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Introduction: This case report presents the intentional periodontal maintenance of two periodontal hopeless lower central incisors with a multidisciplinary approach and 20-year follow-up. Case presentation: A 36-year-old male, in 2001, was diagnosed with aggressive periodontitis, gingival swelling, bleeding, and mandibular central incisors with mobility and poor prognosis. Following periodontal therapy (phase I), root canal treatment, and occlusal adjustment, #31 and #41 were gently extracted to remove the granulation tissues, calculus, and infected cementum from the root surface. Then, tetracycline-HCl was applied for 5 minutes on the root surfaces. The teeth were repositioned into the sockets and splinted with a lingual bar. At 3 months, the bar was removed, and a free gingival autogenous graft was done to improve the local keratinized tissue width. Mobility scores, pocket depths, and clinical attachment levels were recorded, and radiographs were taken at 1, 5, and 20 years. The 5-year follow-up showed that the teeth were clinically and radiographically in function. There was a reduction in probing depth and a gain in clinical attachment and radiographic alveolar bone levels. After 20 years, #41 was stable, but #31 had external root resorption, leading to a new treatment plan (dental implants) and extraction. Conclusion: The clinical result of this case was satisfactory for 20 years. Intentional periodontal maintenance of the teeth may be an alternative treatment, even considering the high level of complexity.

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Durante a 39a Jornada Sulbrasileira de Cirurgia Plástica, em abril de 2024, um debate acalorado surgiu em torno da divulgação do uso de tecnologias para cirurgia de contorno corporal nas redes sociais. Um importante questionamento foi feito: elas estão sendo divulgadas prematuramente nas redes sociais antes de serem rigorosamente avaliadas? A frase do Dr. Ian Malcolm, célebre criação de Michael Chrichton, "Vou te dizer o problema com o poder que você está usando aqui, ele não exigiu nenhuma disciplina para obtê-lo" se aplica perfeitamente a essa situação. A divulgação de técnicas em redes sociais deveria exigir a mesma disciplina rigorosa que a pesquisa científica. A ausência de protocolos de pesquisa aprovados pelo Conselho Nacional de Ética em Pesquisa e de publicações de alto nível de evidência em revistas revisadas por pares levanta preocupações. O poder de aprimorar nossos resultados com o uso dessas fontes de energia externa é real e seu uso consiste em um grande avanço dentro da cirurgia plástica. No entanto, é imperativo que os cirurgiões plásticos exerçam cautela ao promover novas tecnologias. A disciplina científica deve ser o alicerce de qualquer avanço, e a divulgação responsável deve preceder a popularização. Somente assim, poderemos garantir que os pacientes se beneficiem de tratamentos seguros e eficazes, sem comprometer a integridade da nossa especialidade.

During the 39th South Brazilian Plastic Surgery Conference, in April 2024, a heated debate arose regarding the promotion of the use of technologies for body contouring surgery on social media. An important question was raised: are they being prematurely promoted on social media before being rigorously evaluated? The quote from Dr. Ian Malcolm, a famous creation of Michael Chrichton, "I'll tell you the problem with the power you're using here, it didn't require any discipline to attain it" applies perfectly to this situation. Promoting techniques on social media should require the same rigorous discipline as scientific research. The absence of research protocols approved by the National Research Ethics Council and high-level evidence publications in peer- reviewed journals raises concerns. The power to enhance our results using these external energy sources is real, and its use represents a significant advancement within plastic surgery. However, it is imperative that plastic surgeons exercise caution when promoting new technologies. Scientific discipline should be the foundation of any advancement, and responsible disclosure should precede popularization. Only then can we ensure that patients benefit from safe and effective treatments without compromising the integrity of our specialty.

