Kinshasa General Hospital is a hospital in Kinshasa, Democratic Republic of Congo. Before the ousting of President Mobutu Sese Seko it was known as Mama Yemo Hospital after the president's mother. The 2000-bed hospital registers over 3,000 consultations daily. It was one of the first places where AIDS was observed.
To map and critically appraise the current literature on Artificial Intelligence (AI) applications in emergency general surgery, with a focus on clinical decision-support tools for preoperative risk stratification and intraoperative assistance, and to identify ethical, structural, and regulatory barriers to implementation. A scoping review was conducted within the ARIES project, following established methodological frameworks. Relevant studies evaluating AI-based tools in emergency surgical settings were systematically identified and analyzed. The literature describes AI applications mainly in two domains: preoperative decision support, including risk prediction and diagnostic or triage models for acute abdominal and traumatic conditions, and intraoperative assistance, largely focused on computer vision–based systems for anatomical recognition, safety guidance, and navigation in minimally invasive emergency procedures. Additional contributions address training and telementoring platforms, as well as cross-cutting ethical, legal, and regulatory considerations relevant to AI adoption in emergency surgical care. AI has the potential to complement emergency surgeons’ clinical judgment, but its routine adoption in emergency surgical practice remains limited. Addressing methodological, ethical, and regulatory challenges, together with the development of robust data infrastructures and targeted training pathways, is essential to support safe, effective, and equitable implementation in acute care settings. In addition, the lack of dedicated investment and sustainable funding models for large-scale clinical implementation and prospective evaluation represents a critical barrier to the translation of AI from research into routine emergency surgical practice.
Background The choice between primary colorectal anastomosis and Hartmann’s procedure in non-elective surgery for complicated acute diverticulitis remains a challenging and highly variable decision. Although primary anastomosis is increasingly supported in selected patients, operative strategy is still influenced by patient physiology, disease severity, intraoperative findings, surgeon judgment, institutional culture, and perceived risk of anastomotic failure. This variability makes complicated diverticulitis a clinically relevant model for exploring whether standardized clinical and intraoperative visual data may support future artificial intelligence-assisted decision-making in emergency surgery. Methods The AIDE/OBS study is an international, multicenter, observational, non-interventional study designed to collect standardized clinical, radiological, operative, surgeon-reported, and intraoperative visual data from adult patients undergoing non-elective minimally invasive surgery for complicated acute diverticulitis, classified according to the WSES CT-based classification. Eligible procedures include laparoscopic or robotic Hartmann’s procedure and sigmoidectomy or left colectomy with primary anastomosis, with or without diverting stoma. Participating centers will collect pseudonymized clinical data through a predefined electronic case report form and submit anonymized intraoperative videos or still images, according to predefined decision-relevant surgical phases. Outcomes The primary outcome is the creation of a standardized, annotated, multimodal clinical-visual dataset suitable for descriptive and exploratory analysis of intraoperative decision-making. Feasibility will be assessed through clinical data completeness, availability of analyzable visual material, surgical phase documentation, proportion of complete multimodal cases, and inter-center variability. Secondary outcomes include clinical, radiological, operative, visual, and surgeon-reported factors associated with primary anastomosis versus Hartmann’s procedure, as well as postoperative outcomes including anastomotic leak, morbidity, stoma creation, reoperation, length of stay, and 30-day mortality. Conclusions The AIDE/OBS study will evaluate whether AI-ready clinical and intraoperative visual data can be collected reproducibly across centers in non-elective minimally invasive surgery for complicated diverticulitis. By creating a structured multimodal dataset, the study may provide the methodological foundation for future machine-learning and computer-vision tools aimed at supporting more explicit, reproducible, and data-informed intraoperative decision-making in emergency colorectal surgery. Trial registration ClinicalTrials.gov Identifier: NCT07651072
