology (GCOST) from March 12 to May 28, 2022. The review assessed 18 parameters against RCS guidelines. Statistical analysis was performed using Statistical Product and Service Solutions (SPSS, version 25.0; IBM SPSS Statistics for Windows, Armonk, NY), which facilitated comprehensive data examination. RESULTS: In 37 cases (42.05%), the operation notes were written by a medical officer. In 29 cases (32.95%), an orthopaedic resident authored the notes. A specialist documented the notes in 21 cases (23.86%), and a consultant wrote the notes in one case (1.14%). Over 90% of the notes included surgeon and assistant names, procedure names, operative diagnoses, operative procedures, prosthesis details, deep vein thrombosis (DVT) and antibiotic prophylaxis, and signatures. The name of the theatre anaesthetist, elective/emergency details, and additional procedures with reasons were absent in all notes. Less than 50% of the notes documented the time of the procedure, type of incision, operative findings, anticipated blood loss, closure technique specifics, and complications. CONCLUSION: The study emphasizes the shortcomings in the operating notes, underscoring the necessity for training initiatives to enhance the recording by medical officers and orthopaedic trainees. Implementing structured templates that adhere to RCS standards can improve the comprehensiveness and consistency of operating notes, effectively resolving existing discrepancies. Regular audits and feedback sessions are essential for identifying and rectifying persistent issues. It is recommended to arrange workshops and seminars to educate medical officials and trainees on the skills of efficient note-taking and thorough documentation procedures.

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Advances in surgical ergonomics are essential for the performance, health, and career longevity of surgeons. Many surgeons experience work-related musculoskeletal disorders (WMSDs) resulting from various surgical modalities, including open, laparoscopic, and robotic surgeries. To prevent WMSDs, individual differences may exist depending on the surgical method; however, the key is to maintain a neutral posture, and avoid static postures. This review aims to summarize the concepts of ergonomics and WMSDs; identify the ergonomic challenges of open, laparoscopic, and robotic surgeries; and discuss ergonomic recommendations to improve them.

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BACKGROUND: An adequate workforce is needed to guarantee optimal kidney care. We used the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to provide an assessment of the global kidney care workforce. METHODS: We conducted a multinational cross-sectional survey to evaluate the global capacity of kidney care and assessed data on the number of adult and paediatric nephrologists, the number of trainees in nephrology and shortages of various cadres of the workforce for kidney care. Data are presented according to the ISN region and World Bank income categories. RESULTS: Overall, stakeholders from 167 countries responded to the survey. The median global prevalence of nephrologists was 11.75 per million population (pmp) (interquartile range [IQR] 1.78-24.76). Four regions had median nephrologist prevalences below the global median: Africa (1.12 pmp), South Asia (1.81 pmp), Oceania and Southeast Asia (3.18 pmp) and newly independent states and Russia (9.78 pmp). The overall prevalence of paediatric nephrologists was 0.69 pmp (IQR 0.03-1.78), while overall nephrology trainee prevalence was 1.15 pmp (IQR 0.18-3.81), with significant variations across both regions and World Bank income groups. More than half of the countries reported shortages of transplant surgeons (65%), nephrologists (64%), vascular access coordinators (59%), dialysis nurses (58%) and interventional radiologists (54%), with severe shortages reported in low- and lower-middle-income countries. CONCLUSIONS: There are significant limitations in the available kidney care workforce in large parts of the world. To ensure the delivery of optimal kidney care worldwide, it is essential to develop national and international strategies and training capacity to address workforce shortages.