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Introduction Gastrointestinal stromal tumors (GISTs) are neoplasms originating from the interstitial cells of Cajal, pacemaker cells responsible for intestinal motility. Patients with locally advanced GISTs and those with borderline resections due to the proximity of vital anatomical structures, which could result in unacceptable post-surgical morbidity, require special therapeutic consideration. Imatinib, a tyrosine kinase inhibitor, has demonstrated significant success in the non-surgical management of metastatic GIST, and its favorable impact on overall survival in the adjuvant setting makes it logical to speculate on the benefit it could provide as a neoadjuvant medication in patients with locally advanced disease. Methods Patients aged 18-90 years with a diagnosis of GIST confirmed by immunohistochemistry (CD117 positivity) who were treated at the Oncology Hospital of Centro Médico Nacional Siglo XXI in Mexico City from January 2012 to December 2016 were included in the study. It is a retrospective study with a duration of four years. Clinical data were collected from the medical records, which included sex, age, tumor location, initial resectability, reason for unresectability, initial tumor size, and mitotic rate. In the case of unresectable disease, patients who were evaluated by medical oncology and who had received treatment with 400 mg of imatinib daily were evaluated. Results A total of 312 patients diagnosed with GIST were analyzed. One hundred thirty-one were men (42%) with a mean age of 57 years, and 181 were women (58%) with a mean age of 59 years. The most frequent anatomical location was the stomach (n=185, 59.2%). At the time of diagnosis, 210 patients (67.3%) presented with resectable disease, while n=102 patients (32.7%) had unresectable disease. A total of 102 patients with unresectable disease received therapy with 400 mg of imatinib per day. Sixteen patients (15.7%) presented a reduction in tumor dimensions and underwent surgery. Conclusion The study highlights the importance of complete surgical resection and the potential benefit of neoadjuvant imatinib therapy in converting unresectable to resectable disease. The results suggest that imatinib can be effective in converting unresectable GISTs to resectable ones, allowing for a complete resection to be performed and obtaining an R0 resection in 93.7% of these cases.

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PURPOSE: This study has two objectives: (1) to identify the indicators of the nursing outcome "Knowledge: Wound management (3209)" related to the evaluation of knowledge about the care of surgical wounds; (2) to translate and culturally adapt the nursing outcome "Knowledge: Wound management (3209)" into Brazilian Portuguese and Colombian Spanish. METHODS: This is a methodological study with two steps. Initially, a scoping review was conducted based on the methodology of the Joanna Briggs Institute. Subsequently, the translation and cultural adaptation of the outcome were performed by adapting Beaton's recommendations, which included the label, definition, indicators, and measurement scale. FINDINGS: The review identified 31 indicators to evaluate knowledge about surgical wound care. Of these, 16 are described in the original outcome, and 15 new indicators are proposed to be included in the classification. Following this, the label, definition, indicators, and outcome measurement scale were reviewed, translated, and adapted with appropriate terminology for the cultural contexts of Brazil and Colombia. CONCLUSION: The outcome "Knowledge: Wound management (3209)" for evaluating the knowledge of surgical wounds consists of 31 indicators, all supported by scientific literature. The translated and adapted versions into Brazilian Portuguese and Colombian Spanish were found to be equivalent to the original. It is inferred that the identified indicators and the translated versions of the outcome will provide nursing professionals with an accurate assessment of knowledge about surgical incision wound care in daily practice. IMPLICATIONS FOR NURSING PRACTICE: This study reviews the scientific literature on the outcome "Knowledge: Wound management (3209)," facilitating the comprehensive measurement of specific knowledge about the care of surgical wounds in practice, education, or research. Additionally, it makes available the translated and adapted versions of the outcome in Brazilian Portuguese and Colombian Spanish. PROPÓSITO: Este estudio tiene dos objetivos: (1) Identificar los indicadores del resultado de enfermería "Knowledge: Wound Management (3209)" relacionados a la evaluación del conocimiento sobre el cuidado de las heridas quirúrgica; (2) traducir y adaptar culturalmente el resultado de enfermería "Knowledge: Wound Management (3209)" al portugués de Brasil y al español de Colombia. MÉTODOS: Estudio metodológico de dos pasos. Inicialmente, fue realizada una revisión de alcance orientados en la metodología de la Joanna Briggs Institute. Posteriormente, se realizó la traducción y adaptación cultural del resultado adaptando las recomendaciones de Beaton e incluyó la etiqueta, definición, indicadores y escala de medición. HALLAZGOS: En la revisión fueron identificados 31 indicadores para evaluar el conocimiento sobre el cuidado de las heridas quirúrgicas. De los 31 indicadores, 16 son descritos en el resultado y 15 nuevos indicadores propuestos para ser incluidos en la clasificación. A continuación, la etiqueta, definición, indicadores y escala de medición del resultado fueron revisados, traducidas y adaptados con la terminología adecuada para los entornos culturales de Brasil y Colombia. CONCLUSIÓN: El resultado "Knowledge: Wound Management (3209)" para el cuidado de las heridas quirúrgicas está compuesto por 31 indicadores todos sustentados con la literatura científica. Las versiones traducidas y adaptadas al portugués de Brasil y al español de Colombia del resultado fueron equivalentes al original. Se infiere que los indicadores identificados y las versiones traducidas del resultado le proporcionaran al profesional de enfermería una evaluación precisa del conocimiento sobre el cuidado de las heridas quirúrgicas en la práctica diaria. IMPLICACIONES PARA LA PRÁCTICA DE ENFERMERÍA: Este estudio revisa la literatura científica del resultado "Knowledge: Wound Management (3209)" favoreciendo la medición integral del conocimiento específico sobre el cuidado de las heridas quirúrgicas en la práctica, educación o investigación. Además, pone a disposición la versión traducida y adaptada del resultado en portugués de Brasil y en español de Colombia.

