BACKGROUND: Robotic transabdominal preperitoneal inguinal hernia repair (R-TAPP IHR) is a promising minimally invasive tool for inguinal hernias. This study aimed to evaluate short-term postoperative outcomes following R...BACKGROUND: Robotic transabdominal preperitoneal inguinal hernia repair (R-TAPP IHR) is a promising minimally invasive tool for inguinal hernias. This study aimed to evaluate short-term postoperative outcomes following R-TAPP IHR from a high-volume robotic surgeon who has passed the initial robotic learning curve. METHODS: A single-surgeon, single-institution prospective cohort study was conducted from August 2023 to October 2025. Adults who completed an elective R-TAPP IHR were consecutively enrolled. We collected data including baseline demographics and operative characteristics. Postoperative data was assessed and collected via structured telephone follow-up on postoperative day 1 (POD-1), POD-7, and POD-28, evaluating pain scores, postoperative complications, and hospital readmissions. RESULTS: A total of 89 patients underwent 119 repairs. The median console duration was 21 min. The overall operative duration from incision to closure was a median of 38 min, while total theatre time (wheels in to wheels out) was a median of 68 min. These times continued to decrease over the duration of the study. Most patients were discharged on the same day, with a median length of stay of 0 days. Reported pain scores decreased over time, with median values of 4 (out of 10) on POD-1, 2 on POD-7, and 0 by POD-28. Clavien-Dindo grades I-II complications occurred in 4.5% of cases. No grade III-IV complications were observed, and no recurrences were identified during follow-up. CONCLUSION: This study demonstrates that R-TAPP IHR in the post-learning curve setting is highly efficient and is associated with favourable short-term outcomes.
INTRODUCTION: Craniosynostosis, the premature fusion of calvarial bones, requires surgical intervention within a critical time-period. Early referral potentiates the application of less invasive treatments. Previous stud...INTRODUCTION: Craniosynostosis, the premature fusion of calvarial bones, requires surgical intervention within a critical time-period. Early referral potentiates the application of less invasive treatments. Previous studies from the United States have demonstrated that socioeconomically disadvantaged groups experience delayed referrals, older age at surgery and require more complex interventions. This study investigated the relationship between socioeconomic status and management for non-syndromic single suture craniosynostosis within Australia's universal healthcare system. METHODS: A retrospective cohort study was completed at an Australian craniofacial centre from 2018 to 2024. Independent variables (Index of Relative Socioeconomic Advantage and Disadvantage score, rurality, sex, interpreter use) and outcomes (age at referral/surgery, time between referral and appointment, procedure type, complications, and length of stay) were analysed with univariate and multivariate models. RESULTS: Totally, 200 patients were included. Age at referral and surgery were negatively correlated with Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) percentile. Multiple linear regression models demonstrated that for each one-unit increase in the IRSAD decile, age at referral decreased by 24.26 days (p < 0.001) and age at surgery decreased by 23.29 days (p = 0.003). No other factors were found to affect age at referral or age at surgery, and there were no differences in type of surgery, complications or length of stay. DISCUSSION: This study found that patients from socioeconomically advantaged backgrounds were referred earlier and underwent surgery at a younger age compared to disadvantaged counterparts. However, patients underwent the same surgical procedures, indicating that in Australia's universal healthcare setting, patients are falling within the critical window for intervention regardless of socioeconomic status.
This paper describes a novel simple method using intraoperative needle puncture marking on the lung surface to facilitate precise wedge resection of the unpalpable small lung cancers located deep in the posterolateral ba...This paper describes a novel simple method using intraoperative needle puncture marking on the lung surface to facilitate precise wedge resection of the unpalpable small lung cancers located deep in the posterolateral basal segments. This novel method is feasible and can be easily mastered and utilized for wedge resection of the posterolateral basal segments bearing unpalpable deep lung nodules.
