BACKGROUND:Operating room turnover time is a major source of perioperative inefficiency affecting patient care, staff satisfaction, and institutional revenue. A multidisciplinary, collaborative approach to turnover time reduction is required to improve perioperative quality. METHODS:Surgeons, anesthesiologists, nurses, and perioperative leadership collaborated to develop 2 efficiency interventions. The "Showtime" initiative established a service-specific set-time for a surgical and anesthesia representative to meet in preoperative holding for the operating room's next patient. The "Intentional Rounding" initiative included the charge nurse performing room-to-room morning rounds to proactively identify and mitigate turnover time efficiency issues for the day. These interventions were initiated across the neurosurgery, orthopedics, otolaryngology, and transplant/hepatobiliary service lines within an academic medical center. RESULTS:Implementation of the Showtime and Intentional Rounding initiatives resulted in an average reduction in turnover time of 10.5 minutes (20%) across all service lines. Improvement was noted across each service line, with improvement times ranging from 7 to 22 minutes (17% to 32% improvement, respectively), as well as the ability to sustain higher monthly case volumes. An expected 440 hours of turnover time was recovered during the study period, associated with an estimated savings of $361,419 in direct "empty operating room" costs recovered over the 20-month study period (around $18,000/mo). CONCLUSION:Two multidisciplinary perioperative interventions focused on improving operating room turnover time efficiency resulted in a systemwide 20% reduction in average turnover time at an academic medical center, with estimated cost savings of more than $18,000 per month. These interventions are sustainable, low resource-intensive, and reproducible across multiple service lines.

This study describes our institutional experience with robotic hepatectomy, analyzes trends, and evaluates intraoperative and postoperative outcomes stratified by IWATE-defined procedural difficulty. Retrospective cohort study of the first 100 consecutive robotic hepatectomies performed by the abdominal transplant division at a high-volume center (2017–2025). Outcomes were compared across IWATE groups and between early (2017–2021) and late (2022–2025) cohorts. Logistic regression was used to examine the association between IWATE score and conversion to open surgery, 30-day complications, and major complications (Clavien–Dindo ≥ IIIa). Median age was 61 years (IQR 47–70), 52

Background Operating room turnover time is a major source of perioperative inefficiency affecting patient care, staff satisfaction, and institutional revenue. A multidisciplinary, collaborative approach to turnover time reduction is required to improve perioperative quality. Methods Surgeons, anesthesiologists, nurses, and perioperative leadership collaborated to develop 2 efficiency interventions. The “Showtime” initiative established a service-specific set-time for a surgical and anesthesia representative to meet in preoperative holding for the operating room’s next patient. The “Intentional Rounding” initiative included the charge nurse performing room-to-room morning rounds to proactively identify and mitigate turnover time efficiency issues for the day. These interventions were initiated across the neurosurgery, orthopedics, otolaryngology, and transplant/hepatobiliary service lines within an academic medical center. Results Implementation of the Showtime and Intentional Rounding initiatives resulted in an average reduction in turnover time of 10.5 minutes (20%) across all service lines. Improvement was noted across each service line, with improvement times ranging from 7 to 22 minutes (17% to 32% improvement, respectively), as well as the ability to sustain higher monthly case volumes. An expected 440 hours of turnover time was recovered during the study period, associated with an estimated savings of $361,419 in direct “empty operating room” costs recovered over the 20-month study period (around $18,000/mo). Conclusion Two multidisciplinary perioperative interventions focused on improving operating room turnover time efficiency resulted in a systemwide 20% reduction in average turnover time at an academic medical center, with estimated cost savings of more than $18,000 per month. These interventions are sustainable, low resource-intensive, and reproducible across multiple service lines.