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Gastrointestinal stromal tumors (GISTs) are sarcomas affecting the stomach and small intestine, with a rare subtype characterized by succinate dehydrogenase B (SDHB)-loss posing significant diagnostic and therapeutic challenges. A 62-year-old man with weight loss and abdominal pain was diagnosed with a gastric GIST showing SDHB-loss. Initial treatment with Imatinib reduced the tumor size, but surgery revealed no residual tumor. Despite adjuvant Imatinib, recurrence occurred, necessitating further surgical intervention. While GISTs typically benefit from surgery and tyrosine kinase inhibitors (TKIs), those with SDHB-loss are resistant to TKIs, requiring a different management approach. This case emphasizes the importance of surgical intervention for SDHB-deficient GISTs and the need for ongoing research into effective treatments for this subtype.

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Our center launched the first antimicrobial stewardship program in Peru. From 2016 to 2023, the proportion of antimicrobial prescriptions audited increased from 60% to 95%, and 65% to 95% of recommendations were accepted. Vancomycin and meropenem use dropped by 95% and 84%, respectively. The proportion of recommendations for surgical prophylaxis exceeded 90%.

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OBJECTIVE: Unruptured middle cerebral artery aneurysm (uMCAA) has traditionally been treated with open surgical clipping (SC). Endovascular treatments (EVTs) were designed to reduce surgical risks in these cases. Nevertheless, despite its potential benefits, many surgeons favor SC for uMCAA. This updated meta-analysis aimed to compare the safety, efficacy, and clinical outcomes of SC and EVT for uMCAA. METHODS: The authors searched the Medline, Embase, and Cochrane Library databases according to the Cochrane and PRISMA guidelines. Eligible studies included those with ≥ 4 patients with uMCAA reporting comparative data of SC and EVT. The endpoints were the complete occlusion rate (Raymond class I and II), good clinical outcomes (modified Rankin Scale score ≤ 2 or Glasgow Outcome Scale score ≥ 4), procedure-related complications (further divided into major and minor), and mortality. The authors pooled OR with 95% CI values with a random-effects model. I2 statistics were used to assess heterogeneity, and sensitivity analysis was conducted to address high heterogeneity. Publication bias was assessed with funnel plot analysis and the Egger's test. RESULTS: The analysis included data from 10 studies. Regarding the complete occlusion assessment, the comparative analysis revealed OR 0.17 (95% CI 0.08-0.40, p < 0.01), favoring SC. In terms of achieving good clinical outcomes, OR 0.44 (95% CI 0.20-0.97, p < 0.05) was determined, favoring SC. No differences regarding total procedure-related complications, major complications, or mortality were identified. However, a higher likelihood of minor complications was identified for EVT, with OR 4.68 (95% CI 2.01-10.92, p < 0.01). CONCLUSIONS: This systematic review and meta-analysis identified a lower likelihood of complete occlusion at last follow-up and lower likelihood of good clinical outcomes in patients treated with EVT when compared with SC. Furthermore, a higher likelihood of minor complications was identified in patients who underwent EVT when compared with SC. The findings reinforce that, based on the currently available data, SC should be considered the primary approach for treating uMCAA. However, EVT is an evolving approach, and this study's findings represent a synthesis of observational studies. Randomized trials are warranted to elucidate which approach should be the mainstay for uMCAA and to identify the nuances that determine whether SC or EVT is more or less indicated for addressing uMCAA with consideration of the individuality of each patient and aneurysm.