BACKGROUND: Bladder cancer is a globally prevalent malignancy with a marked male predominance. Over the past decade, the androgen receptor has been investigated as a potential contributor to bladder cancer pathophysiolog...BACKGROUND: Bladder cancer is a globally prevalent malignancy with a marked male predominance. Over the past decade, the androgen receptor has been investigated as a potential contributor to bladder cancer pathophysiology. Androgen receptor expression is most commonly assessed via immunohistochemistry, but its association with pathological features and clinical outcomes remains uncertain. This meta-analysis aimed to evaluate whether androgen receptor expression assessed by immunohistochemistry is associated with pathological characteristics of urothelial bladder cancer, with exploratory assessment of reported prognostic outcomes. METHODS: A systematic search of MEDLINE, EMBASE and Cochrane was performed between January 1st 2000 and October 31st 2024. Papers comparing AR expression using immunohistochemistry to bladder urothelial cancer specimens stratified by grade, stage, gender and survival outcomes were included. RESULTS: In total 16 papers were included with 2108 patient samples. No correlation was found between androgen receptor expression and grade (OR 0.83, 95% CI 0.43-1.59), stage (OR 0.94, 95% CI 0.38-2.35), progression free survival (HR 0.84, 95% CI 0.45-1.59) or recurrence free survival (HR 0.81, 95% CI 0.49-1.31). Male bladder cancer specimens were more likely to express the androgen receptor than female bladder cancer specimens (OR 1.40, 95% CI 1.03-1.89). CONCLUSION: Immunohistochemistry as a measure of androgen receptor expression does not show a consistent association with pathological features and demonstrates no reproducible prognostic signal in the available literature. Male bladder cancer specimens express AR more frequently than female bladder cancer specimens. The significance of this needs to be correlated to further research into normal androgen receptor expression patterns in the urinary bladder and more precise measures of androgen receptor activity than immunohistochemistry.
BACKGROUND: Colorectal cancer (CRC) is a significant contributor to preventable deaths worldwide. The assessment of potentially avoidable mortality following elective CRC surgery has yet to be reported. The Australian an...BACKGROUND: Colorectal cancer (CRC) is a significant contributor to preventable deaths worldwide. The assessment of potentially avoidable mortality following elective CRC surgery has yet to be reported. The Australian and New Zealand Audit of Surgical Mortality (ANZASM) seeks to peer-review all deaths associated with surgical care. This study aims to determine the incidence of clinical management issues (CMIs) in potentially preventable deaths following elective CRC surgery. METHODS: ANZASM data from 2013 to 2023 were reviewed, and all in-hospital deaths following elective CRC surgery were selected for analysis. A predefined list of patient-care factors filled in by the treating surgeon and independent assessors was examined to identify CMIs. Deaths were categorized into two groups: potentially preventable and non-preventable. RESULTS: A total of 243 patients died after elective CRC resection over the 10-year study period. Of these, 134 (55.1%) deaths were considered potentially preventable. Compared to the non-preventable group, patients with potentially preventable deaths had higher rates of overall intraoperative (15.7% vs. 3.7%) and postoperative complications (88.8% vs. 63.3%). Potentially preventable deaths also had a greater number of CMIs per patient [median (range): 2 (1-6) vs. 1 (0-3)], with higher CMI rates during preoperative (25.0% vs. 12.8%), intraoperative (32.6% vs. 3.7%) and postoperative (58.8% vs. 28.6%) phases of surgical care. CONCLUSION: Over half of deaths following elective CRC surgery were potentially preventable. This study highlights deficiencies at all stages of surgical care and provides essential feedback to colorectal surgeons and healthcare professionals to further improve the safety and quality of care.