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INTRODUCTION: The Open Payments Program (OPP) was created through the Physician Payments Sunshine Act to disclose transactions between physicians and industry. Various surgical subspecialties have evaluated trends in OPP; however, this has not been looked at among endocrine surgeons. Our objective was to describe OPP trends among members of the American Association of Endocrine Surgeons (AAES). METHODS: A list of members from the AAES was compiled using membership information from the AAES annual meetings. These surgeons were queried in the OPP database from 2014 to 2020. Payments were classified as general payments and research payments. RESULTS: From 2014 to 2020, 417 surgeons in the AAES received a total of $5,870,113 in general payments with an annual range from $542,945 to $1,010,564. The median payment was $701 (interquartile range [IQR] $145-$4641) over all years. The top 10th percentile received >85% of the payments ($5,058,207) with the median payment in this decile being $37,535.06 (IQR $26,599-$112,380). The most common category for payments was food and beverage (63.5%) followed by travel and lodging (22.6%) and consulting fees (4.1%). Regarding research payments, 30 surgeons received $9,522,374 with a median payment of $45,635.68 (IQR $12,050-$158,863). CONCLUSIONS: Members of the AAES received a total of $15,392,487 in money from industry between 2014 and 2020 in general and research payments demonstrating that the industry relationship is substantial. The majority of these payments were given to only a small portion of surgeons. The transparency created by OPP is critical for endocrine surgeons to prevent public misconceptions and identify the potential for any conflicts of interest.

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BACKGROUND: Surgical specialists experience significant musculoskeletal strain as a consequence of their profession, a domain within the healthcare system often recognized for the pronounced impact of such issues. The aim of this study is to calculate the risk of presenting musculoskeletal injuries in surgeons after surgical practice. METHODS: Cross-sectional study carried out using an online form (12/2021-03/2022) aimed at members of the Spanish Association of Surgeons. Demographic variables on physical and professional activity were recorded, as well as musculoskeletal pain (MSP) associated with surgical activity. Univariate and multivariate analysis were conducted to identify risk factors associated with the development of MSP based on personalized surgical activity. To achieve this, a risk algorithm was computed and an online machine learning calculator was created to predict them. Physiotherapeutic recommendations were generated to address and alleviate each MSP. RESULTS: A total of 651 surgeons (112 trainees, 539 specialists). 90.6% reported MSP related to surgical practice, 60% needed any therapeutic measure and 11.7% required a medical leave. In the long term, MSP was most common in the cervical and lumbar regions (52.4, 58.5%, respectively). Statistically significant risk factors (OR CI 95%) were for trunk pain, long interventions without breaks (3.02, 1.65-5.54). Obesity, indicated by BMI, to lumbar pain (4.36, 1.84-12.1), while an inappropriate laparoscopic screen location was associated with cervical and trunk pain (1.95, 1.28-2.98 and 2.16, 1.37-3.44, respectively). A predictive model and an online calculator were developed to assess MSP risk. Furthermore, a need for enhanced ergonomics training was identified by 89.6% of surgeons. CONCLUSIONS: The prevalence of MSP among surgeons is a prevalent but often overlooked health concern. Implementing a risk calculator could enable tailored prevention strategies, addressing modifiable factors like ergonomics.

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OBJECTIVES: To evaluate factors impacting continence recovery following holmium laser enucleation of the prostate (HoLEP) for surgeons early in their HoLEP experience. METHODS: Predefined factors were evaluated from a prospectively maintained database for their impact on the recovery of continence after HoLEP. Both surgeons had performed fewer than 150 HoLEPs as attending physicians. Inclusion criteria were subjects with at least 6 months of incontinence data or documented recovery of continence. One or fewer pads per day was defined as continence. Statistical analyses were performed using R and Prism and included Spearman correlations, linear modeling, and Mantel-Cox log-rank testing as appropriate. RESULTS: From December 2020 to May 2023, 152 subjects met inclusion criteria with a median age of 70 (range: 51-93). The median case number was 56 (1-146). Within the study period, 144/152 (94.7%) recovered continence at a median of 1.6 months postoperatively. Linear modeling demonstrated that younger age (p = 0.01) and shorter enucleation time (p = 0.001) predicted recovery. Enucleation time less than 100 min predicted earlier continence recovery based on Mantel-Cox testing (p = 0.0004). CONCLUSIONS: During the surgeons' HoLEP learning curve, age, and enucleation time were predictive of the recovery of continence. Enucleation time under 100 min predicted a faster rate of continence recovery. The relationship between enucleation time and continence recovery may be demonstrative of case difficulty or may be a result of pressure on the external urethral sphincter during enucleation. These findings further our understanding of HoLEP outcomes early in a surgeon's learning curve.