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Introduction: 3D biomodels represent a cutting-edge advancement in medical imaging technology. The incorporation of 3D technologies in dermatology through the acquisition of onychological images, 3D reconstruction, and development of customized equipment to assist in surgeries demonstrated reduction in operating times and improved surgical outcomes. Additionally, the use of 3D printing in surgical simulation provided a safe environment for training and education. This article explores the application of 3D biomodels in dermatology, focusing on three clinical cases involving nail tumors. Case Presentation: In case 1, a glomus tumor was visualized in 3D, guiding the creation of a personalized surgical device. The minimally invasive surgery, facilitated by the biomodel, resulted in successful tumor removal. Case 2, featuring a subungual keratoacanthoma, utilized 3D biomodels for conservative surgery planning, anatomical comprehension, and patient communication. Case 3 involved a longitudinal groove, where biomodels aided in precise lesion localization and surgical planning. Conclusion: The integration of virtual and physical anatomical biomodels proves valuable in surgical dermatology, contributing to enhanced treatment quality, patient safety, and medical education.

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Introduction Gastric cancer is a significant major global health concern, particularly prevalent in Asia. In recent years, a large number of new cases have been diagnosed worldwide, leading to a substantial number of deaths. The disease tends to present more aggressively in these cases, leading to debates about the prognosis and survival outcomes. Nonetheless, research has shown that survival rates improve significantly when the tumor is completely surgically resected. Materials and methods This retrospective study included patients between 16 and 45 years old, diagnosed with gastric cancer, with the support of the pathology department, who underwent surgery in the upper GI service, in the period from January 2006 to December 2012. Data collected encompassed variables such as gender, age, tumor size, type of surgery, overall survival, disease-free period, type and histological degree of the tumor, clinical stage of the cancer, and R0 resection (curative resection). All patients with a confirmed diagnosis of gastric cancer were included and treated with surgery and D1 limited dissection or extended D2 dissection. Patients who have received chemotherapy prior to surgical treatment and those who have been surgically treated outside the XXI Century National Medical Center were excluded. Results A total of 104 patients were included; the predominant histological type was diffuse adenocarcinoma accounting for 79.8% and 81.7% of the cases were histological grade 3. The most common clinical stage was IIIA in 41.3% of the cases. In 53.8% of the cases, we obtained an R0 resection. D2 lymphadenectomy was performed in 53.8% of the cases, with an overall survival rate of 82.69%. Significant prognostic factors for survival included T4 depth with an increase in risk for mortality (OR: 25.93; 95% CI: 6.41-53.54; p=0.001), lymph node status (OR: 14.76; 95% CI: 4.6-46.83; p<0.001), and size greater than 5 cm (OR: 1.8; 95% CI: 0.61-6.35; p<0.001). Conclusions Gastric cancer is more common in adults aged above 60 years old, but the incidence in young adults under 45 years old has been increasing. Although young gastric cancer patients present with more aggressive tumor behavior, these patients can have similar or even better overall survival compared to older patients, being 35% in some cases, especially in the resectable setting. Further research is still needed to fully characterize the unique biology and optimal management of gastric cancer in young adults.