BACKGROUND: Surgical site infections (SSIs) are among the most common complications following colorectal surgery. This study aimed to systematically review existing evidence on the outcomes of subcutaneous negative sucti...BACKGROUND: Surgical site infections (SSIs) are among the most common complications following colorectal surgery. This study aimed to systematically review existing evidence on the outcomes of subcutaneous negative suction drain versus no drain in adults undergoing colorectal surgeries. METHODS: A systematic review and meta-analysis was conducted to compare the SSI rates between subcutaneous negative suction drain and the no-drain in adults (18 years or older) undergoing colorectal surgery. Randomized controlled trials (RCTs), prospective, or retrospective studies till 2025 reporting use of subcutaneous negative suction drain in elective and emergency colorectal surgeries were included. SSI was defined based on Center for Disease Control and Prevention (CDC) criteria. Results were expressed as Relative Risk (RR) and Confidence interval (CI) of 95%. A p value < 0.05 was considered statistically significant. RESULTS: Combined data from 2177 patients across 10 studies (four: RCTs, five: retrospective cohort, and one: prospective cohort) showed a significant reduction in overall SSIs by 60% (RR = 0.40; 95% CI, 0.30-0.53; p < 0.0001) in groups with a subcutaneous negative suction drain compared to those without. There was a significant reduction in superficial SSIs by 58% (RR = 0.42; 95% CI, 0.26-0.66; p = 0.0002). There was no significant reduction in deep SSIs and organ-space SSIs. The included studies were of medium to high quality. CONCLUSIONS: Subcutaneous negative suction drains reduce overall and superficial SSI after colorectal surgery, but do not affect deep or organ-space infection. ORIGINALITY STATEMENT: This paper provides updated evidence demonstrating that subcutaneous negative suction drains significantly reduce overall and superficial surgical site infections after colorectal surgery, and acknowledges their limited effect on deep and organ-space infections, supporting selective use. TRIAL REGISTRATION: The study protocol was registered with PROSPERO international prospective register of systematic Reviews (Registration ID: CRD420251012636).
PURPOSE: To evaluate long-term shoulder outcomes after sentinel lymph-node biopsy (SLNB) versus axillary lymph-node dissection (ALND) and identify predictors of chronic shoulder dysfunction. MATERIAL AND METHODS: This pr...PURPOSE: To evaluate long-term shoulder outcomes after sentinel lymph-node biopsy (SLNB) versus axillary lymph-node dissection (ALND) and identify predictors of chronic shoulder dysfunction. MATERIAL AND METHODS: This prospective multicenter study enrolled 1111 women (≥ 18 years) undergoing breast cancer surgery with SLNB (n = 931) or ALND (n = 180) across five tertiary hospitals between October 2022 and June 2024. Functional outcomes were assessed using QuickDASH, range-of-motion (ROM), daily-activity limitations, pain, axillary web syndrome (AWS), and lymphedema. Multivariable regression identified independent predictors of poor shoulder function. RESULTS: ALND was associated with consistently greater morbidity. Mean QuickDASH scores were 17.1 ± 10.5 after ALND versus 11.5 ± 9.8 after SLNB (p < 0.001). ROM limitation (38.3% vs. 20.0%), reduced daily-activity performance (41.1% vs. 23.1%), AWS (13.9% vs. 7.0%), and lymphedema (16.1% vs. 4.2%) were all more frequent after ALND (p ≤ 0.002). Pain intensity was higher (2.28 ± 2.82 vs. 1.31 ± 2.11; p < 0.001). In multivariable analysis, ALND (β = 1.18, p < 0.001), higher BMI (β = 0.27, p = 0.001), and depressive disorders (β = 0.31, p < 0.001) independently predicted worse shoulder function; age and physiotherapy timing were not significant. Functional deficits persisted across lumpectomy and mastectomy subgroups. CONCLUSIONS: ALND is associated with greater long-term shoulder dysfunction compared with SLNB. Obesity and depressive symptoms exacerbate morbidity, highlighting the importance of comprehensive survivorship rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05950685.
