Editor's perspective – July 2020

In the June 2020 issue of Editor's perspective, I talked about Industry 3.0 and Surgery 3.0. Surgery 3.0, evolved in the 1990s and is still developing even in the 21st century. As it has drastically changed how surgery is carried out nowadays on a significant proportion of patients, I am going to talk on it in more detail.

Surgery 3.0 is marked by the development and gradual acceptance of minimally invasive surgery (MIS) by surgeons and patients around the world, with the advantages which I mentioned in the June 2020 Editor's perspective. Broadly speaking, MIS includes interventional, laparoscopic and robotic surgery. I am going to talk more on interventional surgery first, and leave laparoscopic and robotic surgery to later issues of Editor's perspectives.

Interventional surgery uses minimally invasive approaches under medical imaging guidance to perform diagnostic and/or therapeutic procedures through small incisions or body orifices [1,2]. Medical imaging guidance includes X-ray fluoroscopy, computed tomography, magnetic resonance imaging or ultrasound. Diagnostic procedures include procedures in making a diagnosis such as image–guided biopsy of a tumor, or procedures in guiding further treatment such as injection of an imaging contrast agent into a blood vessel or a duct. On the other hand, therapeutic procedures include catheter-based therapy (e.g. transcatheter arterial chemoembolization for liver cancer), medical device placement (e.g. stenting for ductal strictures), angioplasty of vascular stenosis, and aspiration/drainage of collections/abscesses. The main benefits of interventional surgery are obtained by employing a tiny incision, or through a body orifice by small needles and catheters to reach to deep structures of the body to perform the intended diagnostic or therapeutic procedures. This results in decreased risks, less pain and faster recovery compared to conventional open surgery. Real-time visualization allows precious guidance to the intended anatomical locations, making the procedure more precise and accurate. The potential disadvantages are the lack of immediate access to the sites should bleeding or perforation occurs, and the risk of additional radiation exposure. Interventional surgery is now carried out in many fields in medicine as its benefits often outweigh its risks.

The highlight of this July 2020 issue of International Journal of Surgery is the impacts of the novel COVID-19 pandemic on surgical practice. There is a systematic review on “International guideline and recommendations for surgery during COVID-19 pandemic” which concluded that during the pandemic, it is important to retrieve resources from non-essential settings to provide care to high priority non-COVID-19 related diseases. There are the Parts I and II of a review article on “Impact of Coronavirus (COVID-19) pandemic on surgical practice” which sought to review the current evidence and to offer recommendations to surgical practice. There is another review article on “Diagnosis and treatment of coronavirus disease 2019 (COVID-19): Laboratory, PCR and chest CT imaging findings”. There are six articles on perspectives on COVID-19: one from Singapore looking at a surgeon's role in fighting the pandemic, one from Wuhan looking at means to avoid healthcare worker infection and containing the disease from the frontline's perspective, one from low- and middle-income countries looking at emergency and essential surgical healthcare services, one also from limited-resource countries looking at how to navigate cancer surgery in the breast, head and neck, skin and soft tissue tumors, one from India looking from laparoscopic surgeons' perspective, and finally one from Argentina looking from general surgeons' perspective on strategies for follow-up after hernia surgery. There are two cross-sectional studies on COVID-19 pandemic. The one from Pakistan looked at the impact of the disease on surgical residency program. The other one from United Kingdom looked at healthcare professional's perspective on current management strategy.

There are 31 invited commentaries/commentaries/correspondences/letters to the Editor from countries all over the world covering the various aspects of COVID-19 pandemic, including comments on articles which have previously been published in our Journal, the impact of the disease on surgical training/medical and surgical services/socio-economic conditions, diagnosis and management of the disease, as well as prognosis and lessons learned from managing the disease. Going through all these articles, I really feel that our Journal is genuinely an international journal of surgery.