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INTRODUCTION: We aim to compare the safety and effectiveness of the KangDuo (KD)-Surgical Robot-01 (KD-SR-01) system and the da Vinci (DV) system for robot-assisted radical nephroureterectomy (RARNU). MATERIALS AND METHODS: This multicenter prospective randomized controlled trial was conducted between March 2022 and September 2023. Group 1 included 29 patients undergoing KD-RARNU. Group 2 included 29 patients undergoing DV-RARNU. Patient demographic and clinical characteristics, perioperative data, and follow-up outcomes were collected prospectively and compared between the two groups. RESULTS: There were no significant differences in patient baseline demographic and preoperative characteristics between the two groups. The success rates in both groups were 100% without conversion to open or laparoscopic surgery or positive surgical margins. No significant difference was observed in docking time [242 (120-951) s vs 253 (62-498) s, P = 0.780], console time [137 (55-290) min vs 105 (62-220) min, P = 0.114], operative time [207 (121-460) min vs 185 (96-305) min, P = 0.091], EBL [50 (10-600) mL vs 50 (10-700) mL, P = 0.507], National Aeronautics and Space Administration Task Load Index scores, and postoperative serum creatinine levels between the two groups. None of the patients showed evidence of distant metastasis, local recurrence, or equipment-related adverse events during the four-week follow-up. One (3.4%) patient in Group 2 experienced postoperative enterovaginal and enterovesical fistulas (Clavien-Dindo grade III). CONCLUSIONS: The KD-SR-01 system is safe and effective for RARNU compared to the DV Si or Xi system. Further randomized controlled studies with larger sample sizes and longer durations are required.

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INTRODUCTION: As part of the International Society of Aesthetic Plastic Surgery, we present an analysis of our global aesthetic statistics, fulfilling the role of a worldwide organization of plastic surgeons with a clear mission to disseminate aesthetic education worldwide, promote patient safety, protect high ethical standards, and communicate. MATERIAL AND METHODS: A retrospective analysis of the ISAPS Global Aesthetic Statistics was conducted annually from 2010 to 2023. The design and analysis of each survey was carefully developed and validated by Industry Insights, Inc. prior to distribution. Participants were recruited using an anonymous online questionnaire that focused primarily on the number of surgical and nonsurgical procedures performed in the previous year, as well as questions related to surgeon demographics and the prevalence of medical tourism. ISAPS invited all physicians in their data base who were board-certified plastic surgeons or equivalent and suggested National Societies to encourage their members to participate. RESULTS: The latest survey reported a global increase in 3.4%, including 34.9 million surgical and nonsurgical aesthetic procedures performed by plastic surgeons in 2023. More than 15.8 million surgical procedures and more than 19.1 million nonsurgical procedures were performed worldwide. During the past decade, a steady increase in aesthetic procedures has been observed, which has been more pronounced since 2021. In the last 4 years, the overall increase in procedures was 40%. SURGICAL PROCEDURES: The top five surgical procedures were liposuction, breast augmentation, eyelid surgery, abdominoplasty, and rhinoplasty. This trend has been stable for 14 years, with the exception of 2022, when breast lift surgery temporarily replaced rhinoplasty. FACE AND HEAD PROCEDURES: These procedures continue to be the most popular. This group included brow lift, ear surgery, eyelid surgery, facelift, facial bone contouring, facial fat grafting, lip augmentation or frontal surgery, neck lift, and rhinoplasty. BODY AND EXTREMITIES PROCEDURES: This group included abdominoplasty, buttock augmentation, buttock lift, liposuction, lower body lift, thigh lift, arm lift, upper body lift, labiaplasty, and vaginal rejuvenation. Over the past 14 years, body and extremity procedures have increased, with more than 5.1 million procedures in 2023 compared to 2.6 million in 2009. NONSURGICAL PROCEDURES: The five most popular nonsurgical procedures are botulinum toxin, hyaluronic acid, hair removal, chemical peels, and nonsurgical fat reduction. In 2022, chemical peels will replace nonsurgical skin tightening in the top five. MALE AESTHETIC SURGERY: Procedures performed on men continue to grow, with minimally invasive procedures dominating. The most recent survey reported that they represented 14.5% of the total. The top five surgical procedures were eyelid surgery, gynecomastia, liposuction, rhinoplasty, and facial fat grafting. The most popular nonsurgical procedures for men were botulinum toxin, hyaluronic acid, hair removal, nonsurgical skin tightening, and nonsurgical fat reduction. This trend has held steady for more than a decade. DISCUSSION: This study analyzes the most recent data and experience of board-certified aesthetic plastic surgeons in surgical and nonsurgical procedures worldwide over 14 years and provides insight into future trends. More than 60 years have passed since the introduction of liposuction, being one of the most performed aesthetic procedures worldwide over the past 14 years and currently number one procedure performed by plastic surgeons. New trends and technologies have evolved over the years, however, plastic surgeons must be cautious, as history has shown that risks increase when new technologies are introduced. With the popularity of liposuction, other body contouring procedures began to gain interest, and in 2015, gluteal lipoinjections were added to the ISAPS global aesthetic statistics and with them complications arise. In 2018 and 2019, the major patient safety societies, ISAPS, ASERF, ASPS, and ASAPS, began a systematic educational campaign to inform their members about the inherent risks of performing gluteal fat transfer surgery and what techniques or equipment can be used to minimize risks. Another procedure added to the ISAPS statistics in 2010 was vaginal aesthetic surgery. With the new trend of vaginal aesthetics, many believed that they were just changing the appearance of the area, but today it is clear that they are here for much more, to truly empower women with their sexuality. Breast augmentation showed a decline for the first-time last year. However, breast augmentation and liposuction have been the most performed procedures by plastic surgeons worldwide for more than a decade. On the other hand, implant removal has been the fastest growing procedure since 2015, with an overall increase in 46.3% over the past 5 years. In relation to male aesthetic surgery, the number of men undergoing aesthetic procedures has remained stable in recent years at around 14%. Male aesthetics is certainly a growing trend, and our practices should be more inclusive. Another prominent field is regenerative medicine. In relation to plastic surgery, regenerative surgery strategies often involve adipose tissue with stem cells and preadipocytes, alone or in combination with scaffolds. In terms of prevention, regenerative medicine aims to improve the quality of the skin by improving our outcomes and would make it possible to avoid the need for facelifts in the future. Finally, given the increasing popularity of medical procedures abroad ("medical tourism") and the fact that safety regulations and guidelines vary widely from place to place, we encourage patients to choose a board-certified, specialized, trained and experienced plastic surgeon for their procedure and an accredited surgical facility to ensure the procedure in done under the highest patient safety standards. CONCLUSIONS: Despite the obvious cultural and social differences from country to country that make certain procedures more desirable in some geographic areas and less so in other parts of the world, the results of this study show a significant overall increase in all surgical and nonsurgical procedures aimed at improving the aesthetic appearance of the body during14 years. As plastic surgeons, we are open to new possibilities in aesthetic procedures and are responsible for patient safety protocols and procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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Pectoralis major muscle flaps are considered versatile and allow large reconstructions of anatomical defects within a single surgical procedure. Considered a "workhorse" due to these characteristics, the pectoralis major muscle is an excellent option for surgical reconstruction. Several uses of this flap are described in the literature, such as protection of the jugulocarotid system after cervical lymph node dissection, oral, cervical, breast, diaphragmatic, hypopharyngeal, pharyngeal, laryngeal, and esophageal reconstructions.