Liver senescence involves the gradual deterioration of hepatic cell function and reduction of regenerative capacity due to aging, chronic liver disease, and cancer. To elucidate the role of liver senescence in aging and cancer, we employed single-cell sequencing, spatial omics, and imaging approaches, collectively over 100 assays, to characterize 43 normal liver samples from a cohort of 95 donors, across ages and selected based on histology and clinical data. We conducted similar assays on samples from 24 patients with colorectal cancer metastasis in the liver. Our study identified CDKN1A+ senescent cells across four liver-resident cell types, namely hepatocytes, fibroblasts, cholangiocytes, and liver sinusoidal endothelial cells, with their prevalence significantly associated with age or liver disease. We observed distinct senescent populations in fibrotic compared to aged livers, indicating differential mechanisms of senescence in these conditions. Fibrosis was related to the expansion of a specific niche residing in portal triads and fibrous septae including immune cells and senescent fibroblasts, which exhibited abundant and strong cellular interactions. Notably, chemotherapy exacerbated senescence, increasing the number of senescent hepatocytes by five-fold compared to aging alone, while the effect of cancer itself was moderate. Other cell types affected by chemotherapy included liver sinusoidal endothelial cells and stellate cells, while CDKN1A+ portal fibroblasts and cholangiocytes were not affected as much. Cancer appeared to induce senescence in nearby hepatocytes, whereas chemotherapy severely affected more distant normal liver tissue. Cancer patients also demonstrated unique populations of CDKN2A+ hepatocytes and cholangiocytes with a distinct secretory phenotype. Senescent cells in liver shared core features, such as AP-1, NFkB activity, SERPINE1, CCL2, COL4A secretion, and anti-apoptotic protein expression, offering new insights into the cellular and molecular mechanisms underlying liver senescence. These findings underscore the complexity and heterogeneity of liver senescence and may have implications for our understanding of liver health and disease. Xiang Li, Alla Karpova, Chien-Wei Peng, Daniel R. Rapp, Kelsey L. Gallant, Andrew J. Houston, Andre Luiz N. Targino da Costa, Michael D. Iglesia, John M. Herndon, Kathleen Byrnes, Nataly Naser Al Deen, Wagma Caravan, Preet Lal, Reyka G. Jayasinghe, Jeffrey A. Blatnik, William G. Hawkins, Dominic E. Sanford, J. Chris Eagon, Natasha Leigh, Maria Bernadette M. Doyle, L. Michael Brunt, William C. Chapman, Roheena Z. Panni, Darren R. Cullinan, Sherri R. Davies, Matthew A. Wyczalkowski, Michael C. Wendl, Hong Zhang, Milan G. Chheda, Sheila A. Stewart, Feng Chen, Ryan C. Fields, Li Ding. Cellular senescence in human liver under normal aging and cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 305.

This review establishes current training pathways for HPB surgeons with a focus on the benefits of abdominal transplant experience for HPB-minded trainees. Abdominal transplant training is increasingly relevant to HPB surgery. Clinically, time spent on liver transplant services facilitates increases exposure to oncotransplant, a budding therapy increasingly utilized for various HPB malignancies. Technically, transplant regularly exposes trainees to retrohepatic anatomy, challenging porta dissections, and vascular anastomoses, skills beneficial for the advanced resections often performed today. Presently, trainees pursuing a career in HPB surgery have multiple means by which to gain transplant exposure, including select fellowships that offer joint HPB-transplant accreditation and institutions that participate in fellowship exchanges. Abdominal transplant surgery training confers unique clinical and technical expertise relevant to today’s HPB surgeon. Although currently HPB trainees may seek out abdominal transplant experience during fellowship, in the future this may be a standardized aspect of HPB fellowship.

The care of patients with necrotizing pancreatitis is a complex problem for the general, acute care, minimally invasive, and hepatopancreatobiliary surgeon. In this brief report, we present a case series of 2 patients with fulminant retroperitoneal necrosis recently treated at our center using a novel robotic-assisted retroperitoneal necrosectomy and debridement (RAND) following failure of the step-up approach. This approach maximizes access to the retroperitoneum and allows improved visualization and dexterity in the challenging retroperitoneal space while maintaining minimally invasive surgical principles. Using the robotic platform permits instrument maneuvering, reduces instrument exchanges, and facilitates definitive debridement without the need for repeated surgical interventions.

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which was the third most common cause of cancer death worldwide in 2020. Transplantation remains the preferred treatment for cure in otherwise unresectable HCC. There are several areas of active research that have led to expansion of eligibility criteria for transplantation including local-regional therapy for downstaging patients presenting outside of the Milan criteria and identification of tumor biomarkers aiding in the early diagnosis, determining prognosis and likelihood of recurrence after transplantation for HCC. New neoadjuvant therapies and post-transplant immunosuppression regimens may also result in expansion of transplant eligibility criteria for HCC.