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Medical practitioners, inevitably scattered across the country, need frequent periodicals to communicate the latest medical information. Journals are an essential component of the infrastructure of modern medicine, yet they were slow to achieve firm roots in Britain during the eighteenth century, with few sustained quarterly periodicals and the only attempt at a monthly lasting a year. Then in 1799, Richard Phillips, owner of the Monthly Magazine, published the Medical and Physical Journal, the first sustained monthly medical journal, which lasted for thirty-four years. Ever since, Britain has never been without a monthly or weekly general medical journal. Responding to the need for a strong commercial focus, the Journal used a magazine format which blended reviews and abstracts of already published material with original contributions and medical news, and it quickly achieved a national circulation by close engagement with all types of practitioners across the country.Contrary to the historiography, the Journal was distinctly different from the contemporaneous monthly science journals. The key to success was two-way communication with all practitioners, especially the numerous surgeons and surgeon-apothecaries who were increasingly better trained and confident of their status. Much of the content of the Journal was written by these readers, and with rapid, reliable distribution and quick publication of correspondence, controversial topics could be bounced back and forth between all practitioners, including the distinguished. Initially, the editors tried to maximise circulation by avoiding any controversy, but this started to change in the first few years of the next century.

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Osteoporosis is an underdiagnosed and undertreated public health issue that contributes to a high financial burden on the healthcare system and imposes significant morbidity and mortality on the patient population. Upper extremity orthopedic surgeons are in a unique position to diagnose osteoporosis prior to patients suffering a fragility fracture by using imaging that they already obtain in their current workflow. The use of X-rays and CT scans can effectively diagnose osteoporosis with high sensitivity and specificity. By incorporating these diagnostic methods into standard practice, upper extremity orthopedic surgeons can play a critical role in the early diagnosis and treatment of osteoporosis. This can prevent severe fractures, improve patient outcomes, and reduce the overall healthcare burden by initiating timely treatment and patient education. This review emphasizes the importance of opportunistic imaging in enhancing osteoporosis management and suggests that upper extremity surgeons can significantly and effectively contribute to primary and secondary fracture prevention.

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BACKGROUND: Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. To address the gap, a wireless handheld telestration device was developed to facilitate dynamic user interaction with live video streams. OBJECTIVE: This study aims to find the perceived usability, ergonomics, and educational value of a first-generation handheld wireless telestration platform. METHODS: A prototype was developed with four core hand-held functions: (1) free-hand annotation, (2) cursor navigation, (3) overlay and manipulation (rotation) of ghost (avatar) instrumentation, and (4) hand-held video feed navigation on a remote monitor. This device uses a proprietary augmented reality platform. Surgeons and trainees were invited to test the core functions of the platform by performing standardized tasks. Usability and ergonomics were evaluated with a validated system usability scale and a 5-point Likert scale survey, which also evaluated the perceived educational value of the device. RESULTS: In total, 10 people (9 surgeons and 1 senior resident; 5 male and 5 female) participated. Participants strongly agreed or agreed (SA/A) that it was easy to perform annotations (SA/A 9, 90% and neutral 0, 0%), video feed navigation (SA/A 8, 80% and neutral 1, 10%), and manipulation of ghost (avatar) instruments on the monitor (SA/A 6, 60% and neutral 3, 30%). Regarding ergonomics, 40% (4) of participants agreed or strongly agreed (neutral 4, 40%) that the device was physically comfortable to use and hold. These results are consistent with open-ended comments on the device's size and weight. The average system usability scale was 70 (SD 12.5; median 75, IQR 63-84) indicating an above average usability score. Participants responded favorably to the device's perceived educational value, particularly for postoperative coaching (agree 6, 60%, strongly agree 4, 40%). CONCLUSIONS: This study presents the preliminary usability results of a novel first-generation telestration tool customized for use in surgical coaching. Favorable usability and perceived educational value were reported. Future iterations of the device should focus on incorporating user feedback and additional studies should be conducted to evaluate its effectiveness for improving surgical education. Ultimately, such tools can be incorporated into pedagogical models of surgical coaching to optimize feedback and training.