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BACKGROUND: Digital technology and gamified apps can be useful in the health care context. Gamification uses technology to influence users' actions and motivations through experiences that resemble games. Patient adherence to the enhanced recovery after surgery (ERAS) program is crucial for achieving early recovery after surgery and continuous monitoring is essential for obtaining good results. OBJECTIVE: This study aimed to describe the development and validation of a mobile app for enhanced recovery after surgery (MobERAS), a gamified mobile health app for telemonitoring patients in the postoperative period based on the ERAS program, and to evaluate its functionality and usability and the experience of patients, health care professionals, and computer professionals with its use. METHODS: We developed MobERAS for postoperative telemonitoring, with active participation of patients in the process, and offering availability of real-time information for the health team. The app development process included idealization, interdisciplinary team formation, potential needs assessment, and product deployment. Usability tests were conducted throughout the development process with improvements, technical adjustments, and updates. After finalization, comprehensive verification tests were performed. The parameters evaluated are those that can influence the length of hospital stay, such as nausea, vomiting, pain scales, return to normal gastrointestinal function, and thromboembolic events. MobERAS was designed to be downloaded by users on their phones, tablets, or other mobile devices and to provide postoperative data. The app has a GPS that monitors the patient's walking time and distance and is connected to a virtual database that stores the collected data. RESULTS: Women undergoing medium and major gynecologic oncologic surgeries were included. We included 65 patients with an average age of 53.2 (SD 7.4, range 18-85) years. The time of use ranged from 23.4 to 70 hours (mean 45.1, SD 19.2 hours). Regarding adherence to the use of MobERAS, the mean fill rate was 56.3% (SD 12.1%, range 41.7%-100%), and ambulation data were obtained for 60 (92.3%) of the 65 patients. The researcher had access to the data filled out by the patients in real time. There was good acceptance of the use of MobERAS by the patients, with good evaluation of the app's usability. MobERAS was easy to use and considered attractive because of its gamified design. The app was rated as good or very good in all items by health care professionals (n=20) and professionals specializing in technological innovation (n=10). CONCLUSIONS: MobERAS is easy to use, safe, well accepted by patients, and well evaluated by experts. It can be of great use in clinical surgical practice and an important tool for greater engagement of patients and health care professionals with the ERAS program.

