Background Whole-body computed tomography (WBCT) is frequently used in trauma, though its value in stable patients remains uncertain. We examined WBCT use after motor vehicle collision (MVC) and whether trauma center designation and American College of Surgeons Committee on Trauma (ACS-COT) verification were associated with imaging practices. Methods Using 2018–2021 Trauma Quality Improvement Program (TQIP) data, we identified adults aged 18–65 with blunt MVC who were stable (systolic blood pressure ≥ 100 and Glasgow Coma Scale 15) and received a CT scan. WBCT was defined as head, chest, and abdomen CT within 2 h of admission; selective CT (SCT) covered fewer than all three regions. Temporal trends by state-designated trauma level and ACS-COT verification were assessed using Cuzick's nonparametric test, and multivariable logistic regression identified factors associated with WBCT use. Results Among 288,264 stable MVC patients receiving CT, 78,796 (27.3%) underwent WBCT, and 209,468 (72.7%) SCT. WBCT utilization declined at ACS-verified (31.9 to 30.2%) and non-verified centers (22.0 to 18.4%), and at Level I (29.1 to 27.1%) and Level II (28.5 to 26.9%) facilities (all nptrend <0.001), with consistent declines across Injury Severity Score strata. After adjustment, ACS verification was associated with higher odds of WBCT (AOR 1.96, 95% CI 1.92–2.00), whereas non-profit or government ownership (AOR 0.55, 95% CI 0.54–0.57) was associated with lower odds. Conclusions In stable MVC patients, WBCT utilization declined from 2018 to 2021 across trauma levels and verification strata, while institutional characteristics remained strongly associated with WBCT.
Objective To identify factors associated with prolonged hospital stay after appendectomy for acute appendicitis in a Peruvian public hospital. Methods We conducted a retrospective case-control study of adults who underwent appendectomy for acute appendicitis at Hospital Jesús Nazareno, Ayacucho, Peru, between January 2021 and December 2024. Cases had a hospital stay of ≥5 days, corresponding to the 75th percentile of the institutional distribution, and controls had a stay of <5 days. From 96 eligible cases and 288 eligible controls, 73 patients from each group were selected by simple random sampling. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression. Results Median hospital stay was 6.0 days (IQR, 5.0–9.0) among cases and 2.0 days (IQR, 2.0–3.0) among controls. Complicated appendicitis was more frequent among cases than controls (97.3% vs. 27.4%), as was surgical site infection (38.4% vs. 1.4%). After multivariable adjustment, complicated appendicitis (adjusted OR, 38.62; 95% CI, 7.78–191.82) and surgical site infection (adjusted OR, 9.58; 95% CI, 1.14–80.55) remained associated with prolonged hospital stay. Conclusion Complicated appendicitis and surgical site infection were associated with prolonged hospital stay after appendectomy. Because the timing of surgical site infection onset was not captured, its temporal relationship with prolonged stay cannot be established. Timely management of complicated appendicitis and adherence to perioperative infection-prevention practices may help reduce prolonged hospitalization.
Tibialis anterior tendon (TAT) ruptures are uncommon and may occur acutely or present in a chronic, neglected form. Chronic ruptures, generally defined as those present for more than four weeks, are frequently associated with tendon retraction, degenerative stump tissue, and a segmental defect that precludes primary end-to-end repair. Established reconstructive options include tendon transfer, autograft interposition, and allograft interposition, each carrying trade-offs in donor site morbidity, tissue availability, and cost. We describe reconstruction of a chronic insertional TAT rupture in a 68-year-old male using a degradable synthetic polycaprolactone-based polyurethane urea matrix (FlexBand; Artelon, Inc., Marietta, GA, USA) secured to the medial cuneiform with two bone anchors and sutured to a debrided and lengthened proximal tendon stump. At final documented follow-up of 12 weeks, the patient ambulated without foot slap or compensatory gait deviation, with dorsiflexion and plantarflexion clinically symmetric to the contralateral limb and no restriction in activities of daily living. This report describes the technical feasibility of the approach.