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Robotic surgery, known for its minimally invasive techniques and computer-controlled robotic arms, has revolutionized modern medicine by providing improved dexterity, visualization, and tremor reduction compared to traditional methods. The integration of artificial intelligence (AI) into robotic surgery has further advanced surgical precision, efficiency, and accessibility. This paper examines the current landscape of AI-driven robotic surgical systems, detailing their benefits, limitations, and future prospects. Initially, AI applications in robotic surgery focused on automating tasks like suturing and tissue dissection to enhance consistency and reduce surgeon workload. Present AI-driven systems incorporate functionalities such as image recognition, motion control, and haptic feedback, allowing real-time analysis of surgical field images and optimizing instrument movements for surgeons. The advantages of AI integration include enhanced precision, reduced surgeon fatigue, and improved safety. However, challenges such as high development costs, reliance on data quality, and ethical concerns about autonomy and liability hinder widespread adoption. Regulatory hurdles and workflow integration also present obstacles. Future directions for AI integration in robotic surgery include enhancing autonomy, personalizing surgical approaches, and refining surgical training through AI-powered simulations and virtual reality. Overall, AI integration holds promise for advancing surgical care, with potential benefits including improved patient outcomes and increased access to specialized expertise. Addressing challenges and promoting responsible adoption are essential for realizing the full potential of AI-driven robotic surgery.

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INTRODUCTION: The operating room is no longer the ideal place for early surgica training of cardiothoracic surgery residents, forcing the search for simulation-based learning options. The study's aim was the construction and surgicaltraining of coronary anastomosis in a portable, low-cost, homemade simulator. METHODS: This is an observational, analytical, and multicenter study. The simulator was built with common materials and was evaluated with the Objective Structured Assessment ofTechnical Skills (or OSATS) Modified. All junior and senior residents from nine national cardiothoracic surgery centers were considered for 90 days. Operative skill acquisition and time in the creation of side-to-side (S-T-S), end-to-side (E-T-S), and end-to-end (E-T-E) coronary anastomoses were evaluated. All sessions were recorded and evaluated by a single senior cardiothoracic surgeon during two time periods. RESULTS: One hundred and forty residents were assessed in 270 sessions. In junior residents, a significant improvement in final scores was identified in S-T-S (use of Castroviejo needle holder, needle angles, and needle transfer) (P<0.05). In seniors, a significant improvement was identified in S-T-S (graft orientation, appropriate spacing, use of forceps, angles, and needle transfer) anastomoses (P<0.05). A significant improvement in the final anastomosis time of senior residents over junior residents was identified in S-T-S (8.11 vs. 11.22 minutes), E-T-S (7.93 vs. 10.10 minutes), and E-T-E (6.56 vs. 9.68 minutes) (P=0.039). CONCLUSION: Our portable and low-cost coronary anastomosis simulator is effective in improving operative skills in cardiothoracic surgery residents; therefore, skills acquired through simulation-based training transfer have a positive impact on the surgical environment.

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OBJECTIVE: To determine the current status and main factors influencing the level of emergency laparoscopic surgery in the Russian Federation. MATERIAL AND METHODS: A retrospective nationwide analysis included patients ≥18 years old undergoing surgery for acute cholecystitis (AC), acute appendicitis (AA), perforated ulcer (PU) and ileus. The database of the chief surgeon of the Russian Ministry of Health for 2018 - 2022 was used. To investigate possible reasons influencing the level of emergency laparoscopic surgeries, we performed online survey of medical organizations connected to the electronic reporting system. RESULTS: Over five years, the incidence of laparoscopic surgeries for AC increased from 52.6% to 70.5% (p<0.001), for AA from 25.1% to 41.0% (p<0.001), for PU from 9.4% to 13.2% (p<0.001) and for ileus from 5.9% to 8.5% (p<0.001). The percentage of emergency laparoscopic surgeries in rural hospitals (level I) was 14.8%, level II hospitals - 40.2%, level III - 67.7% (p<0.001). We obtained responses from 1.982 (84.9%) out of 2.335 hospitals included in the database. Significant differences were revealed in equipment of hospitals of different levels with laparoscopic surgical systems and proportion of surgeons proficient in laparoscopic techniques (p<0.001). The same factors influence laparoscopy in different federal districts to a greater extent than their geographic and demographic characteristics. CONCLUSION: Laparoscopic emergency procedures became more widespread, but vary widely between regions, urban and rural. Availability of laparoscopic surgery is influenced by availability of equipment and trained surgeons, geographic distance and population density, level of hospital and ability to maintain acquired skills and increase experience in appropriate surgeries.

