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ACS analysis finds 1,180 counties without a general surgeon; robotic esophagectomy yields more nodes; robotic cholecystectomy costs more
THE SHORT READ
An American College of Surgeons (ACS) analysis published Sept. 28 found 1,180 U.S. counties, home to 15.1 million people, with no general surgeon. In the ROBOT-2 randomized trial, robotic esophagectomy removed more lymph nodes than conventional minimally invasive esophagectomy with similar complication rates. A study in the Journal of the American College of Surgeons tied robotic cholecystectomy for acute cholecystitis to more bailout procedures and higher one-year costs, and a cohort study linked pancreatic enucleation to more pancreatic fistulas but fewer major complications than pancreatoduodenectomy.
THE DETAILS
- Workforce Sept 28, 2026The study by the American College of Surgeons and the University of North Carolina's Sheps Center also found 951 of 3,144 U.S. counties had no identified surgeon in any of 12 surgical specialties. It found 475 hospitals and surgical facilities, including 434 critical access hospitals, in counties without an identified surgeon. National supply was 59.2 surgeons per 100,000 people, ranging from 20.8 to 250.4 across hospital referral regions. "For a patient, the question is not how many surgeons the country has; it is whether there is one available where they live," said co-author Dr. Thomas Tsai.
- Research Sept 30, 2026In the phase 3 trial at four high-volume centers in Germany, the Netherlands and Switzerland, 218 patients with resectable esophageal or esophagogastric junction adenocarcinoma were randomized and 202 underwent transthoracic esophagectomy. The median number of resected lymph nodes was 36 with robot-assisted surgery versus 32 with conventional minimally invasive esophagectomy (P = .005). Complication rates were similar, 90-day mortality was 1.0% versus 3.0% (P = .62), and one-year survival did not differ. The authors wrote in JAMA Surgery that the results support robotic esophagectomy as a standard approach for these cancers.Source: JAMA Surgery
- Research Sept 28, 2026Among 384,617 patients treated in New York and Florida from 2012 to 2021, 4% had robotic surgery, which had higher bailout rates than laparoscopy (1.7% versus 1.4%), including more conversions to open surgery and subtotal cholecystectomies, according to the Journal of the American College of Surgeons study. Bile duct injury was 1.6% in both groups, and median one-year costs were $29,702 versus $24,483. A separate national analysis of 231,048 non-elective cholecystectomies found robotic use rose from 1.78% in 2022 to 13.57% in 2024, while adjusted 30-day mortality fell from 0.59% in 2015 to 0.38% in 2024.
- Research Sept 30, 2026The retrospective JAMA Surgery cohort of patients with benign or low-grade pancreatic head tumors at four high-volume Chinese centers compared 217 propensity-matched pairs. Clinically relevant pancreatic fistula, the primary end point, was more common after enucleation (33.2% versus 10.6%), while major complications (8.8% versus 17.1%) and delayed gastric emptying (4.6% versus 25.3%) were less common, and median stays were nine versus 15 days. Among 551 patients who completed quality-of-life assessment, new-onset diabetes occurred in 7.8% versus 33.3%. The authors said enucleation is a viable option when technically feasible, particularly for tumors 2.5 cm or smaller.Source: JAMA Surgery