Primary liver cancer was the third most common cause of death due to cancer worldwide in 2020. As the predominant type, hepatocellular carcinoma (HCC) represents the overwhelming majority of newly diagnosed primary liver tumours. Liver transplantation remains the treatment of choice for a cure in otherwise unresectable HCC. For nearly thirty years, the Milan and Barcelona Clinic Liver Cancer (BCLC) criteria have guided physicians' clinical decision-making for selection of liver transplant candidates in the treatment of HCC. More recently, studies have demonstrated survival benefit for patients transplanted beyond Milan criteria. This remains an area of active research and includes advancements in local-regional therapies and their role in downstaging tumours to within transplant criteria as a bridge to transplant. Other advancements on the horizon include the identification of tumour biomarkers that may lead to earlier diagnosis and more accurate prediction of prognosis and risk of recurrence, as well as new neoadjuvant therapies and post-transplant immunosuppression regimens that may allow for further expansion of transplant eligibility criteria. Additionally, several recent studies have investigated the potential survival benefit of combination therapy using local-regional intervention with systemic immunotherapy to downstage otherwise unresectable disease that is beyond Milan criteria. Liver transplantation will continue to play an important role in the treatment of HCC for the foreseeable future and based on currently available evidence, both local-regional therapies and immunomodulation in combination are poised to change the landscape of liver transplantation for HCC as we currently know it.

We investigated the use of robotic objective performance metrics (OPM) to predict number of cases to proficiency and independence among abdominal transplant fellows performing robot-assisted donor nephrectomy (RDN). 101 RDNs were performed by 5 transplant fellows from September 2020 to October 2023. OPM included fellow percent active control time (

BACKGROUND:Geographic inequities are known to affect access to liver transplant (LT); however, the impact of these disparities postoperatively remains unknown. We focus on primary care physicians (PCPs), as frequent managers of long-term LT recipient care. METHODS:Clinical data on adults undergoing liver-only transplant 2010-2021 were obtained from the Organ Procurement and Transplantation Network and linked to zip code-based PCP density and social vulnerability index (SVI) data to quantify the impact of PCP density on graft and overall survival. RESULTS:64,593 patients were divided into quintiles by PCP density. Compared to patients in the lowest PCP quintile, patients in the 3rd, 4th, and 5th quintiles had 6%-8% lower mortality risk (HR3rd ​= ​0.94, HR4th ​= ​0.92, HR5th ​= ​0.94, p for trend ​= ​0.002). PCP density remained significant after accounting for SVI and local surgeon and gastroenterologist availability (p ​= ​0.002). CONCLUSIONS:Increased PCP availability is associated with improved survival, emphasizing the importance of establishing longitudinal care.

HCC continues to be a leading cause of cancer-related death in the United States. With advances in locoregional therapy for unresectable HCC during the last 2 decades and the recent expansion of transplant criteria for HCC, as well as ongoing organ shortages, patients are spending more time on the waitlist, which has resulted in increased usage of locoregional therapies. This changing landscape is well displayedin Fig. 1, which demonstrates the number of treatments per patient by year of listing (A) and the proportion of locoregional therapy type by year of treatment (B).91 Less than half of liver transplant candidates on the waiting list underwent locoregional therapy before listing in 2003, whereas 92.4% underwent some form of locoregional therapy in 2018.91 Although TACE is the current preferred modality for liver-directed therapy as a bridge to transplant in patients with HCC, recent evidence suggests that radioembolization may prolong time to progression when compared with chemoembolization. In just the last 5 years, the proportion of radioembolization performed for HCC has increased significantly, from less than 5% in 2013 to 19% in 2018.91 Expanding on the proven value of locoregional therapies, the plethora of molecularly targeted therapies and ICIs under investigation represent the new horizon of treatment of HCC not only in advanced stages but also potentially at every stage of diagnosis and management. Although data remain sparse in the pretransplantation population, the possibility of downstaging patients previously considered unresectable or initially outside of transplant criteria is an extremely alluring strategy, which may prove vital in establishing transplant candidacy for an expanded host of patients. Combination therapies have already begun to show promise in maintaining disease control and may ultimately prove lifesaving in patients who are able to undergo liver transplant. Although it will be critical in the coming years to determine timing of therapy and appropriate postoperative immunosuppression strategies, both locoregional techniques and immunomodulation will change the history of liver transplant for HCC as we currently know it.