Purpose This study aimed to assess the performance of ChatGPT, specifically the GPT-3.5 and GPT-4 models, in understanding complex surgical clinical information and its potential implications for surgical education and training. Methods The dataset comprised 280 questions from the Korean general surgery board exams conducted between 2020 and 2022. Both GPT-3.5 and GPT-4 models were evaluated, and their performances were compared using McNemar test. Results GPT-3.5 achieved an overall accuracy of 46.8%, while GPT-4 demonstrated a significant improvement with an overall accuracy of 76.4%, indicating a notable difference in performance between the models (P < 0.001). GPT-4 also exhibited consistent performance across all subspecialties, with accuracy rates ranging from 63.6% to 83.3%. Conclusion ChatGPT, particularly GPT-4, demonstrates a remarkable ability to understand complex surgical clinical information, achieving an accuracy rate of 76.4% on the Korean general surgery board exam. However, it is important to recognize the limitations of large language models and ensure that they are used in conjunction with human expertise and judgment.

Background. Microsatellite status is a prognostic biomarker in advanced gastric cancer. This retrospective study aimed to investigate the usefulness of microsatellite status in predicting prognosis and response to adjuvant treatment in pT1N1 gastric cancer. Patients and Methods. Among 875 patients who underwent radical gastrectomy for pT1N1 gastric cancer at two tertiary hospitals, 838 with available microsatellite instability (MSI) data were included and classified into two groups according to microsatellite status: microsatellite stable (MSS) and MSI-high (MSI-H). Recurrence-free survival rate and risk factors for tumor recurrence were analyzed. Results. Of 838 gastric cancer patients, 100 (11.9%) were MSI-H and 307 (36.6%) received adjuvant treatment. During median follow-up of 70 months, 42 (5.0%) patients

Background: Pure laparoscopic donor hepatectomy (PLDH) has become a standard procurement practice for living donor liver transplantation in expert centers. During the procedures of PLDH, a good anatomical approach for donor bile duct division is crucial to avoid multiple bile duct openings, which increases the risk of biliary complications for the recipient. This study was designed to develop a deep learning-based artificial intelligence model to identify biliary structures intraoperatively, helping to determine the optimal transaction site. Methods: Semantic segmentation of the bile duct was performed using a convolutional neural network-based approach. Deep-LabV3+ was utilized as the model with the ResNet as a backbone. Ground truth annotations were generated with the help of images of the bile duct under infrared fluoroscopy with indocyanine green by a single surgeon. The dice coefficient was utilized as an evaluation metric for the proposed model. Results: Three hundred images of the biliary structure were extracted from 30 PLDH videos, 80% of images were used as train dataset, and 20% were used for validation dataset. As a result, the model predicted the area of the bile duct with a precision of 0.66. Conclusions: Intraoperative artificial intelligence-guided bile duct division can be used for PLDH. This technology may provide real-time guidance and improve surgical outcomes.

Purpose This study aimed to assess the performance of ChatGPT, specifically the GPT-3.5 and GPT-4 models, on the Korean general surgery board exam questions and investigate the potential applications of large language models (LLM) for surgical education and training. Method The dataset comprised 280 questions from the Korean general surgery board exams conducted between 2020 and 2022. Both GPT-3.5 and GPT-4 models were evaluated, and their performance was compared using the chi-square test. Result GPT-3.5 achieved an overall accuracy of 46.8%, while GPT-4 demonstrated a significant improvement with an overall accuracy of 76.4%, indicating a notable difference in performance between the models (p<.001). GPT-4 also exhibited consistent performance across all subspecialties, with accuracy rates ranging from 63.6% to 83.3%. Conclusion ChatGPT, particularly GPT-4, demonstrates a remarkable ability to understand complex surgical clinical information, achieving an accuracy rate of 76.4% on the Korean general surgery board exam. As LLM technology continues to advance, its potential applications in surgical education, training, and continuous medical education (CME) are anticipated to enhance patient outcome and safety.