Background Near-infrared autofluorescence (NIRAF) enhances parathyroid gland (PG) identification during thyroidectomy. However, its identification rate is frequently affected by false-positive and false-negative results. Methods This prospective cohort study enrolled 50 patients scheduled for endoscopic thyroidectomy, employing a 1:1 case-matched design. The patients were assigned to an experimental group (NIRAF group; n = 25) and a control group (Non-NIRAF group; n = 25). Results In the NIRAF group, levels of parathyroid hormone (PTH) on the first postoperative day (P = 0.002) and at the first postoperative month (P = 0.04), as well as serum calcium levels at the first month, were significantly higher than those in the Non-NIRAF group (P = 0.03). The sensitivity and specificity of NIRAF for identifying PGs were 80% and 84%, respectively. A higher body mass index (BMI) was associated with an increased incidence of false negatives (P = 0.07). Four false-positive events were recorded, originating from a thyroid nodule, thymus, adipose tissue, and a lymph node. Conclusion NIRAF is a highly sensitive navigation tool that effectively improves PG preservation and postoperative outcomes. Nevertheless, its diagnostic accuracy is challenged by false positives from heterogeneous tissues and false negatives driven by anatomical barriers like excessive fat.
Background:Contemporary national data on inpatient appendectomy practice remain limited. We evaluated recent trends in appendectomy utilization and operative approach among patients hospitalized with appendicitis and examined patient- and hospital-level factors associated with operative management and inpatient outcomes. Methods:We performed a retrospective cross-sectional study of the National Inpatient Sample from 2016 to 2022. Hospitalized patients with appendectomy procedures were identified using ICD-10 codes. Operative approach was categorized as open, laparoscopic, or robotic. Weighted analyses and multivariable regression evaluated utilization, approach, length of stay, and adverse discharge. Results:Among 1,035,444 appendicitis hospitalizations, appendectomy utilization declined from 88.8% in 2016 to 82.2% in 2022 (p < 0.001). Among 889,289 appendectomy cases, laparoscopic appendectomy was performed in 90.2% overall and increased to 92.3% by 2022, while open appendectomy declined from 12.4% to 5.9%. Robotic appendectomy increased from 80 to 1900 during study period, (OR 47.02, 95% CI 23.72-93.22). Hispanic patients had slightly higher odds of appendectomy (OR 1.02, 95% CI 1.02-1.03), whereas Black patients (OR 0.94, 95% CI 0.93-0.95) and patients aged ≥65 years (OR 0.85, 95% CI 0.83-0.86) had lower odds. Rural hospitals had lower odds of laparoscopic (OR 0.92, 95% CI 0.91-0.92) and robotic (OR 0.03, 95% CI 0.02-0.03) approaches. Black race and ECI ≥5 were associated with longer length of stay, while older age, Black race, Medicare insurance, and ECI ≥5 were associated with adverse discharge. Conclusions:Appendectomy utilization declined while laparoscopy remained dominant, open surgery decreased, and robotic use increased but remained uncommon. These findings provide a national descriptive framework for future clinically granular studies of appendicitis management.
Surgical Preference Cards (SPCs) have traditionally been regarded as tools for standardizing surgical procedures, optimizing resource utilization, and improving operating room efficiency. Consequently, their educational value has received relatively little attention. However, emerging evidence suggests that SPCs can improve clinical performance, self-efficacy, clinical skills, and competence while reducing anxiety among operating room students. Drawing on Cognitive Load Theory and educational scaffolding, we argue that SPCs have the potential to serve as cognitive supports that facilitate learning in the complex operating room environment. We propose that SPCs should be recognized not only as resource management tools but also as educational resources and advocate for their integration into operating room curricula and digital educational repositories.
Introduction:Laryngeal complications (LC) or dysphagia are often underdiagnosed among those undergoing cardiac surgery. With conflicting reports on the relevance of LC, we characterized the prevalence, risk factors, and outcomes of this complication in a national cohort of older adults receiving cardiac surgery across the U.S. Methods:Adults (≥65 years) receiving coronary, valvular and proximal aortic operations were tabulated from the 2016-2022 Nationwide Readmissions Database. Patients were stratified by the concomitant diagnosis of LC. Mixed regression models were developed to identify the association of LC with outcomes of interest. Results:Among 1,092,639 patients, 1.6% comprised LC. Compared to others, LC patients were older (74 Interquartile Range [IQR]: [70-79] vs 72 years [68-77], P < 0.001), more frequently female (31.9 vs 30.1%, P < 0.001) and insured by Medicare (88.6 vs 86.8%, P < 0.001).Following risk adjustment, LC was associated with greater odds of mortality (Adjusted Odds Ratio [AOR] 1.23, 95% Confidence Interval [CI] 1.06-1.55), respiratory (AOR 1.72, 95% CI 1.61-1.83), and infectious complications (AOR 1.51, 95% CI 1.41-1.62). LC was also associated with greater length of stay (β +5.43 days, 95% CI 5.09-5.78), hospitalization costs (β + $17,600, 95% CI 16,100-19,100), and 30-day non-elective readmission (AOR 1.30, 95% CI 1.22-1.39). Conclusions:LC appears to be associated with increased mortality, postoperative complications, and 30-day readmissions. Furthermore, LC is linked with an incremental increase in length of stay and hospitalization expenditures. While causality could not be established, our findings suggest the relevance of early detection and potential interventions to mitigate sequelae of LC in older patients.