BACKGROUND: Peptic ulcer disease (PUD) continues to be a health issue, mainly due to Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drugs (NSAIDs). Despite better treatment of H. pylori and...BACKGROUND: Peptic ulcer disease (PUD) continues to be a health issue, mainly due to Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drugs (NSAIDs). Despite better treatment of H. pylori and use of proton pump inhibitors, the rate of reduction in PUD complications is slowing down. This may be predominantly because of increased NSAID and aspirin use, especially among older adults and those in higher socioeconomic regions. Understanding changing causes of perforated PUD is important for prevention and care. METHODS: This retrospective audit reviewed patients who underwent surgical repair for peptic ulcer perforations at tertiary hospitals in Western Australia from 2010 to 2018. The study assessed patient demographics, ulcer sites, risk factors (including NSAID/aspirin use and H. pylori status), eradication, and follow-up care to evaluate the relative impact of NSAID use and H. pylori infection on ulcer perforation. RESULTS: A cause for perforated PUD was identified in 78% of 359 patients; 72% had a history of NSAID or aspirin use and 42% tested positive for H. pylori. More gastric than duodenal perforations were observed. Practices around H. pylori testing, eradication, and follow-up varied. Malignant gastric perforation was rare. CONCLUSION: NSAID/Aspirin use may be surpassing H. pylori as the main cause of perforated PUD in Western Australia, mirroring global patterns. H. pylori remains important but identifying NSAID use as a modifiable risk and standardising testing, eradication, and follow-up-including endoscopy-are needed. These findings should guide clinical practice for post-operative and preventive care.
BACKGROUND: Examining how Australian medical students form career intentions is essential to supporting quality surgical healthcare provision and outcomes in Australia. Creating a diverse workforce through empowering und...BACKGROUND: Examining how Australian medical students form career intentions is essential to supporting quality surgical healthcare provision and outcomes in Australia. Creating a diverse workforce through empowering under-represented groups, such as female surgeons, is therefore a critical consideration in workforce planning. This qualitative study investigates factors that shape students' views of surgical careers in Australia. METHODS: A total of 12 final-year medical students (11 cisgendered female, 1 cisgendered male) joined focus groups exploring factors influencing surgical career intention. Data were transcribed and analysed using reflexive thematic analysis. RESULTS: A total of 4 themes and 10 subthemes were identified as contributing to students' perceptions: inclusion before surgery; varying learning opportunities; the pathway to surgery is challenging; and the decision to pursue a surgical career is readily influenced by outsiders. CONCLUSION: Multiple factors influence students' perceptions of a surgical career. As respondents were predominantly cisgender female, the results are particularly relevant in efforts to support cis female surgeons. A broader framework that encompasses surgeon-trainee interactions, the broader hospital team and the wider community may enable future actions to support workforce diversity.
OBJECTIVES: The effect of COVID-19 lockdown periods on surgical admission patterns in the Australian healthcare system has been relatively unexplored. The impact of these lockdowns was investigated via analysis of a surg...OBJECTIVES: The effect of COVID-19 lockdown periods on surgical admission patterns in the Australian healthcare system has been relatively unexplored. The impact of these lockdowns was investigated via analysis of a surgical mortality dataset. SETTING: All cases that had completed the evaluation process by 4 March 2025 (patient death between 1 January 2017 and 31 December 2024, n = 28 685) were included. The ANZASM database captures deaths during surgical admissions, not all surgical admissions. Data from NSW were unavailable at the time of extraction. Cases were grouped into three cohorts, according to date of patient death: pre-COVID (2017-2019), COVID (2020-2021) and post-COVID (2022-2024). RESULTS: Demographics were consistent across cohorts, with minor differences between pre- and post-COVID for age (p < 0.05), length of stay (p < 0.05) and ASA score (p < 0.001). Differences were observed in admission patterns (p < 0.001). There was a 3.9% decrease in private hospital admissions between pre- and post-COVID (19.1% vs. 15.2%), contrasting with a 4.3% increase in public hospital admissions (79.4% vs. 83.7%). Similarly, there was a decrease in elective procedures between pre- and post-COVID (18.5% vs. 12.9%) and an increase in 'scheduled emergency' procedures (i.e., > 24 h post-admission) (29.7% vs. 33.1%). While there was an overall decrease in postoperative complications post-COVID, there was an increase in the occurrence of anastomotic leaks. There was an increase in palliative care observed between pre- and post-COVID (2.2% vs. 4.1%; p < 0.001). CONCLUSION: These data indicate lasting shifts in surgical care patterns following the COVID-19 pandemic. The increase in admissions for palliative care under surgery post-COVID could indicate that disease states customarily amenable to surgical intervention had progressed due to delayed diagnosis and COVID-associated shutdowns of elective theatre activity. The increased occurrence of anastomotic leaks post-COVID may reflect skill fatigue, but other potential explanations for this observation also warrant further investigation.