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Background: While kidney transplantation in the elderly diabetic patient is an accepted treatment, pancreas transplants in older patients are controversial. Many centers have an age limit of 60 years or lower in place. The aim of this study was to describe the surgical risk of pancreas transplantation in the elderly and the potential life-years gained by undergoing a pancreas transplant. Methods: Between 2000 and 2017, 885 diabetic patients 58 years of age or older were listed for a primary deceased donor pancreas transplants in the USA. 75% of patients were listed for a simultaneous pancreas kidney transplant (SPK), 12% previous kidney for a pancreas after kidney (PAK) and 12% for a pancreas transplant alone (PTA). Uni-and multivariate statistical methods were used to assess wait-list mortality, outcomes and life-years gained for older pancreas transplant recipients. Each patient had a potential follow-up of at least 4 years post-transplant. Results: The 1-and 3-year mortality rates while waiting for a transplant were 9.6% and 32.6% for SPK, 5% and 14% for PAK, and 6.9% and 15.4% for PTA. Of these wait-listed patients, a total of 489 underwent a pancreas transplant (333 SPK,79 PAK, 77 PTA). Table 1 shows the demographics and outcomes for the 3 transplant categories. Patient and pancreas graft survival was not statistically different between the 3 transplant categories. Conclusions: Pancreas transplants can be safely performed in older patients with excellent patient and graft outcomes. The additional gain in life-years is especially high in SPK recipients. The gain in life-years is not as high in solitary transplants because the mortality on the wait-list is not as high as in SPK patients. The mortality of patients with hypoglycemia remains high at any age and should also be an indication for pancreas transplantation in older, diabetic patients.

Background: Increasingly many patients are being relisted for repeat kidney transplantation due to longer survival times after transplantation. This study compared the outcomes of second living donor kidney transplantations (LDKTs) with those of first LDKTs. Methods: Data were collected retrospectively for 1,429 LDKTs performed from 1995 to 2020 at Samsung Medical Center. The demographics of recipients and donors, immunologic factors, and outcomes of second LDKTs were compared to those of first LDKTs. Results: Among 1,429 cases of LDKT, 1,355 were first LDKT cases and 74 were second LDKT cases. Basic demographic data were comparable for the two groups of patients.The 5-and 10-year graft survival rates were 94% and 84% for first LDKTs and 96% and 86% for second LDKTs, respectively, with neither difference statistically significant (P=0.399). The 5-and 10-year patient survival rates were 98% and 94% for the first and 96% and 93% for the second LDKTs, respectively; neither difference was statistically significant (P=0.766). Multivariate analysis confirmed that a history of previous transplantation was not a statistically significant risk factor for graft loss (hazard ratio [HR], 0.83; P=0.677) or patient death (HR, 1.68; P=0.396). Conclusions: These results indicate that repeat kidney transplantation from living donors is a reasonable choice for patients who have experienced graft loss.

Background: The number of patients relisting on kidney transplantation (KT) wait list due to prior allograft loss is increasing which accounts for 9.2% according to the Korean Network for Organ Sharing (KONOS) data. Therefore, this study is designed to understand the outcomes of second KT compared to first KT as the needs for repeat transplantation are increasing. Methods: Data were collected retrospectively for 1,429 living donor KT, performed from 1995-2020 at Samsung Medical Center. Demographics of recipients and donors, immunologic factors and outcomes of retransplantation group were compared to first transplant. Primary outcomes are death-censored graft survival and patient survival. Results: Among 1,429 cases, first KT were 1,355 and second KT were 74. Five-and 10-year graft survival of patients with first KT are 94.26% and 83.54%, those of second KT are 96.12% and 85.95%, showing no statistically significant differences (P=0.3988). Five-year patient survival of first KT was 97.7% and that of second KT was 96.27%, and 10-year survival of first KT was 94.22% and that of second KT was 92.57%, which show no statistically significant differences (P=0.7657). This study analyzed changes of serum creatinine after transplantation for 10 years to evaluate trends of graft function over time. As time goes, serum creatinine levels of both groups were tended to increased, however, there was no significant differences in rate of changes between two groups. Multivariate analysis confirmed that age of donor (hazard ratio [HR], 1.0289) and number of mismatched human leukocyte antigen (HLA) class II (HR, 1.634) increase risk of graft failure. Age of recipient, diabetes mellitus (recipient), hypertension (donor), and number of HLA class II mismatch are associated with higher risk of mortality. History of previous transplantation was not a risk factor of any outcomes. Conclusions: This study revealed that repeat renal transplantation with living donor kidney offers comparable graft and patient survival to first transplantation. Therefore, repeat KT with living donor is reasonable treatment of choice.