Purpose This study examines the relationships between formal and informal gender bias and burnout among surgeons, and it assesses whether job satisfaction mediates these associations differently for women and men. We conducted a nationwide survey of practicing surgeons in Korea, and the primary exposures were experiences of formal gender bias (e.g., hiring, pay, promotion, and leadership opportunities) and informal gender bias (e.g., exclusion from networks, limited access to resources, and derogatory or gendered comments). Key outcome variables were overall job satisfaction and burnout. Analyses were stratified by gender, and mediation models were used to explore indirect pathways through job satisfaction. Results Women surgeons reported substantially higher exposure to formal (62.5% vs. 11.3%) and informal (83.9% vs. 19.2%) gender bias than men. For both women and men, formal gender bias was associated with lower job satisfaction, and the relationship between formal gender bias and burnout appeared to operate indirectly through job satisfaction. Informal gender bias was also associated with lower job satisfaction for both genders. For men, informal gender bias retained a direct positive association with burnout after accounting for job satisfaction, while for women the association between informal gender bias and burnout was consistent with an indirect pathway through job satisfaction. Conclusions Gender bias is strongly linked to burnout among surgeons, operating largely through job satisfaction but with important gender-specific differences. Organizational strategies that enhance equity and job satisfaction may reduce burnout, while targeted efforts to address informal, interpersonal bias are needed to further mitigate burnout risk.
Magnetic resonance imaging (MRI) aids in detecting infiltrative growth; however, preoperative determination of the extent of soft-tissue sarcoma (STS) infiltration remains challenging. Ultrasonography could also detect infiltration effectively. We investigated the usefulness of MRI and ultrasonography as preoperative assessments for infiltrative STS. We retrospectively evaluated the data of 24 patients with subcutaneous infiltrative STS. Infiltrative length was measured using gadolinium-enhanced fat-suppressed T1-weighted imaging (GdFsT1) (M-IL) and ultrasonography (U-IL). The reactive layer was set at a greater distance of M-IL or U-IL. The surgical margin was set at greater distance of 2 cm from the tumor edge or 1.5 cm beyond the reactive layer. Histological infiltrative length (H-IL) and histological surgical margin length (H-margin) were measured using specimens. Relationships among M-IL, U-IL, and H-IL were analyzed using Spearman's rank correlation coefficients. Clinical outcomes, such as overall survival (OS) and local recurrence (LR), were evaluated using the Kaplan-Meier method. In 19 of 64 directions, H-IL was wider than M-IL. Among the 19 directions, U-IL was wider than H-IL in 11 directions, whereas H-IL was wider than U-IL in 8 directions. Mean H-margin was 29 mm, and the margin was negative in all directions. Spearman's correlation revealed weak associations between H-IL and M-IL (ρ = 0.08, p > 0.05) and H-IL and U-IL (ρ = 0.16, p > 0.05). The 5-year LR and OS were 91% and 87.5%, respectively. GdFsT1 alone underestimated STS infiltration. Combined MRI and ultrasonography represent a feasible approach for preoperative assessment and aids in achieving margin-negative resection for subcutaneous STS.
Background:Robotic-assisted liver surgery (RALSs) has numerous advantages over laparoscopic and open procedures. However, prior abdominal surgeries (PAS) are frequently considered as constraints for RALSs. Our study evaluated the impact of PAS on the intraoperative course and postoperative outcomes after RALSs. Materials and methods:For this retrospective cohort study, clinicopathological data were collected from all patients who underwent RALSs at the University Hospital Münster between December 2018 and March 2024. Patients were stratified based on whether they had undergone PAS or not (NPAS), the intraoperative course and postoperative outcomes after RALSs were analyzed. Results:In total, 116 patients were identified, 79 patients had undergone PAS, and 37 patients had not. The mean surgery time, conversion rate, intraoperative complications, postoperative intensive care unit (ICU) admissions and length of hospital stay (LOS) were comparable between the two groups. Forty-three patients had postoperative complications, without significant difference (PAS: 34 patients, NPAS: 9 patients). No deaths were observed within 30 days of surgery. One PAS patient died within 90 days of surgery. Discussion:Perioperative outcomes in patients undergoing RALSs were comparable in between PAS and NPAS patients and PAS was not associated with an increased risk of postoperative complications. PAS alone should not be considered as contraindication for RALSs.
