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Background: The use of digital online teaching media in improving the surgical skills of medical students is indispensable, yet it is still not widely explored objectively. The first-person-view online teaching method may be more effective as it provides more realism to surgical clerkship students in achieving basic surgical skills., Objective: This study aims to objectively assess the effectiveness of the first-person-view live streaming (LS) method using a GoPro camera compared to the standard face-to-face (FTF) teaching method in improving simple wound suturing skills in surgical clerkship students., Methods: A prospective, parallel, nonblinded, single-center, randomized controlled trial was performed. Between January and April 2023, clerkship students of the Department of Surgery, Pelita Harapan University, were randomly selected and recruited into either the LS or FTF teaching method for simple interrupted suturing skills. All the participants were assessed objectively before and 1 week after training, using the direct observational procedural skills (DOPS) method. DOPS results and poststudy questionnaires were analyzed., Results: A total of 74 students were included in this study, with 37 (50%) participants in each group. Paired analysis of each participant's pre-experiment and postexperiment DOPS scores revealed that the LS method's outcome is comparable to the FTF method's outcome (LS: mean 27.5, SD 20.6 vs FTF: mean 24.4, SD 16.7; P=.48) in improving the students' surgical skills., Conclusions: First-person-view LS training sessions could enhance students' ability to master simple procedural skills such as simple wound suturing and has comparable results to the current FTF teaching method. Teaching a practical skill using the LS method also gives more confidence for the participants to perform the procedure independently. Other advantages of the LS method, such as the ability to study from outside the sterile environment, are also promising. We recommend improvements in the audiovisual quality of the camera and a stable internet connection before performing the LS teaching method., (© Freda Halim, Allen Widysanto, Petra Octavian Perdana Wahjoepramono, Valeska Siulinda Candrawinata, Andi Setiawan Budihardja, Andry Irawan, Taufik Sudirman, Natalia Christina, Heru Sutanto Koerniawan, Jephtah Furano Lumban Tobing, Veli Sungono, Mona Marlina, Eka Julianta Wahjoepramono. Originally published in JMIR Medical Education (https://mededu.jmir.org).)

Introduction: Acute appendicitis is the most common surgical emergency in pregnant women. There has been a wide variance in clinical practice worldwide, with some favoring an antibiotic-only approach while others prefer surgery as the first-line management. Therefore, we designed the current analysis to synthesize the available evidence on the efficacy and safety of antibiotics versus surgery management. Methods: We searched PubMed, Scopus, EuropePMC, and Cochrane Central from March 4, 1904 until November 25, 2022, to look for studies comparing antibiotics and surgery in pregnant patients with acute appendicitis. We only included studies that provided a comparison between the two treatments. We included preterm delivery, fetal loss, maternal death, and complications as outcomes. The results were compared using an odds ratio and 95% confidence interval. We also performed a sensitivity analysis by excluding studies with a serious risk of bias. Results: We included five non-randomized studies for the analysis. We found that patients in the antibiotic group had a lower risk of preterm labor (OR 0.63 [95% CI 0.43-0.92]; p 0.02) but a higher risk of complications (OR 1.79 [95% CI 1.19-2.69]; p 0.005). We did not find any difference in the other outcomes. Conclusion: The increased risk of complications should caution clinicians about using antibiotics as the first-line management. More studies are required to identify patients who would benefit the most before antibiotics could be adopted as a treatment for acute appendicitis in pregnant patients., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Candrawinata V et al.)

Fibrin sealants have recently been thoroughly studied in several surgical specialties; however, results are conflicting. We aimed to examine the safety and efficacy of fibrin sealant patients having thyroidectomies. A thorough, systematic literature search was carried out using the terms thyroidectomy and fibrin sealant using PubMed, Cochrane Library, and Clinicaltrials.gov on December 25, 2022. The primary outcome of interest in this review was the amount of drainage, whereas hospitalization, the length of drain retention, and temporary dysphonia were secondary outcomes. Our meta-analysis ( n  = 249) showed that application of fibrin sealant is associated with lesser total drainage [SMD -2.76 (-4.83, -0.69); P  = 0.009; I2 97%], but not with retention time of drainage [SMD -2.35 (-4.71, 0.01); P  = 0.05; I2 98%], hospitalization time [SMD -1.65 (-3.70, 0.41); P  = 0.12; I2 97%], and transient dysphonia [RR 1.01 (0.27, 3.82); P  = 0.99; I2 0%]. The systematic review found that the use of fibrin sealant in thyroid surgery is positive in total volume drainage but not with the retention time of drainage, hospitalization time, and transient dysphonia. It is notable to remember that this interpretation is complicated by uneven, occasionally subpar technique and trial reporting, according to this systematic review's findings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Koerniawan, Candrawinata, Tjahyanto, Wijaya, Putra and Wijaya.)

Background: Botulinum Toxin (BTX) has been found to have anti-spasm and analgesic effects. The utility of BTX after conventional hemorrhoidectomy remains unclear. Thus, a systematic review and meta-analysis are required to find out its utility after conventional hemorrhoidectomy., Methods: Using specific keywords, we comprehensively go through the potential articles on PubMed, ClinicalTrials.gov, and Europe PMC sources until March 27 th , 2022. All published studies on botulinum toxin anal sphincter injection after conventional hemorrhoidectomy were collected. We were using Review Manager 5.4 software to conduct statistical analysis., Results: Five clinical trial studies with a total of 260 patients undergoing hemorrhoidectomy were included in the analysis Our pooled analysis revealed that BTX injection after hemorrhoidectomy was associated with lower VAS at 24 h post-operative [Mean Difference -1.35 (95% CI -1.90, -0.80), p  < 0.00001, I 2 = 0%] and shorter time to return work [Mean Difference -8.94 days (95% CI -12.57, -5.30), p  < 0.00001, I 2 = 0%]. However, BTX injection did not differ significantly from placebo in terms of time to first defecation ( p  = 0.22), fecal incontinence ( p  = 0.91) and urinary retention incidence ( p  = 0.18)., Conclusion: BTX sphincter injection may offer some benefit after conventional hemorrhoidectomy in reducing pain from the first day after the procedure and promoting wound healing without complication. Further randomized clinical trials are still needed to confirm the results of our study.