BACKGROUND AND AIMS: Shoulder-tip pain is a common and distressing side effect following laparoscopic surgery. Standard systemic analgesic regimens are used to manage postoperative pain but are often associated with side...BACKGROUND AND AIMS: Shoulder-tip pain is a common and distressing side effect following laparoscopic surgery. Standard systemic analgesic regimens are used to manage postoperative pain but are often associated with side effects such as nausea and vomiting. There is some evidence to support a reduction in insufflation pressure to lessen shoulder-tip pain. This narrative review examined the efficacy of intraperitoneal anaesthesia on shoulder-tip and overall pain after laparoscopic surgery. METHODS: Relevant literature was identified through database searches containing terms related to intraperitoneal anaesthesia, insufflation pressure, laparoscopic surgery, shoulder-tip pain and postoperative pain. RESULTS: Most studies evaluating intraperitoneal local anaesthesia used bupivacaine or ropivacaine. There was a wide variety of surgical procedures with limited reporting of shoulder-tip pain. Mixed results were found regarding the efficacy of intraperitoneal anaesthesia on total pain scores. CONCLUSIONS: Intraperitoneal anaesthesia may be an effective strategy to reduce postoperative shoulder-tip and overall pain scores following laparoscopic surgery, but the evidence remains inconclusive due to methodological heterogeneity. Further well-designed studies, particularly in upper gastrointestinal laparoscopic surgery, using standardised dosing of intraperitoneal anaesthesia, standard versus low insufflation pressure, and validated outcome measures are required to determine its clinical efficacy.
BACKGROUND: Pleomorphic dermal sarcoma (PDS) is a rare cutaneous sarcoma with locally aggressive behaviour and metastatic potential. Optimal surgical management remains uncertain, with both wide local excision (WLE) and...BACKGROUND: Pleomorphic dermal sarcoma (PDS) is a rare cutaneous sarcoma with locally aggressive behaviour and metastatic potential. Optimal surgical management remains uncertain, with both wide local excision (WLE) and Mohs micrographic surgery (MMS) used in clinical practice. This systematic review aimed to compare oncological outcomes following WLE and MMS for PDS. METHODS: A systematic literature search was conducted in multiple databases from inception to December 2025. Studies reporting histologically confirmed PDS treated with WLE and/or MMS and including recurrence and/or survival outcomes were eligible. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. RESULTS: Thirteen retrospective studies comprising 543 patients were included. PDS predominantly affected elderly patients and mostly involved the head and neck, particularly the scalp. WLE was the primary surgical modality, while MMS was reported in two studies. Local recurrence rates following WLE ranged from 4.2% to 69%, with higher rates observed in cohorts including incomplete excision, satellite metastases, or recurrent disease. Median time to recurrence was typically within the first year. MMS series reported recurrence rates between 12.5% and 20.9%, though interpretation was limited by small sample sizes, heterogeneous baseline disease, and confounding by indication. Metastatic rates ranged from 0% to 19%, and disease-specific mortality was uncommon but occurred predominantly following distant metastases. CONCLUSION: Complete surgical excision with clear margins remains the cornerstone of PDS management. While MMS may be considered in selected cases, particularly in anatomically constrained sites, current evidence is insufficient to support its routine use over WLE. Further multicentre studies are required to better define optimal surgical strategies.
