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Background: Several health-care measures were taken during the coronavirus disease-2019 (COVID-19) pandemic that may affect surgical residents' exposure and training. Objectives: The objective of this study is to assess and measure the impact of the COVID-19 pandemic on surgical residents' education and their burnout level during that time. Materials and Methods: A cross-section questionnaire-based study was conducted among 417 residents in various surgical specialties in Saudi Arabia from April 2021 to July 2021. Results: A total of 135 residents (32.4%) were level 1, and 112 residents (26.9%) were level 2. During the pandemic, 41% of the residents reported that the number of educational didactics was lower than before, and 24.9% indicated more didactics now. The proportion of residents who attended clinics and surgical cases was higher before the pandemic compared to during the pandemic. However, 36.2% of the residents were concerned that the changes in surgical training during the pandemic could lead to unpreparedness for the next career step. In addition, most of the residents were more burnout during the pandemic compared to before. Conclusion: Surgical residents were concerned that they might be less competent in their specialty due to a reduction in educational didactics during the pandemic. In addition, a higher level of burnout and stress was observed in the majority of residents.

The postoperative outcome of rectal cancer has been improved after the introduction of the principles of total mesorectal excision (TME). Total mesorectal excision includes resection of the diseased rectum and mesorectum with non-violated mesorectal fascia (en bloc resection). Dissection along the mesorectal fascia through the principle of the “holy plane” minimizes injury of the autonomic nerves and increases the chance of preserving them. It is important to stick to the TME principle to avoid perforating the tumor; violating the mesorectal fascia, thus resulting in positive circumferential resection margin (CRM); or causing injury to the autonomic nerves, especially if the tumor is located anteriorly. Therefore, identifying the anterior plane of dissection during TME is important because it is related with the autonomic nerves (Denonvilliers fascia). Although there are many articles about the Denonvilliers fascia (DVF) or the anterior dissection plane, unfortunately, there is no consensus on its embryological origin, histology, and gross anatomy. In the present review article, I aim to delineate and describe the anatomy of the DVF in more details based on a review of the literature, in order to provide insight for colorectal surgeons to better understand this anatomical feature and to provide the best care to their patients.

Background Pituitary adenoma, a benign tumor of the pituitary gland, represents 10-15% of intracranial tumors. Although non-cancerous, its size and location can cause significant health issues, including hormonal imbalances and compression of nearby structures like the optic chiasm, leading to conditions such as Cushing’s disease, acromegaly, and visual disturbances. The prevalence ranges from 46 to 95 per 100,000 individuals. This study evaluates the effectiveness and safety of dexmedetomidine versus placebo in patients undergoing transsphenoidal resection of pituitary adenomas. Methods A systematic review and meta-analysis following PRISMA guidelines included 10 RCTs with 633 patients. English-language RCTs were sourced from PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library. Risk of bias was assessed using the ROB2 tool, and statistical analyses were performed using RevMan 5.3. Results Dexmedetomidine significantly reduced heart rate after intubation (MD: -6.61 bpm, 95% CI: -8.98 to -4.24, p < 0.00001) and post-extubation (MD: -6.77 bpm, 95% CI: -8.59 to -4.96, p < 0.00001). Mean arterial pressure decreased after intubation (MD: -10.49 mmHg, 95% CI: -12.73 to -8.26, p < 0.00001) and post-extubation (MD: -12.97 mmHg, 95% CI: -14.37 to -11.57, p < 0.00001). Dexmedetomidine also reduced surgical duration (SMD: -0.23, 95% CI: -0.41 to -0.05, p = 0.01), blood loss (MD: -109.49 mL, 95% CI: -152.60 to -66.38, p < 0.00001), propofol dose (SMD: -1.04, 95% CI: -1.72 to -0.37, p = 0.002), extubation time (SMD: -0.70, 95% CI: -0.93 to -0.47, p < 0.00001), and postoperative nausea and vomiting (OR: 0.45, 95% CI: 0.25 to 0.80, p = 0.007). Conclusions Dexmedetomidine enhances perioperative outcomes in transsphenoidal resection of pituitary adenomas, supporting its use as an effective anesthetic adjunct.

Background Lumbar radicular discomfort is often induced by mechanical compression of the nerve root and inflammatory reactions. Platelet-rich plasma (PRP) is an efficacious therapy modality, albeit ongoing controversies regarding its effectiveness, and it possesses the advantage of minimal side effects. Therefore, we conducted the current systematic review and meta-analysis to investigate the efficacy and safety of PRP in the treatment of lumbar disc herniation (LDH). Methods We conducted our database searching on PubMed, Scopus, and Web of Science from inception till August 2024 to look for articles that fulfil our aim. The search strategy was based on three main keywords: “Platelet-rich plasma” AND “Lumbar” AND “Hernia*”. We conducted the pooled analysis of continuous variables using mean difference (MD) and we used pooled odds ratio (OR) for dichotomous variables with 95% confidence intervals (CI). Results The use of PRP was statistically significant associated with reduced visual analogue scale (VAS) compared with no PRP with MD of -0.44 (95%CI:-0.76, -0.11, p=0.008), and Oswestry Disability Index (ODI) with MD of -5.36 (95%CI: -8.25, -2.48, p=0.0003). However, no significant difference was observed regarding Japanese Orthopedic Association (JOA) with MD of 2.52 (95%CI:-0.8, 5.84, p=0.14) with non-significant heterogeneity. PRP was also associated with reduced risk of complications with OR of 0.22 (95%CI:0.07, 0.68, p=0.009) and non-significant heterogeneity. Conclusion PRP use in patients with LDH is associated with positive outcomes presented in reduction of pain, and disability (decrease in ODI scale) in addition to being safe with less incidence of complications compared with patients not receiving PRP.