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BACKGROUND: The Laparoscopic Approach to Cervical Cancer study results revolutionized our understanding of the best surgical management for this disease. After its publication, the guidelines state that the standard and recommended approach for radical hysterectomy is an open abdominal approach. Nevertheless, the effect of the Laparoscopic Approach to Cervical Cancer trial on real-world changes in the surgical approach to radical hysterectomy remains elusive. OBJECTIVE: This study aimed to investigate the trends and routes of radical hysterectomy and to evaluate postoperative complication rates before and after the Laparoscopic Approach to Cervical Cancer trial (2018). STUDY DESIGN: The National Surgical Quality Improvement Program registry was used to examine radical hysterectomy for cervical cancer performed between 2012 and 2022. This study excluded vaginal radical hysterectomies and simple hysterectomies. The primary outcome measures were the trends in the route of surgery (minimally invasive surgery vs laparotomy) and surgical complication rates, stratified by periods before and after the publication of the Laparoscopic Approach to Cervical Cancer trial in 2018 (2012-2017 vs 2019-2022). The secondary outcome measure was major complications associated specifically with the different routes of surgery. RESULTS: Of the 3611 patients included, 2080 (57.6%) underwent laparotomy, and 1531 (42.4%) underwent minimally invasive radical hysterectomy. There was a significant increase in the minimally invasive surgery approach from 2012 to 2017 (45.6% in minimally invasive surgery in 2012 to 75.3% in minimally invasive surgery in 2017; P<.01) and a significant decrease in minimally invasive surgery from 2018 to 2022 (50.4% in minimally invasive surgery in 2018 to 11.4% in minimally invasive surgery in 2022; P<.001). The rate of minor complications was lower in the period before the Laparoscopic Approach to Cervical Cancer trial than after the trial (317 [16.9%] vs 288 [21.3%], respectively; P=.002). The major complication rates were similar before and after the Laparoscopic Approach to Cervical Cancer trial (139 [7.4%] vs 78 [5.8%], respectively; P=.26). The rates of blood transfusions and superficial surgical site infections were lower in the period before the Laparoscopic Approach to Cervical Cancer trial than in the period after the trial (137 [7.3%] vs 133 [9.8%] [P=.012] and 20 [1.1%] vs 53 [3.9%] [P<.001], respectively). In a comparison of minimally invasive surgery vs laparotomy radical hysterectomy during the entire study period, patients in the minimally invasive surgery group had lower rates of minor complications than in those in the laparotomy group (190 [12.4%] vs 472 [22.7%], respectively; P<.001), and the rates of major complications were similar in both groups (100 [6.5%] in the minimally invasive surgery group vs 139 [6.7%] in the laparotomy group; P=.89). In a specific complications analysis, the rates of blood transfusion and superficial surgical site infections were lower in the minimally invasive surgery group than in the laparotomy group (2.4% vs 12.7% and 0.6% vs 3.4%, respectively; P<.001; for both comparisons), and the rate of deep incisional surgical site infections was lower in the minimally invasive surgery group than in the laparotomy group (0.2% vs 0.7%, respectively; P=.048). In the multiple logistic regression analysis, the route of radical hysterectomy was not independently associated with the occurrence of major complications (adjusted odds ratio, 1.02; 95% confidence interval, 0.63-1.65). CONCLUSION: Although the proportion of minimally invasive radical hysterectomies decreased abruptly after the Laparoscopic Approach to Cervical Cancer trial, there was no change in the rate of major postoperative complications. In addition, the hysterectomy route was not associated with major postoperative complications.