Background Two-stage pancreatojejunostomy (PJ) after pancreatoduodenectomy (PD) is one of the methods available for minimizing the possibility of grade C postoperative pancreatic fistula (POPF), especially in patients with a soft pancreatic consistency. Methods We studied 131 patients with a soft pancreatic texture who underwent initial PD without PJ. The pancreatic tube was exteriorized through the abdominal wall incision. Three months later, we performed PJ, except for four patients died of recurrence. The remaining 127 patients underwent two-stage PJ. To assess the changes in pancreatic consistency after PD, computed tomography (CT) attenuation of the pancreas was measured before PD and compared with that after PD in 36 patients. Results After initial PD, none of the patients suffered grade C POPF and postoperative mortality was zero. After the second operation, none of the patients suffered grade C POPF. One patient died due to recurrence of cancer. There was no mortality attributable to any adverse effect of POPF. The postoperative mortality rate was 0.7%. At the time of two-stage PJ, surgeons confirmed that texture of the remnant pancreas had changed from soft to hard. CT attenuation of the remnant pancreas before PJ was significantly lower than that of the pancreas body before PD (32.3 ± 10.0 vs. 40.5 ± 8.2, p < 0.001). Conclusion Two-stage PJ can be considered to minimize likelihood of grade C POPF. The changes in CT attenuation before PD and before PJ provide objective confirmation of a change in pancreatic texture from soft to hard, thus largely accounting for the reduced incidence of fatal POPF.
Temporal artery biopsy (TAB) for suspected giant cell arteritis (GCA) represents an infrequent but important inpatient consultation for acute care surgery (ACS) services. Given the morbidity associated with delayed treatment, corticosteroids are often initiated before biopsy, raising questions about the diagnostic utility and impact of TAB in contemporary practice. We performed a review of all inpatient TABs completed by an ACS service at a tertiary center between March 2015 and January 2024 to characterize case volume, pathology results, and influence of biopsy findings on corticosteroid management.Sixty-four patients underwent TAB, the majority of whom were elderly and female, with visual symptoms and headache being the most common presenting complaints. Nearly all patients were initiated on high-dose corticosteroids prior to biopsy, with a median of two days between ACS consultation and procedure. Pathologic findings confirmed GCA in 10% of cases, with additional biopsies demonstrating intimal fibroplasia or equivocal inflammatory changes. Despite widespread steroid initiation, biopsy results influenced discharge management, as patients with negative pathology were more likely to undergo corticosteroid tapering prior to or shortly after discharge. The median American College of Rheumatology 1990 classification score was three, with just over half of patients meeting criteria for GCA. No TABs were performed during 2020, but biopsy volume increased substantially in the post-COVID period.These findings suggest that ACS services play an important role in the diagnostic evaluation of suspected GCA. Although corticosteroid therapy is frequently initiated prior to biopsy, TAB continues to yield clinically meaningful information that informs subsequent management decisions.
Introduction:Acute Care Surgery (ACS) surgeons care for a wide variety of life-threatening surgical conditions and have a high burden of night and weekend calls. Maintaining current knowledge of published literature is increasingly challenging. This study aims to describe motivations and methods used by ACS surgeons to stay current with published literature. We focused on how ACS surgeons acquire new information and apply it in practice, their views on the effectiveness, efficiency, and potential bias of their methods, and their perspectives regarding future knowledge acquisition methods. Methods:A prospective qualitative semi-structured interview study was performed. Informed consent was obtained from purposively recruited participants: ACS surgeons practicing in the United States. Interviews continued until theme saturation. Reflexive inductive thematic analysis was used to generate qualitative results. Results:Thirteen interviews were conducted, averaging 27.3 min each. Participant interviews revealed several motivations for remaining current with published literature: problem-based literature review, self-promotion, curiosity, job performance, and job satisfaction. Participants used various strategies to identify and access new literature, including academic and non-academic sources. Barriers included paywalls, time constraints, and information overload. Facilitators included user-friendly interfaces and working at an academic institution. Participants provided insights into their effectiveness, efficiency, and biases and were wary of artificial intelligence processes that may reinforce bias. Participants unanimously desired more efficient methods when asked how literature acquisition may improve in the future. Conclusions:ACS surgeons are motivated to stay current with published literature. Current barriers and facilitators were identified, and participants desired more efficient methods to stay current.