BACKGROUND: This study sought to assess clinician ability to correctly identify unwell surgical patients from the 'end-of-bed' to determine the validity of this commonly utilised clinical tool, and whether accurate asses...BACKGROUND: This study sought to assess clinician ability to correctly identify unwell surgical patients from the 'end-of-bed' to determine the validity of this commonly utilised clinical tool, and whether accurate assessment increases with experience. METHODS: This prospective observational study recruited patients at the time of surgical admission. Patients were filmed responding to three standard questions concerning their presentation. Each patient video was then viewed by five participants from various groups: surgical consultants, registrars, interns, medical students and orderlies (control group). Five 'Yes/No' questions were answered for each video, regarding how unwell patients appeared and their likely clinical trajectory. Assessor answers were compared with 'correct' answers as determined by the investigators, utilising patient clinical data. For each group, the percentage of questions answered correctly was calculated across 99 patients. The mean and standard deviation for the percentage correct was calculated as well as Cohen's Kappa Score when comparing the score for each assessor group with the 'correct' answer. RESULTS: The percentage of correctly answered questions was highest in the registrar group (82.21%), closely followed by consultants (82.04%), interns (80.47%), medical students (79.74%) and orderlies (79.44%) (p values < 0.001, except students' p value 0.0729). The order of Cohen's Kappa for correctly answered questions found consultants to have the highest agreement (0.26-fair agreement), followed by registrars (0.25-fair agreement) and lastly medical students (0.14-slight agreement) (p values < 0.001). CONCLUSION: The 'end-of-bed' assessment is a potential initial tool for assessing disease severity and clinical trajectory of surgical patients and improves with clinician experience.
BACKGROUND: Surgical marking pens are commonly used for marking operative sites, anatomical landmarks, and demarcating wounds with cellulitis. Reuse of these pens by surgeons and registrars poses a risk of transmitting m...BACKGROUND: Surgical marking pens are commonly used for marking operative sites, anatomical landmarks, and demarcating wounds with cellulitis. Reuse of these pens by surgeons and registrars poses a risk of transmitting multiresistant bacteria. We aim to investigate this risk, hypothesizing that the alcohol-based ink may have inherent antimicrobial properties. METHODS: Five study groups were included: one control and four bacterial groups. Multiple pens were used in the bacterial groups for repeatability. Pens were inoculated with common organisms from prosthetic infections and swabbed at various time points. In total, 65 swabs were taken for bacterial culture. RESULTS: All pens were sterile before inoculation, and the control group remained negative, confirming initial sterility. At 2 min, all 12 inoculated pens showed heavy bacterial growth. From 15 to 120 min, bacterial load decreased on all pens. Reinoculation of pens to account for the debridement effect of the swab demonstrated bacterial growth in at least 1 pen in all bacterial groups at T120. CONCLUSION: The study confirms that the alcohol-based pens are sterile out of the box and exhibit bactericidal properties over a 120-min period. However, sterility cannot be guaranteed with reuse.
BACKGROUND: Head and neck cancer (HNC) survivors often experience significant physical and psychological challenges posttreatment, including functional impairments and social isolation. Peer support programs, where survi...BACKGROUND: Head and neck cancer (HNC) survivors often experience significant physical and psychological challenges posttreatment, including functional impairments and social isolation. Peer support programs, where survivors share experiences and offer mutual support, can improve emotional well-being, reduce isolation, and offer practical advice. METHODS: This qualitative study involved in-depth semistructured interviews with 25 HNC survivors recruited from a single health service. Participants provided insights into their experiences with their diagnosis and treatment, and preferences regarding peer support, including perceived benefits, challenges, and preferences for program design and delivery. Data were analyzed thematically, with key themes identified through coding of interview transcripts. RESULTS: Participants highlighted several key themes: emotional and social support, information sharing, practical advice, and encouragement. The vast majority of participants (96%) believed peer support would have been beneficial during their treatment journey. However, some expressed concerns about potential negative effects, such as increased anxiety. Preferences were varied, with some preferring one-on-one sessions while others preferring group meetings. Most preferred in-person delivery, and most preferred their peers be matched for relevant demographic and treatment characteristics. CONCLUSION: Peer support holds significant potential for improving the quality of life for HNC survivors, offering both emotional comfort and practical guidance. However, careful program design is needed to address potential drawbacks. Tailored, flexible peer support programs that account for individual preferences and needs may provide the most benefit for this population.