A recent General Surgery digest,
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Study Type: Retrospective single-dataset predictive modelling study (machine learning, cross-validated); no external validation reported.

Key Question: Do task-level kinematic performance indicators add predictive value beyond preoperative clinical variables for surgeon experience, case complexity, and outcomes in robotic cholecystectomy?

Key Findings:

• Kinematic indicators alone matched combined models for surgeon experience (AUROC 0.967 vs 0.964) and case complexity (0.791 vs 0.792), and outperformed clinical variables alone.
• For outcomes, the combined model performed best but gains were modest (AUROC 0.753 vs 0.720 for either single modality; P=0.015 and 0.005).
• Kinematic features contributed 90.7%, 73.3% and 51.7% of SHAP value for experience, complexity and outcomes respectively.

Clinical Relevance: Supports the potential of automated robotic performance metrics for objective trainee assessment, though outcome prediction remains too weak for clinical use as the NHS expands robotic cholecystectomy and training.

Limitations: Small, single-source retrospective sample (234 dissections, only 36 by trainees) without external validation, and the outcome endpoint is not defined in the abstract.

Study Type: Single-centre, two-phase cohort study (retrospective development, prospective validation).

Key Question: Can a simple endoscopic classification of fundoplication integrity predict pathologic reflux after antireflux surgery?

Key Findings:

• Three retroflexed-view parameters correlated with pathologic GERD (Lyon 2.0): intrathoracic valve, disrupted valve, and visible hiatus.
• Pathologic GERD rose stepwise with the number of impaired mechanisms (0 to 3): 11.8%, 37.5%, 85.7%. Symptoms, manometric features, and reflux burden worsened in parallel.
• AUC for discriminating pathologic GERD was 0.860 (development, n=73) and 0.870 (validation, n=49).

Clinical Relevance: Endoscopy is already routine in assessing post-fundoplication symptoms, so a simple three-item score could help triage which patients need physiology testing or revisional surgery assessment, particularly where access to HRM and pH monitoring is limited.

Limitations: Small single-centre cohort (n=122) with a modest validation set and no reported inter-observer agreement, limiting generalisability to routine practice.

Study Type: Qualitative study (semistructured interviews, n=17, purposive and snowball sampling; US)

Key Question: How do LGBTQ+ general surgery residents navigate identity disclosure and assess psychological safety when applying through the residency Match?

Key Findings:

• Applicants disclosed identity strategically, either as a "litmus test" to filter for affirming programmes or concealed it, fearing it would reduce their chance of being ranked.
• Psychological safety was judged from subtle cues (pronouns, pride symbols), the tone and manner of responses to LGBTQ+-related questions, and visible LGBTQ+ resident/faculty representation.
• Applicants used geography and regional sociopolitical climate as a proxy for acceptance.

Clinical Relevance: Although set in the US Match, the findings may inform inclusive recruitment and selection practice for UK surgical training and consultant-led interview panels, where EDI and workforce retention are priorities.

Limitations: Small, predominantly White sample of current residents (selection and survivor bias), with US-specific context limiting transferability to UK training pathways.

Study Type: Qualitative study (semistructured focus groups and individual interviews, thematic analysis). Sample size not reported in the abstract.

Key Question: What are female general surgery trainees' and recent graduates' experiences of pregnancy loss during training, and what gaps exist in programme support?

Key Findings:

• Pregnancy loss had pervasive mental health, physical and professional impacts on participants.
• Five barriers to seeking support were identified: burden to colleagues, privacy concerns, reputation concerns, guilt and isolation, and training rigidity. Facilitators were fewer but described as highly beneficial.
• Themes informed proposed components of a pregnancy loss policy aimed at reducing stigma, supporting well-being and limiting attrition.

Clinical Relevance: UK training programmes and NHS trusts face similar workforce retention pressures, so these findings could inform deanery and departmental policy on compassionate leave, flexibility and confidential support for surgical trainees.

Limitations: Participants were self-selected via social media and all US-based surgeons (apparently), limiting transferability, including to the UK training context; the abstract does not report sample size.

Study Type: Retrospective cohort study (trauma registry linked to consumer credit reports; 29 US Level I/II trauma centres, 20,613 patients)

Key Question: Does the treating hospital independently influence the medical debt patients accrue after acute traumatic injury?