Objective:This study aimed to identify and quantify systematic cognitive differences between clinical faculty and surgical residents regarding core competency requirements in standardized residency training, using the Entrustable Professional Activities (EPA) framework, and to provide evidence for optimizing competency-based training curricula. Methods:A multicenter cross-sectional anonymous online questionnaire survey was administered in March 2025 to 42 supervising faculty and 68 surgical residents across three training bases in Guizhou Province. The questionnaire was developed in accordance with the 2022 Edition of the National Standards and Contents for Residency Training in China, covering 100 EPA items across five subspecialties: neurosurgery, general surgery, urology, orthopedics, and anesthesiology. Participants rated the importance and necessity of each item using a 4-point Likert scale. Reliability was evaluated using Cronbach's α and intraclass correlation coefficient (ICC). Group differences were analyzed via independent-samples Mann-Whitney U tests, with Cohen's d for effect size, and inter-rater consistency was assessed using Kendall's W. Results:A total of 110 valid questionnaires were recovered (valid response rate: 93.2%). The overall Cronbach's α was 0.951, and the test-retest ICC was 0.89, indicating excellent reliability. High consistency (> 90%) was observed between faculty and residents for general surgery and neurosurgery EPAs. Among 19 orthopedic EPAs, 10 items showed significant differences (P < 0.05), with Cohen's d ranging from 0.82 to 1.55; residents consistently rated these items higher than faculty. For three anesthesiology items related to "Life Monitoring and Resuscitation," faculty scored a mean of 4.00 ± 0, whereas residents scored 3.36 ± 1.03 (d = 0.98, P < 0.01). Kendall's W ranged from 0.10 to 0.17, indicating weak overall consistency. Both groups emphasized strengthening training in soft skills, including medical documentation and physician-patient communication. Conclusion:Systematic discrepancies exist between faculty and residents in perceptions of orthopedic procedural skills and anesthetic safety during surgical residency. To address this gap, unified entrustment benchmarks, integrated assessable soft-skill training, and continuous formative feedback should be prioritized to improve competency-based surgical residency education.
Objectives:Intraoperative CT-based navigation (iCT) is increasingly used in complex spine surgeries. We examined the impact of this technology on interprofessional work in the operating room (OR). Methods:Single-site qualitative study. We interviewed surgeons, anesthesiologists, and nurses involved in spine surgeries with iCT. We modeled the work system using the SEIPS framework and conducted inductive content analysis. Results:We interviewed 20 professionals. All participants agreed on the benefits of iCT for surgical outcomes. However, it came with ergonomic challenges. The imaging system is a large piece of equipment. Its installation in a preexisting OR resulted in limitations of movements around the patient and in the room. Anesthesiologic and surgical teams required additional time to discuss patient positioning and ensure sufficient space for everyone, as well as adequate access to airways for anesthesiologists and anesthesia nurses. With the new technology also came new tasks. Surgeons usually managed the initial image acquisition, but to avoid desterilization during the procedure, nurses also had to learn to use the equipment. Permanent staff members progressively developed expertise; however, with high turnover among nurses and the use of agency staff, it proved difficult to ensure that surgical nurses were consistently trained in the use of the equipment. Over time, anesthetic and surgical teams adjusted their practices to balance the surgical benefits of the technology with ergonomic concerns. Conclusion:Implementing iCT can disrupt work systems and requires careful consideration of human and organizational factors in the OR to ensure patient safety. Multicentric studies would be needed.