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BACKGROUND: In the Arab region, there's a dearth of research on female surgeons' experiences and challenges. To address this gap, a scoping review aims to map existing literature. It seeks to understand the hurdles faced by female surgeons in Arab countries and examine any gender biases in public preferences for surgeons. No previous reviews were conducted on female surgeons in the Arab region. By identifying systemic barriers, the review aims to promote inclusivity and support for female surgeons in the Arab medical community. METHODS: A scoping review was performed and reported using the PRISMA extension for scoping reviews. Five databases were searched which include PubMed, Web of Science, Scopus, Embase, and ProQuest. The search strategy included three main strings that are "Women" AND "Surgeons" AND "Arab Country". A priori-identified spreadsheet was used for data extraction. RESULTS: A total number of 23 studies were included in this review. The findings were categorized under several headings, such as the general public's preferred gender of surgeon and well-being, challenges, and experiences of female surgeons as well as career perspectives, choices, and satisfaction. CONCLUSIONS: This scoping review explores experiences and challenges faced by female surgeons in the Arab region, emphasizing the need to address systemic barriers and promote inclusivity.

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Head and neck squamous cell carcinomas account for most head and neck malignancies. While multi-modality treatment may be offered for locally advanced cancer, distant metastasis still occurs in a significant number of patients. This paper aims to present a rare case of a patient who developed bony metastases in the cervical spine from a primary hypopharyngeal malignancy status post-laryngopharyngectomy. We report a case of a male patient presenting with acute-on-chronic hypercapnic and hypoxic respiratory failure with two months of dysphagia and weight loss. On arrival, a barium swallow revealed mucosal irregularity of the upper thoracic esophagus as well as narrowing and stenosis. A direct laryngoscopy with biopsy revealed squamous cell carcinoma of the hypopharynx. CT neck and chest were obtained for staging. He underwent a total laryngopharyngectomy, bilateral neck dissections, and a free flap. His final staging was pT4aN2c cM0. Three months post-admission, during inpatient radiation therapy, the patient reported midline neck pain with focal bone tenderness, and an MRI was obtained of his cervical and thoracic spine with a report concerning spinal metastasis.A subsequent bone biopsy showed findings consistent with osseous metastasis from a primary hypopharyngeal squamous cell carcinoma. After multidisciplinary goals of care discussions, the patient ultimately decided to be discharged to inpatient hospice. This report highlights a rare case of hypopharyngeal carcinoma metastasis to the cervical spine. Despite its rarity and poor prognosis, such a metastasis should be considered in the differential diagnosis of patients with a history of hypopharyngeal squamous cell carcinoma and localizing symptoms.

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Backgrounds Colorectal surgeons worldwide have differing opinions on the best way to handle rare cases of splenic flexure colon cancers (SFCs). Although the majority of reviews indicate no significant variation in oncological outcomes among the three different procedure types used to treat SFCs, surgeons still exhibit diversity in their practices. This study determined the treatment preferences of colorectal surgeons in Saudi Arabia. Methods A descriptive cross-sectional study evaluated the management of colorectal surgeons in handling SFC cases. We utilized a validated questionnaire developed by Manceau et al., consisting of 14 questions. Emails and phone numbers of members of the Saudi Society of Colorectal Surgery (SSCRS) were gathered. Google Forms surveys were administered from October 1-30, 2023. Results A response rate of 66% (58/88) was obtained among questioned colorectal surgeons. Their responses revealed that there was no consensus regarding the preferred procedure to treat SFCs. The most common treatment reported was segmental colectomy (SC) 21/58 (36.2%), followed by subtotal colectomy (STC) (19/58, 32.8%) and left hemicolectomy (LHC) (18/58, 31%). There was a strong consensus of 96% (56/58) of the respondents in favor of using stapler anastomosis rather than hand sewing. The frequency of performing SC, STC, and LHC in France was 70%, 13%, and 17%, respectively, compared to 36.2%, 32.8%, and 31% in Saudi Arabia, with a p-value of 0.001. The surgeons' preferred approaches to managing SFCs utilizing laparoscopic, open, or hand-aided in France versus Saudi Arabia were 63%, 31%, and 11%, respectively, compared to 84.5%, 8.6%, and 6.9%, with a p-value of 0.001. Conclusion A significant disparity exists regarding the treatment of SFCs between colorectal surgeons in France and Saudi Arabia. Furthermore, there is a lack of consensus among colorectal surgeons in Saudi Arabia regarding the surgical management of SFCs. Hence, it is imperative for the SCRSS to assemble a panel of experts to reach a consensus for the most appropriate and effective treatment of SFCs.

