Effect of Obesity on Surgical Outcomes and Complication Rates in Pediatric Patients: A Comprehensive Systematic Review and Meta-Analysis.

Obesity is one of the primary public health problems faced by children. The increased incidence of obesity in the pediatric population poses significant challenges during and after surgical procedures. This systematic review and meta-analysis aimed to understand to what extent obesity is to surgical complications in pediatric patients. A systematic database search of PubMed, Web of Science, Scopus, and Science Direct was performed in June 2023. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction, and quality evaluation of the retrieved literature. The Newcastle-Ottawa Scale score was used for quality evaluation, and a meta-analysis was performed using Review Manager software 5.4.1. A total of 1,170 relevant articles were initially identified, and 20 articles were finally included for data extraction and meta-analysis. The results of the meta-analysis showed that compared with normal-weight individuals, obese pediatric patients had a higher risk of developing surgical site infection (SSI) (relative risk (RR) = 1.63; 95% confidence interval (CI) = 1.33-2.00), wound dehiscence (RR = 2.01; 95% CI = 1.24-3.23), and underwent procedures that were 11.32 minutes longer (95% CI = 5.36-17.29). There were no differences in bleeding requiring transfusion, deep venous thromboembolism, postoperative abscess rate, and length of stay. Obese pediatric patients have a higher risk of SSI and dehiscence, along with a longer operative time. The established risks in obese adults undergoing surgery suggest a similar risk for obese pediatric patients. The findings of this study hold significant implications for clinical practice, suggesting the potential for additional measures to prevent surgical complications in children.

Robotic surgery across Latin America: a bibliometric analysis of research trends from 2009 to 2022.

The rise of robotic surgery throughout the world, particularly in Latin America, justifies an objective evaluation of research in this field. This study aimed to use bibliometric techniques to identify the research trends and patterns of robotic surgery in Latin America. The research strategy used the terms "Robotic," "Surgery," and the name of all the Latin American countries, in all fields and collections of Web of Science database. Only original articles published between 2009 and 2022 were included. The software Rayyan, Bibliometric in the R Studio, and VOSViewer were used to develop the analyses. After screening, 96 articles were included from 60 different journals. There was a 22.51% annual increase in the scientific production of robotic surgery in the period studied. The more frequent topics by specialty were: Urology (35.4%), General Surgery (34.4%), and Obstetrics and Gynecology (12%). International cooperation was observed in 65.62% of the studies. The Latin American institution with the highest production of manuscripts was the Pontificia Universidad Católica de Chile. Mexico, Chile, and Brazil were, in descending order, the nations with the highest number of corresponding authors and total citations. When considering the total number of articles, Brazil ranked ahead of Chile. Scientific production regarding robotic surgery in Latin America has experienced accelerated growth since its beginning, supported by the high degree of collaboration with leading countries in the field.

Autonomous Robotic Surgery: Has the Future Arrived?

Autonomous robotic surgery represents a pioneering field dedicated to the integration of robotic systems with varying degrees of autonomy for the execution of surgical procedures. This paradigm shift is made possible by the progressive integration of artificial intelligence (AI) and machine learning (ML) into the realm of surgical interventions. While the majority of autonomous robotic systems remain in the experimental phase, a notable subset has successfully transitioned into clinical applications. Noteworthy procedures, such as venipuncture, hair implantations, intestinal anastomosis, total knee replacement, cochlear implant, radiosurgery, and knot tying, among others, exemplify the current capabilities of autonomous surgical systems. This review endeavors to comprehensively address facets of autonomous robotic surgery, commencing with a concise elucidation of fundamental concepts and traversing the pivotal milestones in the historical evolution of robotic surgery. This historical trajectory underscores the incremental assimilation of autonomous systems into surgical practices. This review aims to address topics related to autonomous robotic surgery, starting with a description of fundamental concepts and going through the milestones in robotic surgery history that also show the gradual incorporations of autonomous systems. It also includes a discussion of the key benefits and risks of this technology, the degrees of autonomy in surgical robots, their limitations, the current legal regulations governing their usage, and the main ethical concerns inherent to their nature.