BACKGROUND Iatrogenic injury to critical anatomic structures remains a leading source of surgical morbidity, most commonly due to visual misperception rather than technical error. Despite a rapidly expanding ecosystem of intraoperative visualization adjuncts, the surgeon's perspective on current limitations and unmet needs has not been evaluated. The objective of this study was to characterize practicing surgeons' experiences with intraoperative anatomical visualization, the strategies and adjuncts they currently employ, the perceived limitations of available technologies, and the features they would prioritize in future solutions. METHODS Qualitative study using semi-structured one-on-one interviews conducted between September 2025 and March 2026 at a single large academic medical center in the United States. Purposive sampling was used to recruit attending surgeons and fellows representing a range of surgical specialties and levels of experience. Interviews were transcribed and analyzed using a deductive and inductive thematic approach with team-based coding. Data analysis was conducted from October 2025 to April 2026. Outcomes were themes reflecting surgeons' perspectives on intraoperative visualization, current adjunct use, barriers to adoption of new technologies, and features of an ideal solution. RESULTS Nineteen attending surgeons and fellows were interviewed (10 [53%] males; 12 [63%] attendings; median duration of independent practice, 14.7 years [IQR, 12.2-19.0]). Five themes emerged: (1) identification of critical structures as a safety imperative tied to injury avoidance and functional preservation; (2) structural, patient-level, and case-level factors as barriers to visualization; (3) reliance on direct visualization supplemented by intraoperative adjuncts and preoperative planning, with adjuncts perceived as imprecise, workflow-disruptive, or limited in depth and specificity; (4) openness to new technology contingent on trade-offs across safety, intraoperative time, cost, operational feasibility, and training implications; and (5) convergence on two paradigms for an ideal solution: real-time, structure-specific identification within the operative field and dynamic superimposition of preoperative imaging onto the operative field. CONCLUSIONS Findings from this qualitative study suggest that surgeons evaluate new visualization technologies based on more than clinical effectiveness alone. Grounding the development and evaluation of these technologies in surgeons' experiential knowledge, and engaging explicitly with operational feasibility, cost, training, and equity of access, will improve the likelihood that emerging tools translate into improved intraoperative safety.
ABSTRACT Background Postoperative ileus (POI) is a common complication following major abdominal surgery. Currently, limited treatment options for POI exist. Recent preclinical studies show that direct electrical stimulation of the gastrointestinal tract may prevent POI. The aim was to evaluate the safety and feasibility of direct electrical stimulation of the stomach in patients undergoing major abdominal surgery. Method A single‐center, randomized blinded feasibility study conducted at Aarhus University Hospital, Denmark. Patients who underwent cytoreductive surgery with heated intraperitoneal chemotherapy for low‐grade appendiceal mucinous neoplasm or colorectal or appendiceal cancer with peritoneal metastases were eligible. After surgery, a pace lead was attached to the stomach and connected to an external stimulator (Enterra Medical, Minneapolis, USA). Participants were randomized, 1:1, to an intervention group (stimulator on) or a control group (stimulator off). The primary outcome was completion of the intervention as a measure of tolerability. Results Of 63 eligible patients, 27 consented to participate (43%). Seven patients were excluded perioperatively. Twenty patients were randomized. Nineteen patients were eligible for analysis, 10 in the intervention group and 9 in the control group. The treatment was well tolerated. The completion rate was 8/10 in the intervention group and 9/10 in the control group. Abdominal muscle spasms were the most common adverse events reported in both groups. Conclusion Electrical stimulation appears safe, feasible and well tolerated. This study supports further clinical studies on electrical stimulation as prevention of POI. Trial Registration The study was registered at ClinicalTrials.gov (NCT05752071)
ABSTRACT Introduction Positive margins following breast‐conserving surgery (BCS) remain a common cause of re‐operation. Image‐guided localization techniques may reduce margin positivity at index wide local excision (WLE), but their influence on re‐operation outcomes is less well defined. Our objective was to evaluate the association between index localization method and margin positivity and to assess re‐operation pathology and operative outcomes following positive margins in BCS. Methods A retrospective cohort study was conducted at a single breast unit including women undergoing re‐operation for positive margins following index WLE between January 2020 and January 2025. Patients were stratified by index localization: none, wire, or radio‐frequency identification tag (RFID). Localization groups were pooled for comparison with non‐localized cases. Primary outcomes were margin involvement pattern at index surgery and residual tumor at re‐excision. Secondary outcomes included re‐operation type, operative duration, interval to re‐operation, and adjuvant radiotherapy. Results Among 524 index WLEs, 72 patients (13.7%) underwent re‐operation for positive margins. Margin positivity was higher in non‐localized cases compared with localized cases (18.6% vs. 10.6%; p = 0.013; OR 0.52, 95% CI 0.31–0.85). Among re‐operated patients, margin involvement patterns, re‐operation strategy, residual tumor rates (39.5% vs. 55.9%; p = 0.238), operative duration, and time to re‐operation were similar between groups. All re‐operations were performed as day‐case procedures without complications. Conclusions Localization at index WLE is associated with lower rates of positive margins, reflecting case selection. However, localization does not significantly influence re‐operation pathology or operative outcomes once margin positivity occurs.