Background/hypothesis:Preoperative planning software has gained traction in shoulder arthroplasty, enabling surgeons to better visualize patient's anatomy and optimize implant positioning. Widespread adoption of such tools depends not only on their efficacy but also on surgeon satisfaction and perceived utility in day-to-day practice. However, data on surgeons' satisfaction and perceived utility of such software remain limited. This survey aimed to evaluate surgeons' overall satisfaction, perception and the willingness to recommend the software as a training tool for fellows. Materials and methods:A retrospective observational survey was conducted to evaluate overall satisfaction and usage patterns among orthopedic surgeons using pre-operative 3D planning software (Blueprint®). All surgeons were contacted via email with a web-based questionnaire. Reponses were analyzed with descriptive statistics to assess overall surgeon satisfaction, level of agreement with predefined statements, likelihood of future use and willingness to recommend the software to others. Results:The web-based questionnaire was distributed to 1100 orthopedic surgeons between September 30, 2024, and November 11, 2024. 312 responses were received, of which 273 were evaluable responses. Most respondents were low-volume or medium-volume surgeons, and high-volume surgeons were underrepresented (<7.7%). 270 responses were collected from surgeons evaluating their overall satisfaction, with 97% of the feedback being positive. 96% of surgeons said the planning software boosted their confidence in their preoperative plan and 33% during surgery, and 86% reported lower stress compared to performing the procedure without it. Conclusions:This survey suggests that pre-operative 3D planning software (Blueprint®) is a well-received digital solution in shoulder arthroplasty, with perceived benefits regarding surgical planning, surgeon's stress level, confidence and training.
Background: Although research on the gut microbiota and cholangiocarcinoma has developed rapidly in recent years, and the gut microbiota plays an important role in cholangiocarcinoma, there is currently a lack of comprehensive and objective understanding of the latest progress and future research directions in this field. This study comprehensively evaluated and visually analyzed this research area based on bibliometric methods. Methods: This analysis used tools such as the “Bibliometrix” R package, VOSviewer, CiteSpace, and Microsoft Office Excel (2019 version) to comprehensively conduct a bibliometric analysis of scientific research outputs related to the gut microbiota and cholangiocarcinoma. The data analyzed were all sourced from the Web of Science Core Collection (2009–2025). Results: A total of 124 research achievements published from 2009 to 2025 were included. Eight hundred and ninety-six researchers from 278 institutions in 37 countries/regions participated in the research on the gut microbiota and cholangiocarcinoma. The number of global publications has steadily increased, reaching a peak in 2024. China had the most publications and citations, followed by Italy and the United States. The University of Oslo, Khon Kaen University, and Università degli Studi di Palermo were the main institutions in this research area and made important contributions. Cancers, International Journal of Microorganisms, and Microorganisms were the most relevant journals in this research area. DI CARLO P, GIAMMANCO A, and SERRA N were the most relevant authors in this research area and made important contributions. The latest frontier research direction focuses on “metabolism”, aiming to further explore the pathogenesis of cholangiocarcinoma through the gut microbiota and to find new therapeutic approaches. Conclusion: This study comprehensively summarized the development of research on the gut microbiota and cholangiocarcinoma from 2009 to 2025. The research results revealed the latest research frontiers and hotspots in this field and provided valuable insights for future research. However, it should be noted that although WoSCC is a widely recognized and authoritative database, it may have limitations in terms of regional bias, language coverage, and metadata accuracy, which may affect the comprehensiveness of our analysis.
Objective:This study aimed to compare perioperative outcomes between minimally invasive lower median sternotomy (LMS) and conventional full median sternotomy (FMS) in patients undergoing isolated aortic valve replacement (AVR). Methods:This retrospective cohort study enrolled 41 patients who underwent isolated AVR (25 via LMS, 16 via FMS). Patient demographics, intraoperative data, and early postoperative outcomes were analyzed and compared between the two groups. Results:The two groups were comparable in terms of baseline characteristics. There were no significant differences in intraoperative metrics, including operation time (LMS 238.6 ± 45.3 vs. FMS 264.9 ± 77.7 min, P = 0.177), cardiopulmonary bypass time (145.5 ± 41.6 vs. 140.9 ± 27.7 min, P = 0.700), and aortic cross-clamp time (116.4 ± 32.9 vs. 111.6 ± 23.1 min, P = 0.609). No red blood cell or plasma transfusion was required in either group. Postoperatively, there were no 30-day deaths or severe adverse events. The lengths of hospital stay (7.5 ± 3.6 vs. 7.6 ± 4.0 days, P = 0.972), ICU stay (1.9 ± 1.1 vs. 2.2 ± 1.0 days, P = 0.366), and mechanical ventilation time (12.5 ± 5.9 vs. 12.6 ± 5.3 h, P = 0.954) were similar between the two groups. Patient satisfaction with scar appearance was significantly higher in the LMS group than in the FMS group (92.0% vs. 37.5%, P = 0.001). Conclusion:LMS for isolated AVR represents a safe and feasible minimally invasive alternative to conventional FMS, with equivalent intraoperative efficiency and early postoperative safety profiles, and offers superior cosmetic outcomes. LMS offers a viable minimally invasive option without compromising procedural outcomes.