Despite the availability of several appendicitis grading systems and ongoing efforts toward standardization, substantial variability persists worldwide in the management of acute appendicitis. Differences are particularly evident in operative approach, stump closure, postoperative antibiotic use and duration, drainage, interval appendectomy after non operative management and follow-up strategies. The PAMAP-W project was designed as a sequential mixed-method study to explore real-world practice patterns and to develop grade-linked expert statements to support clinical and surgical decision-making. The study consisted of two complementary phases. First, an international cross-sectional web-based survey was conducted among surgeons involved in emergency and acute care surgery to assess practices and attitudes regarding appendicitis severity classification and grade-linked management. The questionnaire explored demographics, surgical approach, appendiceal stump management, intra-abdominal lavage and drainage, postoperative antibiotic therapy, and follow-up strategies according to acute appendicitis severity. Second, a Delphi consensus process involving an international expert panel was carried out to review and refine candidate grade-linked management statements derived from areas of heterogeneity identified in the survey. Consensus thresholds were predefined for each Delphi round. A total of 467 surgeons from 64 countries completed the survey, providing an international snapshot of contemporary appendicitis management. Laparoscopy was the preferred approach across all grades, although increasing disease severity was associated with greater variability in operative choices and postoperative management. Considerable heterogeneity was observed in stump closure techniques, use of drainage, duration of antibiotic therapy, and follow-up strategies, particularly in complicated appendicitis. Fifty international experts were invited to participate in the Delphi process, 37 and 33 completed rounds 1 and 2, respectively. Most candidate statements achieved consensus after two rounds, resulting in a set of grade-linked expert statements intended to support more consistent interpretation and management of appendicitis severity. Marked international heterogeneity persists in the intraoperative and postoperative management of acute appendicitis, particularly in complicated disease. The PAMAP-W project combines real-world practice mapping with expert consensus refinement to support a pragmatic, grade-linked framework for clinical and surgical decision-making. The WSES Acute Appendicitis grading system is intended to complement, not replace, formal evidence-based recommendations. Further studies are needed to assess its reproducibility, implementation, and impact on clinical outcomes.
Emergency surgery is characterized by clinical uncertainty, time pressure, evolving information, physiological instability, and substantial variability in available resources. In this setting, adverse outcomes may occur despite timely and appropriate care and should not automatically be interpreted as evidence of professional failure. Nevertheless, surgeons may be exposed to retrospective, outcome-driven, and overly individualized attribution of blame when the complexity of the original decisional environment is insufficiently considered. A structured framework is therefore needed to support fair, proportionate, and learning-oriented accountability in emergency surgical practice. This evidence-informed position paper was developed through a structured multidisciplinary review of literature from patient-safety science, cognitive psychology, medical ethics, health-systems research, surgical professionalism, and high-reliability organization theory, complemented by iterative expert discussion within the World Society of Emergency Surgery–Journal of Medical and Surgical Errors working group. The literature was synthesized narratively to identify the principal contextual, cognitive, ethical, professional, and organizational domains relevant to fair accountability and adverse-event review in emergency surgery. The resulting statements were framed as ungraded evidence-informed Good Practice Statements according to the GRADE framework rather than clinical practice recommendations based on comparative effectiveness evidence. The synthesis identified seven interrelated principles for fair accountability in emergency surgery: contextual proportionality; distinction between accountability and blame; mitigation of hindsight, outcome, and attribution bias; recognition of distributed responsibility across individuals, teams, and systems; protection of professional integrity; procedural fairness and institutional responsibility; and application of high-reliability principles. Particular attention is given to the dynamic and time-dependent nature of emergency surgical decision-making, the incomplete representation of clinical reasoning in contemporaneous documentation, the limitations of population-based scoring systems and benchmarks, and the influence of resource availability on feasible treatment options. These principles were integrated into a structured framework for adverse-event review aimed at supporting proportionate analysis of adverse outcomes and avoiding premature attribution of individual blame when harm reflects interacting clinical, cognitive, team-level, and system-level factors. Accountability in emergency surgery should evaluate decisions according to the information, physiological condition, reasonable alternatives, and resources available at the time of care. Contextualization should not eliminate individual responsibility; rather, it should make responsibility attribution more accurate, proportionate, and fair. A bias-aware, procedurally fair, and high-reliability approach can protect surgeons from premature, punitive, outcome-driven blame while preserving legitimate accountability for unsafe practice, reckless conduct, or misconduct. Such a framework may strengthen patient safety, professional integrity, organizational learning, and public trust.
Background: Preeclampsia (PE) is a pregnancy-specific complication affecting 3 to 8