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BACKGROUND: Feedback is an essential tool for learning and improving performance in any sphere of education, including training of resident physicians. The learner's perception of the feedback they receive is extremely relevant to their learning progress, which must aim at providing qualified care for patients. Studies pertinent to the matter differ substantially with respect to methodology, population, context, and objective, which makes it even more difficult to achieve a clear understanding of the topic. A scoping review on this theme will unequivocally enhance and organize what is already known. OBJECTIVE: The aim of this study is to identify and map out data from studies that report surgical residents' perception of the feedback received during their education. METHODS: The review will consider studies on the feedback perception of resident physicians of any surgical specialty and age group, attending any year of residency, regardless of the type of feedback given and the way the perceptions were measured. Primary studies published in English, Spanish, and Portuguese since 2017 will be considered. The search will be carried out in 6 databases and reference lists will also be searched for additional studies. Duplicates will be removed, and 2 independent reviewers will screen the selected studies' titles, abstracts, and full texts. Data extraction will be performed through a tool developed by the researchers. Descriptive statistics and qualitative analysis (content analysis) will be used to analyze the data. A summary of the results will be presented in the form of diagrams, narratives, and tables. RESULTS: The findings of this scoping review were submitted to an indexed journal in July 2024, currently awaiting reviewer approval. The search was executed on March 15, 2024, and resulted in 588 articles. After the exclusion of the duplicate articles and those that did not meet the eligibility criteria as well as the inclusion of articles through a manual search, 13 articles were included in the review. CONCLUSIONS: Conducting a scoping review is the best way to map what is known about a subject. By focusing on the feedback perception more than the feedback itself, the results of this study will surely contribute to gaining a deeper understanding of how to proceed to enhance internal feedback and surgical residents' learning progress. TRIAL REGISTRATION: Open Science Framework yexb; https://osf.io/yexkb. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56727.

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•Thrombotic thrombocytopenic purpura (TTP) may relapse after surgery.•In a systematic review, we assessed preoperative TTP prophylaxis.•Pre-emptive ADAMTS-13 activity measurement prior to surgery may improve relapse risk.•Preoperative TTP prophylaxis may lower surgical relapse risk.

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INTRODUCTION: Hepatectomies associated with vascular resections pose a technical challenge for surgeons, involving multiple reconstruction techniques. Moreover, adding clinical and surgical risks in the postoperative setting of these complex procedures are mainly due to prolonged surgical periods and potential complications inherent to vascular manipulation. Leveraging the expertise of a Cancer Center, we propose an institutional assessment utilizing the case series from A. C. Camargo Cancer Center in hepatectomies associated with vascular resection, evaluating postoperative complications and outcomes while highlighting clinical, laboratory, pathological, and surgical factors that may influence results. OBJECTIVE: To assess mortality and morbidity associated with hepatectomies involving vascular resection. MATERIALS AND METHODS: From a prospective database, a study was performed evaluating postoperative survival and morbidity using scoring systems such as Clavien-Dindo through a cohort analysis. RESULTS: From a total of 1021 liver resections for a period of 10 years, 31 cases were evaluated from a unique cancer center in Brazil! Factors such as the performance of major hepatectomies, the need for blood transfusion, and the administration of neoadjuvant or adjuvant systemic therapy did not appear to influence the outcome of morbidity or mortality. However, the resection of the associated bile duct and the type of vascular resection seemed to influence morbidity outcomes with statistical significance (p = 0.006+ …). CONCLUSION: Hepatectomies associated with vascular resections are safe in selected cases and when performed in referral centers. Factors such as associated bile duct resection and type of vascular resection should be considered for procedure indication.

