key: cord-033829-56ka60bc
authors: Lau, Joseph W.Y.
title: Editor’s Perspective November 2020
date: 2020-10-16
journal: Int J Surg
DOI: 10.1016/j.ijsu.2020.10.002
sha: 
doc_id: 33829
cord_uid: 56ka60bc

nan

Editor's Perspective November 2020

In the October 2020 issue of Editor's Perspective, I focused on the major advances in fibre-optic endoscopic surgery, a branch of minimally invasive surgery which marks the major developments of Surgery 3.0. Rapid developments in rigid endoscopic surgery, together with interventional and fibreoptic endoscopic surgeries form the foundation-stones of Surgery 3.0, which rapidly became accepted by clinicians and patients in many routine over conventional open surgical procedures because of the advantages of minimal-invasiveness.

Rigid endoscopic surgery has developed in almost every specialties of surgery, including general surgery, neurosurgery, cardio-thoracic surgery, urology, paediatric surgery, plastic surgery, orthopedic surgery, otorhinolaryngology and emergency surgery. Even within the specialty of general surgery, rigid endoscopic surgery has developed rapidly in its subspecialties including hepatico-pancreato-biliary, upper and lower gastrointestinal, and endocrine surgery.

Again, like fibre-optic endoscopic surgery, the approach as used in rigid-endoscopic surgery can be made through (i) a natural human orifice like the mouth, anus, urethral opening or vagina, or (2) through a small incision to access into a cavity like in thoracoscopic, laparoscopic or arthroscopic surgeries.

There are limitations to the use of rigid compared with fibre-optic endoscopic instruments because rigid scopes cannot negotiate through a curvature. However, rigid instruments have the merits of ease in removing large foreign bodies and in crushing large urinary bladder stones.

The best developments in rigid endoscopic surgeries are in thoracic surgery using video assisted thoracoscopic surgery (VATS), laparoscopic surgery with its further developments, and arthroscopic surgery. I shall talk more about these developments in the future issues of Editor's Perspective.

In this November 2020 issue of International Journal of Surgery, there are 6 systematic reviews with meta-analyses. The first article is a systematic review and Bayesian network meta-analysis comparing "the efficacy and prognosis of different strategies for intrahepatic recurrent hepatocellular carcinoma". The study concluded that salvage liver transplantation and repeat hepatectomy gave better long-term survival outcomes than radiofrequency ablation, stereotactic body radiation therapy and transarterial chemoembolization. Another systematic review and network meta-analysis of randomized clinical trials on "Mesh position for hernia prophylaxis after midline laparotomy "concluded that onlay and retrorectus mesh augmentation to be more effective than preperitoneal or intraperitoneal mesh augmentation. The third article is a systematic review and meta-analysis on 22 randomized trials looking at the "effect of acute normovolemic hemodilution on coronary artery bypass grafting". The study concluded that acute normovolemic hemodilution reduced the number and rate of transfusion of allogenic red blood cell units and estimated blood loss in patients undergoing coronary artery bypass grafting. The fourth article on "Robotic surgery for gastric cancer in the west" concluded that robotic gastrectomy had comparable short-term outcomes as open and laparoscopic approaches. However, long-term outcomes require further studies. The fifth article comparing "the efficacy and safety of thoracic endovascular aortic repair (TEVAR) versus open repair or optimal medical therapy for acute type B aortic dissection" concluded that TEVAR produced better 30 days/in-hospital mortality than open surgery and better long-term mortality than optimal medical therapy. Finally, the sixth article compared "Clinical efficacy of surgical versus conservative treatment for multiple rib fractures" concluded that surgical treatment resulted in faster recovery, with a lower risk of complications and better prognosis than conservative treatment.

There are two randomized comparative studies. The first study which compared "side-to-end vs end-toend techniques for colorectal anastomosis" concluded that end-to-end anastomosis yielded better results in the subgroup of patients with tumors in the low-mid rectum. The second study compared trans-abdominal preperitoneal repair (TAPP) for adult inguinal hernia with or without tacker mesh fixation showed without tacker mesh fixation to be better.

In this November 2020 issue, there is a qualitative study on facilitators and barriers on implementation of the WHO Trauma Checklist, an interesting article for trauma and emergency surgeons. Another very interesting article to read is the cross-sectional study which concluded that there is still a significant gender based disparity in leadership positions and academic ranks in the United States of America. This article calls for "Institution level measures to embrace support, mentorship, and sponsorship for women to achieve overall parity in general surgery".

There are 3 prospective studies. The first study was conducted to determine the "outcomes of a new slowly resorbable biosynthetic mesh (Phasix TM ) in potentially contaminated incisional hernias." The second study aimed to compare between the "P-POSSUM and Apache-II scores in predicting outcomes of perforation peritonitis". The third study highlighted "sarcopenia management for promoting surgical outcomes in esophageal cancers".

Of seven retrospective studies, the first is a retrospective study on prospectively collected data to look at the impact of microscopic resection margins on survival outcomes for colorectal liver metastases. The second article compared oblique lateral interbody fusion combined with percutaneous pedicle screw fixation versus traditional posterior transforaminal or transpedicular approach debridement and pedicle screws fixation for treatment of a single segment lumbar tuberculosis. The third article looked at the impact of choledochotomy techniques during laparoscopic common bile duct exploration on short-and long-term clinical outcomes. The fourth article determined the oncologic outcomes of earlyonset rectal cancer in patients aged 40 years or less compared with older patients. The fifth article determined whether laparoscopic surgery to be safe and effective for management of patients with colorectal cancer liver metastases in a population-based analysis in Ontario, Canada. The sixth article looked at the "mechanisms of recurrent laryngeal nerve injury near the nerve entry point in thyroid surgery". Finally, there is a population-based cohort study on "primary tumour removal on prognosis in patients with stage IV breast cancer".

There are two Experiential Research articles. The first article is on the "expression of a human complement-regulatory protein on protection of xenograft cells from systemic complement activation". The second study is on the "Effects of endothelin receptor blockade and COX inhibition on intestinal ischemia/reperfusion injury in a rat model".

As usual, there are a lot of Invited Commentaries/Commentaries/Letters to Editor in the November 2020 issue. Of particular interests are the 3 Letters to Editor which are worthy of special mentioning.

This letter is recommended to surgeons who are actively managing COVID-19 patients. The remaining two letters are technical notes with one letter on the use of "root of helix inter tragus notch incision (RHITNI) for temporomandibular open surgery"; and the other letter on "cortical bone incarcerating a guidewire within a tibial intramedullary nail

As the Editor-in-Chief of the Journal, I am delighted to see more and more high-quality research articles submitted to us for publication. I welcome suggestions and comments on how the

Academician of the Chinese Academy of Sciences