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PURPOSE: European training pathways for surgeons dedicated to treating severely injured and critically ill surgical patients lack a standardized approach and are significantly influenced by diverse organizational and cultural backgrounds. This variation extends into the realm of mentorship, a vital component for the holistic development of surgeons beyond mere technical proficiency. Currently, a comprehensive understanding of the mentorship landscape within the European trauma care (visceral or skeletal) and emergency general surgery (EGS) communities is lacking. This study aims to identify within the current mentorship environment prevalent practices, discern existing gaps, and propose structured interventions to enhance mentorship quality and accessibility led by the European Society for Trauma and Emergency Surgery (ESTES). METHODS: Utilizing a structured survey conceived and promoted by the Young section of the European Society of Trauma and Emergency Surgery (yESTES), we collected and analyzed responses from 123 ESTES members (both surgeons in practice and in training) across 20 European countries. The survey focused on mentorship experiences, challenges faced by early-career and female surgeons, the integration of non-technical skills (NTS) in mentorship, and the perceived role of surgical societies in facilitating mentorship. RESULTS: Findings highlighted a substantial mentorship experience gap, with 74% of respondents engaging in mostly informal mentorship, predominantly centered on surgical training. Notably, mentorship among early-career surgeons and trainees was less reported, uncovering a significant early-career gap. Female surgeons, representing a minority within respondents, reported a disproportionately poorer access to mentorship. Moreover, while respondents recognized the importance of NTS, these were inadequately addressed in current mentorship practices. The current mentorship input of surgical societies, like ESTES, is viewed as insufficient, with a call for structured programs and initiatives such as traveling fellowships and remote mentoring. CONCLUSIONS: Our survey underscores critical gaps in the current mentorship landscape for trauma and EGS in Europe, particularly for early-career and female surgeons. A clear need exists for more formalized, inclusive mentorship programs that adequately cover both technical and non-technical skills. ESTES could play a pivotal role in addressing these gaps through structured interventions, fostering a more supportive, inclusive, and well-rounded surgical community.

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Introduction Accurate and detailed documentation of surgical operation notes is crucial for post-operative care, research and academic purposes, and medico-legal clarity. Several studies have shown their defiency and inaccuracy sometimes, and some methods have been proposed to make them more objective. This study aimed to evaluate the completeness of thyroidectomy operative notes in a tertiary center and to assess the adequacy of video documentation by comparing it to the corresponding operative notes. Methods A retrospective review of thyroidectomy operative notes from 2010 to 2020 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, was performed to ensure completeness. Subsequently, 15 thyroidectomies were video recorded, and their notes were compared to the corresponding written operative notes. The completeness score was calculated based on an item list that included items that had to be included in an operative note. An independent samples t-test was used to compare the completeness score means between the two groups. One-way analysis of variance was used to compare the completeness score means between two or more groups. Result A total of 385 thyroidectomy-operative notes were retrospectively reviewed. The completeness scores ranged between 6% and 89% for the various items that had to be documented, with a mean of 54.47%. The mean score of the video-documented operative record was 83.86%±12.84%, which was significantly higher than the corresponding written operative notes (47.53%±18.06%) (p <0.001). Conclusion Video documentation showed significant improvement compared to the corresponding written and retrospective operative notes. Video recording can also be a valuable tool when teaching anatomy and surgical skills and conducting research.