Putting the articles on COVID-19 aside, in this issue of our Journal there are five systematic reviews and meta-analyses. The first article on “The incidence of right-sided colon cancer in patients aged over 40 years with acute appendicitis” concluded that the risk of right sided colon cancer in these patients was 10 times higher than the risk in general population, suggesting the needs for routine preoperative CT scans and postoperative colonic assessment in these patients. The second article compared “Perioperative outcomes between laparoscopic with open repeat liver resection for post-hepatectomy recurrent liver cancer” concluded that the laparoscopic approach resulted in significantly less intra-operative blood loss, less complications, a shorter hospital stay and a higher R0 resection rate. The third article on “Prognostic role of pretreatment lactate dehydrogenase (LDH) in patients with metastatic renal cell carcinoma found a high level of pretreatment serum LDH to be associated with worse long-term survival outcomes in these patients. The fourth article on “The efficacy and safety of probiotics for patients with constipation-predominant irritable bowel syndrome” suggested that probiotics are safe and may improve whole gut transit time, stool frequency and stool consistency. However, better designed studies are required before probiotics can be adopted as a treatment for these patients. Finally, the article on “Arthroscopic partial menisectomy combined with medical exercise therapy versus isolated medical exercise therapy for degenerative meniscal tear” concluded that the combined treatment was more effective in reducing pain and improving range of motion in the early postoperative period.

There is a review article on “Diagnostic dilemma of perioperative myocardial infarction after coronary artery bypass grafting”. The study concluded that while there is still no perfect diagnostic test for the detection of perioperative myocardial infarction, a combination of existing modalities with knowledge of expected post-procedural changes can allow for early and reliable detection.

There are three comparative studies, the first one is a randomized controlled trial on “The efficacy of transversus abdominis plane block with or without dexmedetomidine for postoperative analgesia in renal transplantation”. This study concluded that addition of dexmedetomidine provided a more effective analgesic effect. The second study is a retrospective comparative study on “The diagnostic value of prostate cancer between holmium laser enucleation of the prostate and transurethral resection of the prostate for benign prostatic hyperplasia”. The study concluded that the former treatment technique provided a higher total detection rate of prostatic cancer, especially in patients with a prostate specific antigen less than 10 ng/ml. The third is a retrospective comparative study from a single center on “using three different bone graft methods for a single segment lumbar tuberculosis”. The study concluded that granular bone graft was the best compared with iliac bone graft and titanium mesh bone graft.

Of the original researches, there is a cross-sectional study on the use of vital signs in predicting surgical intervention in a South African population; a multicenter prospective cohort and validation study on reducing the negative appendectomy rate using the laparoscopic appendicitis score; a prospective before-after study on Cyp3A4 activity after major hepatectomy in the early postoperative period; a retrospective cohort study on feasibility and safety of bisegmentectomy 7–8 while preserving hepatic venous outflow of the right liver, a tumor marker prognostic study on differential hypermethylation of the VTRNA2-1 promoter in hepatocellular carcinoma as a prognostic factor, a retrospective cohort study on preoperative hypoalbuminemia being an independent risk factor for postoperative complications in Crohn's disease patients with normal body mass index, and an experimental study on automated laparoscopic colorectal surgery workflow recognition using artificial intelligence.

There are 23 invited commentaries/commentaries/correspondences/letters to the Editor which are not related to COVID-19 pandemic in this issue of International Journal of Surgery. A lot can be learned from these articles, especially those commenting on the articles which have been published in our Journal.

Finally, there is a corrigendum to “Readmission and reoperation rates following negative diagnostic laparoscopy for clinically suspected appendicitis: The “normal” appendix should not be removed – A retrospective cohort study” (Int J Surg 2019; 64:1–4). This is made on the request of the authors to correctly put Anders Bech Jørgensen's name as it now appears in this corrigendum.

This July 2020 issue of our Journal contains more articles than the other issues. About half of the space of this issue is dedicated to articles on COVID-19, reflecting on the wide interest of the users of our Journal on this topic. However, there are still a lot of good research articles on various subjects in surgery for our readers to go through in their leisure time.

I hope this perspective finds everybody and your loved ones to be in good health!