Background: Post-thyroidectomy hypocalcemia is a common complication, yet the optimal perioperative markers for identifying high-risk patients and guiding supplementation remain debated. This study aimed to evaluate factors associated with hypocalcemia at 24 h after total thyroidectomy, identify independent predictors, and assess the reliability of early PTH measurement in determining supplementation needs. Methods: We conducted a single-center prospective cohort study including 200 patients undergoing total thyroidectomy at Genesis Hospital, Thessaloniki, between November 2022 and March 2025. PTH was measured preoperatively, 10 min post-resection, and at 24 and 72 h; calcium and phosphorus were measured preoperatively and postoperatively. Results: Independent predictors of hypocalcemia at 24 h were female sex, preoperative calcium, and PTH at 10 min. Age, pathology, incidental parathyroid excision, and extent of surgery were not significantly associated with hypocalcemia. ROC analysis showed that a preoperative calcium cutoff of 9.47 mg/dL yielded an AUC of 0.73, with 70.1% sensitivity and an NPV of 82%. PTH at 10 min with a cutoff of 24.6 pg/mL yielded an AUC of 0.66, with 70.1% sensitivity and an NPV of 79%. For supplementation needs, PTH at 10 min demonstrated excellent discrimination, with a cutoff of 16.3 pg/mL at 24 h and 14.1 pg/mL at 72 h. Conclusions: Preoperative calcium and PTH measured 10 min after thyroid removal are useful markers for predicting hypocalcemia after total thyroidectomy, with early PTH also accurately identifying supplementation needs.

BACKGROUND Gender disparities across nearly all surgical specialties have become an issue of increasing attention, reflecting persistent inequities in representation, leadership, and career advancement. Despite growing numbers of female medical graduates worldwide, women continue to remain underrepresented in surgery, particularly in subspecialties such as transplantation surgery. AIM To explore gender inequalities among transplant surgeons from the perspective of transplant unit directors and female surgeons worldwide. METHODS This study consists of two arms: (1) An 8-item anonymous questionnaire was sent to transplant centers to assess the gender distribution of consultant surgeons’ positions and academic roles among female and male surgeons; and (2) A 23-item anonymous questionnaire with closed and open questions was distributed to female transplant surgeons worldwide, addressing demographic profile, working experiences, and suggestions towards professional equality. The questionnaires were promoted through email, social media and professional platforms. RESULTS Of 46 transplant units participated. Among the 381 board-certified surgeons reported to work in these transplant centers, 102 were women (27%). In the second arm, 75 female transplant surgeons responded. The respondents had a mean age of 43.7 ± 8.8 years (24-70), with most of them working in European transplant centers (65.3%) and self-identifying as White/Caucasian (76%).72% reported gender discrimination, 56% faced verbal sexual harassment from colleagues, and 26.6% from patients, 41.3% were dissatisfied with their work-life balance, with commonly reported challenges including balancing career and family, lack of institutional support and inclusion and sexual harassment. The majority of recommendations involved mentorship, equal opportunities for leadership positions, and flexible working hours. CONCLUSION This is the first cross-sectional study addressing gender equity within the field of transplantation surgery worldwide, documenting gender disparities, professional conflicts, and concerning experiences of sexual harassment. This study provides preliminary evidence that underscores the need for further research and structural reforms to promote gender equity in transplantation surgery.

Liver transplantation (LT) has evolved significantly since its inception in 1963, transitioning from an experimental procedure to a life-saving intervention for patients with end-stage liver disease and selected liver cancers. Through these years, advances in surgical techniques, graft preservation, and postoperative care have resulted in 1-year survival rates exceeding 90%. Despite the increase in 1 year graft function, issues like organ shortage and long-term complications remain major challenges. This chapter explores cutting-edge innovations that aim to improve LT outcomes and address these limitations. Recent developments in precision medicine, artificial intelligence (AI), and other technological breakthroughs have enhanced all stages of LT, from organ allocation to post-operation management. Other major improvements include advancements in the field of immunosuppression protocols, with studies now supporting drug minimization and withdrawal in selected patients. Innovations in the field of diagnosis aim to improve sensitivity and specificity, while also focusing on the development of non-invasive diagnostic methods with clinical applicability. Furthermore, the usage of marginal grafts has led to emerging preservation technologies, such as normothermic and hypothermic machine perfusion. Collectively, these innovations mark a transformative era for LT, moving toward safer, more personalized, and sustainable transplantation practices.