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Resumo Fundamento Análises em grandes registros apontam desfechos desfavoráveis para mulheres submetidas à cirurgia de revascularização do miocárdio (CRM), enquanto estudos randomizados sofrem com a falta de representatividade. Objetivo Comparar os resultados hospitalares ajustados entre homens e mulheres submetidos à CRM. Métodos Entre julho de 2017 e junho de 2019, 3991 pacientes foram submetidos à CRM primária isolada, tanto de forma eletiva como de urgência, em 5 hospitais de estado de São Paulo, Brasil. Para equilibrar as diferenças entre homens e mulheres, as populações foram ajustadas utilizando o Propensity Score Matching. Os desfechos considerados para análise foram os utilizados pelo STS Adult Database. As análises foram conduzidas no software R, considerando significância valores de p < 0,05. Resultados Após o Propensity Score Matching (1:1), cada grupo incluiu 1089 pacientes. Em relação às variáveis intraoperatórias os homens apresentaram maior tempo de CEC (p<0,001), tempo cirúrgico (p<0,001), número de anastomoses distais (p<0,001) e uso de enxertos arteriais. Em relação aos desfechos as mulheres apresentaram maior incidência de infecção de ferida profunda (p=0,006), tempo prolongado na Unidade de Terapia Intensiva (p=0,002), maior necessidade do uso de balão intraórtico (p=0,04), maior taxa de transfusão sanguínea (p<0,001), maior readmissão hospitalar em até 30 dias após a cirurgia (p=0,002) e maior taxa de óbitos (p=0,03). Conclusões Apesar dos homens terem apresentado um maior tempo de CEC, maior número de enxertos arteriais e maior número de anastomoses distais, os resultados imediatos após CRM foram piores em mulheres.

Abstract Background Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. Objective To compare adjusted hospital outcomes between men and women undergoing CABG. Methods From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. Results After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Conclusions Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

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ABSTRACT Background and Objective Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number. With increasing use of whole gland and focal ablative therapies, updates on sRARP in this setting are needed. The aim of this narrative review is to provide an overview of recently reviewed studies on the oncologic outcomes, functional outcomes, and complications after post-radiation and post-ablative sRARP. Tips and tricks are provided to guide surgeons who may perform sRARP. Materials and Methods We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010-2022 without limitation on study design. Only case reports, editorial comments, letters, and manuscripts in non-English languages were excluded. Key Content and Findings Salvage robotic radical prostatectomy is performed in cases of biochemical recurrence after radiation or ablative therapies. Oncologic outcomes after sRARP are worse compared to primary surgery (pRARP) though improvements have been made with the robotic approach when compared to open salvage prostatectomy. Higher pre-sRARP PSA levels and more advanced pathologic stage portend worse oncologic outcomes. Patients meeting low-risk, EAU-biochemical recurrence criteria have improved oncologic outcomes compared to those with high-risk BCR. While complication rates in sRARP are higher compared to pRARP, Retzius sparing approaches may reduce complication rates, particularly rectal injuries. In comparison to the traditional open approach, sRARP is associated with a lower rate of bladder neck contracture. In terms of functional outcomes, potency rates after sRARP are poor and continence rates are low, though Retzius sparing approaches demonstrate acceptable recovery of urinary continence by 1 year, post-operatively. Conclusions Advances in the robotic platform and improvement in robotic experience have resulted in acceptable complication rates after sRARP. However, oncologic and functional outcomes after sRARP in both the post-radiation and post-ablation settings are worse compared to pRARP. Thus, when engaging in shared decision making with patients regarding the initial management of localized prostate cancer, patients should be educated regarding oncologic and functional outcomes and complications in the case of biochemically recurrent prostate cancer that may require sRARP.