Background: Surgical training suffers from a global deficit; 5 billion people lack access to safe surgery, with an estimated 143 million additional procedures needed annually. Traditional surgical education, constrained by the apprenticeship model, faces critical limitations in standardization and scalability, particularly in low- and middle-income countries where expert mentors are scarce. AI-augmented tutoring systems represent a potentially transformative solution. This systematic review and meta-analysis were conducted to address that evidence gap. Methods: Following PRISMA 2020 guidelines, we systematically searched major databases for trials comparing AI tutoring with expert instruction. Primary outcomes were performance (Intelligent Continuous Expertise Monitoring System [ICEMS] score) and skill acquisition (Objective Structured Assessment of Technical Skills [OSATS] score). Cognitive load was a secondary outcome, measured using the Mental Effort Scale (MES) and Cognitive Load Index (CLI). Results: Our search yielded 40 studies for narrative synthesis. Four studies (3 RCTs and 1 pilot prospective study), encompassing a total of 268 participants, were included in the meta-analysis. AI tutoring showed a small, statistically significant improvement in expert-rated OSATS scores (MD 0.20; 95% CI, 0.01 to 0.39) with no heterogeneity (I2 = 0%) but with low certainty. The AI group reported a significantly higher extraneous cognitive load (MD 0.23; p = 0.01). No significant difference was found in ICEMS scores. Conclusion: AI tutoring systems demonstrated comparable effectiveness to expert instructors in simulated surgical skill acquisition. The small OSATS advantage (0.20 points) is of uncertain clinical significance, falling below commonly published competency cut-points for meaningful change on global rating scales, and is based on low-certainty evidence driven by a single high-risk-of-bias study. AI tutoring imposed a higher extraneous cognitive load. These findings do not support replacing human instructors with AI. Instead, the evidence supports a hybrid model, though this itself requires rigorous empirical validation.

Background: Roux-en-Y gastric bypass (RYGB) is a widely performed metabolic and bariatric surgery (MBS) procedure with proven efficacy. However, significant variability exists in its technical execution. This study aimed to evaluate global practice patterns among surgeons affiliated with the International Federation for the Surgery and Other Therapies for Obesity (IFSO), identifying key variations and factors influencing intraoperative decision-making. Methods: A cross-sectional survey was distributed between January and November 2025 to active IFSO members performing RYGB. The survey explored techniques related to the gastric pouch configuration, intestinal limb lengths, gastrojejunostomy, ring augmentation, and adjunct use. Responses from 245 surgeons across 47 countries were analyzed using descriptive statistics, subgroup comparisons, and multivariable logistic regression. Results: Technical variability was widespread. Only 53.5% routinely measured gastric pouch length; 67.3% described their pouches as “short” or “small,” with variable anatomical endpoints. Bougie sizes ranged from 28 to 46 Fr, with 36 Fr being most common (41.2%). Only 21.6% of respondents reported routinely measuring total bowel length. Ring-augmentation was used by 20.4%, with significant regional and experiential variation. Linear stapling was preferred for gastrojejunostomy (81.2%), but stoma size and suture materials varied. Routine closure of both Petersen’s space and the jejunojejunal mesenteric defect was common (69%) yet non-uniform. High-volume surgeons had shorter hospital stays and longer follow-up, but technical patterns were similar. Conclusion: Global RYGB practice exhibits heterogeneity in several key operative steps. Improved reporting of intraoperative technical variables may help clarify which differences are most relevant to perioperative, long-term, and registry-based outcomes, and may support future consensus-building in areas where standardization is clinically justified.

CKD patients are susceptible to pneumoperitoneum-induced renal injury; comparative outcomes of robotic versus laparoscopic inguinal hernia repair are unknown. Retrospective propensity score–matched cohort using TriNetX (184 HCOs; 2015–2026). CKD adults undergoing robotic or laparoscopic inguinal hernia repair were matched 1:1 on 61 covariates (1,693 per arm at 1 month; 1,659 at 6 months). Primary outcomes were AKI and MACE; secondary outcomes were metabolic acidosis, urinary retention, hyperkalemia, and post-operative eGFR and creatinine. Cox regression, Kaplan–Meier, and competing-risk CIF were used, with E-values for unmeasured confounding. At 1 month, robotic repair had higher AKI (5.0% vs. 2.9%; HR 1.74, 95% CI 1.22–2.47; p = 0.002) and MACE (2.5% vs. 1.4%; HR 1.84; p = 0.017). At 6 months, AKI persisted (HR 1.41; p = 0.002) and urinary retention emerged (HR 1.33; p = 0.039); MACE (p = 0.112) and acidosis (p = 0.199) did not. New-onset hyperkalemia was lower with robotic (HR 0.58; p = 0.045). eGFR MDRD declined less at 1 month (Δ − 1.28 vs. − 3.21; p = 0.049); 6-month creatinine was lower (p = 0.013). CIF (deaths 1.5% vs. 1.9%) confirmed AKI; KM overstated 6-month incidence by 1.1–1.9 points. 1-month AKI E-value 2.87 (CI 1.74). Robotic inguinal hernia repair in CKD was associated with higher AKI and early MACE in the all-events analysis, but the incident AKI signal was borderline and post-operative laboratory renal function favored the robotic arm. This discordance may reflect differential ascertainment at robotic-predominant academic centers. These hypothesis-generating findings do not establish a renal safety advantage for either approach; prospective validation with KDIGO-defined AKI endpoints is required. Graphical abstract

Background: Multiple chemotherapeutic agents, such as anthracyclines, have recently shown a fatal potential for cardiotoxic effects in their patients. However, their efficacy is often hindered by their harmful adverse effects, mostly cardiotoxicity. DM medications such as metformin, SGLT-2 inhibitors, and GLP-1 receptor agonists have exhibited promising cardioprotective properties in rat clinical trials. Purpose: We conducted our study to investigate the observational association between diabetic medications and Cardioprotective effect in cancer patients treated with cardiotoxic chemotherapeutics. Methods: A meta-analysis following PRISMA guidelines included observational studies comparing diabetic cancer patients treated with chemotherapy. Outcomes evaluated were heart failure (HF) incidence, HF exacerbation, atrial fibrillation (AF), hospitalization, and mortality. Data were independently extracted by five investigators from multiple databases up to January 20, 2025. Results: Eight studies involving 27,015 patients were included. DM medication use may be associated with lower mortality (OR 0.50, p < 0.00001), HF incidence (OR 0.36, p = 0.007), HF exacerbation (OR 0.58, p < 0.0001), although heterogeneity was significant. Subgroup analysis revealed that SGLT-2 inhibitors may be associated with reduced mortality by 50%, HF incidence by 64%, and HF exacerbation by 49%. Hazard ratio analysis indicated SGLT-2 inhibitors use was associated with lower mortality risk in patients receiving cardiotoxic chemotherapy (HR 0.58, p = 0.001). Conclusion: Diabetic medications, particularly SGLT-2 inhibitors, may be associated with observational cardioprotective effect in cancer patients undergoing cardiotoxic chemotherapy. These findings highlight the need for further prospective trials to confirm subgroup benefits.