Key Findings:

• Mean change in medical debt in collections was $314 (SD $3,464) from baseline to months 9-18 post-injury.
• After risk adjustment, 4 hospitals (14%) were high outliers (+$365 to +$566 per patient versus expected) and 4 (14%) were low outliers (−$292 to −$676).
• Low-outlier hospitals treated younger, lower-income, higher-risk patients, and results were robust to sensitivity analyses.

Clinical Relevance: Although set in the US insurance-based system and not directly transferable to the NHS, it shows that institutional administrative practices can drive patient financial harm independently of clinical factors, which is relevant to UK discussions of indirect costs of injury (lost income, out-of-pocket expenses).

Limitations: Debt in collections is a crude proxy for financial hardship, and the cohort (mean age 63, 82% non-Hispanic White, single state) limits generalisability; the specific hospital practices driving variation were not identified.

Study Type: Retrospective analysis of a prospectively maintained database (single-centre, 2010–2024)

Key Question: Does liver transplantation (LT) offer durable oncologic benefit over liver resection (LR) in combined hepatocellular-cholangiocarcinoma (cHCC-CCA), and which factors predict recurrence?

Key Findings:

• LT (n=79) outperformed LR (n=32) at 5 years: OS 89.9% vs 65.6% (P=0.007); RFS 84.8% vs 53.1% (P=0.001). The benefit persisted within UCSF criteria.
• 5-year OS after LT for cHCC-CCA was comparable to HCC (89.9% vs 86%, P=0.721).
• In LT recipients, macrovascular invasion (HR 25.01) and poor differentiation (HR 7.29) independently predicted recurrence.

Clinical Relevance: Suggests cHCC-CCA need not be an absolute transplant contraindication in selected patients, which is relevant to UK transplant centres and MDT discussions, although diagnosis is rarely certain pre-transplant.

Limitations: LT diagnoses were made on explant, and selection bias is likely given the non-randomised design; the LT and LR cohorts were probably not comparable at baseline, and the abstract reports no adjustment for this.

Study Type: Target trial emulation (retrospective national database cohort, IPTW-adjusted), French discharge data 2014-2023.

Key Question: In resectable synchronous rectal cancer liver metastases, does combined rectal and liver resection differ from staged resection in morbidity and survival?

Key Findings:

• Of 1872 eligible patients, 73% had combined and 27% staged resection. Severe complications (Clavien-Dindo ≥III) were 39.7% vs 45.3% (adjusted OR 0.82, 95% CI 0.58-1.16); 30-day mortality was 1.8% vs 1.5%.
• Overall survival was comparable: median 52.4 vs 57.3 months (adjusted HR 0.88, 95% CI 0.65-1.19), consistent across landmark analyses.
• Major hepatectomy independently increased severe complications (adjusted OR 1.81, 95% CI 1.06-3.08).

Clinical Relevance: This supports MDT-led individualisation of sequencing in UK practice, with the complexity of the liver resection, rather than the combined approach itself, being the main driver of morbidity.

Limitations: Administrative data lack oncological detail (e.g., stage, metastatic burden, neoadjuvant therapy, margin status), so residual confounding and selection bias remain likely despite IPTW.

Study Type: Systematic review and meta-analysis (23 studies, including 4 RCTs; 2,845 patients, 1,154 with ICG assessment)

Key Question: Does intraoperative ICG fluorescence angiography reduce anastomotic leakage and other postoperative complications after oesophagectomy?

Key Findings:

• ICG use was associated with lower anastomotic leakage (OR 0.44, 95% CI 0.29–0.65; NNT 13) and conduit necrosis (OR 0.32, 95% CI 0.12–0.85).
• No significant differences in mortality (OR 1.43, 95% CI 0.69–2.97), reoperation (OR 0.84, 95% CI 0.51–1.39), severe leak, overall morbidity, readmission, operating time, or length of stay.
• GRADE certainty was low or very low for all outcomes.

Clinical Relevance: ICG is a low-cost adjunct that may reduce leak rates in UK oesophagectomy practice, but the evidence is not yet strong enough to mandate routine use or to justify claims of improved survival or reduced reoperation.

Limitations: Most included studies were observational, and ICG assessment remains qualitative and operator-dependent, so confounding and heterogeneity limit confidence in the effect estimates.