Aim: Artificial intelligence (AI) is rapidly evolving in healthcare worldwide, especially in surgery. This article reviews important terms used in machine learning and the challenges of deep learning in surgery. Methods: A review of the English literature was carried out focused on the terms “challenges of deep learning” and “surgery” using Medline and PubMed between 2018 and 2022. Results: In total, 54 articles discussed the challenges of deep learning in general. We include 25 articles from various surgical specialties discussing challenges corresponding to their respective specialties. Conclusion: The increased utilization of AI in surgery is faced with a wide variety of technical, ethical, clinical, and business-related challenges. The best way to expedite its expansion in surgery in the safest and most cost-efficient manner is by ensuring that as many surgeons as possible have a clear understanding of basic AI concepts and how they can be applied to the preoperative, intraoperative, postoperative, and long-term follow-up phases of the surgical patient care.
Introduction Fetus in fetu (FIF) is an extremely rare condition of abnormal twinning during embryogenesis. Most publications are single case reports. We describe the combined experience of four large tertiary referral centers with FIF which were not previously reported or published, and thereby draw conclusions to establish criteria for the workup, diagnosis, and management including intraoperative risk.
Materials and Methods A survey was forwarded to a national pediatric surgery group which includes members from all pediatric surgery centers in the country enquiring about unpublished cases of FIF encountered over a 20-year interval. The cohort was analyzed for age of presentation, type of presentation, diagnostic workup, surgical management, and outcome.
Results From 1998 to 2018, a total of 10 FIF cases were included in the study. Mean age of presentation was 4 months. Computed tomography and ultrasound were the main preoperative diagnostic modality in our cohort. Resection of the mass was curative in nine cases. Two cases in which the FIF was in direct topographic proximity to the biliary tree suffered severe intraoperative or lethal postoperative complications.
Conclusion Complete excision of FIF is the treatment of choice and generally results in excellent long-term quality of life. Mortality is rare and may be associated with biliary involvement and retroperitoneal right upper quadrant location of the FIF tends to be associated with increased risk in excision, and there is also a possible association with the presence of immature elements in the pathology report.
Background
A urachal cyst has a rare incidence that has been reported as 1/5,000 live birth.
Case presentation
We report two patients with a complicated urachal cyst, a 5-year-old female who presented to the emergency department with severe abdominal pain and a 3-year-old female presenting with abdominal pain and constipation. Upon laparoscopic exploration both patients had complicated urachal cysts which were adherent to the urinary bladder.
Conclusion
Complicated urachal cysts can present with acute abdominal pain.
Epidermoid cysts are encapsulated sebaceous cysts that contain keratin. They present at any age, yet they are commoner in adults. They mainly affect face, neck, trunk and to a lesser extent groin, but can potentially arise as a subepidermal nodule anywhere on the body. They develop from the follicular infundibulum, and are different from dermoid cysts as epidermoid cysts do not contain other adnexal structures of embryonic origin. Epidermoid cysts are mostly silent but can rupture, get inflamed, become infected or develop daughter cysts. Very rarely epidermoid cysts develop in proximity to testicles. They can be mistaken for a testicular tumor. The preoperative diagnosis is essential to avoid unindicated testicular surgery. Magnetic resonance imaging (MRI) is vital for diagnosis. We report a 6-year-old child with a long standing painless scrotal swelling thought by the parents to be polyorchidism. They were alarmed by its recent rapid growth. By examination it was a median raphe cyst. Pre-operative imaging and operative surgical removal proved it to be an inflamed epidermoid cyst. The surgery was uncomplicated and the child had an uneventful recovery. Testicular epidermoid cysts in children are exceptionally rare, yet they can present as median raphe cysts. Inflammation within the epidermoid cyst presents clinically as rapid painless growth. Clinical examination, high index of suspicion and pre-operative MRI avoid unnecessary testicular surgery.
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