2026

Remote home cardiotocography: A systematic review and meta-analysis (2026)

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Type of publication:

Systematic Review

Author(s):

Le Vance, Jack; *Adeoye, Adekunle; Man, Rebecca; Eltaweel, Nashwa; Gurney, Leo; Morris, R Katie; Hodgetts Morton, Victoria.

Citation:

PLOS Digital Health. 5(1):e0001184, 2026 Jan.

Abstract:

Cardiotocography (CTG) is a common investigative modality in obstetrics to evaluate the fetal condition. Advancements in digital technology has enabled the innovation of CTG monitoring for usage in the home setting. This review aims to comprehensively examine the current evidence on the effectiveness and applicability of home antenatal CTG monitoring. MEDLINE, EMBASE, Cochrane, Web of Science, and PubMed databases were searched from inception to June 2025. Primary studies examining home antenatal CTG were included. For randomised controlled trials (RCTs), the joint primary outcomes were perinatal mortality and emergency caesarean section. For observational studies, the feasibility, diagnostic accuracy, qualitative and economic burden of home CTG were evaluated. RCTs were eligible for meta-analysis using risk ratio or mean difference, with 95% confidence intervals. Included observational studies were narratively described due to significant methodological heterogeneity. 39 studies (28 observational, seven RCTs and four qualitative studies), comprising of 7240 participants were included. Home antenatal CTG monitoring was non-inferior to conventional care across all meta-analysed maternal, perinatal and healthcare usage outcomes. GRADE assessments were low/very low quality of evidence. Home CTG monitoring was feasible in several settings and remote interpretation was graded as moderate to excellent. Transmission failures were frequently low but commonly occurred due to infrastructure and/or equipment errors. Remote CTG monitoring demonstrated comparative capabilities to conventional CTG with respect to coincidence and beat-to-beat variability. Overall acceptability ratings were high for patient and providers. Often implementation costs were high but accrued back by non-fixed savings when compared against routine care. High-quality studies were underrepresented, particularly when assessing service-led and safety outcomes. Home antenatal CTG monitoring demonstrates noninferiority to conventional care across several outcomes, representing a promising avenue for antenatal management However, current evidence is of low quality and additional high-quality evidence with sufficient methodological detail and standardised outcome assessment is required prior to making definitive recommendations.

DOI: 10.1371/journal. pdig.0001184

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Is robotic surgery ready for emergency cholecystectomy? A systematic review and meta-analysis of robotic versus laparoscopic approach in acute cholecystitis (2026)

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Type of publication:

Systematic Review

Author(s):

Jamal, Zohaib; Talal, Muhammad Anza; Saeed, Jahanzaib; Siddiqui, Asher; Haider, Muhammad Ijlal; Zafar, Khizra; Zaidi, Hammad.

Citation:

Journal of Robotic Surgery. 20(1):166, 2026 Jan 12.

Abstract:

INTRODUCTION: Acute cholecystitis is typically managed with laparoscopic cholecystectomy, though inflammation and distorted anatomy can increase operative difficulty. Robotic cholecystectomy may offer technical advantages through improved visualisation and instrument dexterity, yet current evidence is limited, heterogeneous, and entirely observational, with no randomized trials comparing the two approaches in the emergency setting. This systematic review and meta-analysis synthesises existing comparative data to determine whether robotic assistance confers meaningful operative or postoperative benefits over standard laparoscopy in acute cholecystitis.

MATERIALS AND METHODS: A PRISMA-compliant systematic review and meta-analysis was performed. Comprehensive searches of major databases (2015-2025) identified comparative studies of robotic versus laparoscopic cholecystectomy for acute/emergency cholecystitis in adults. Eligible studies reported at least one perioperative or postoperative outcome; elective, paediatric, single-incision, and non-comparative designs were excluded. Outcomes included operative time, conversion, intra-operative complications, bile duct injury, length of stay, readmission, reoperation, and mortality. Risk of bias was assessed using ROBINS-I. Meta-analyses were conducted in RevMan using random-effects models, with heterogeneity assessed by I2 and standard continuity corrections applied for zero-event studies.

RESULTS: Seven observational studies comprising 143,717 patients met the inclusion criteria. Operative time and length of stay could not be meta-analysed due to inconsistent reporting and were therefore summarised narratively, with both outcomes appearing broadly comparable between robotic and laparoscopic groups. Meta-analysis demonstrated a significantly lower risk of conversion to open surgery with robotic cholecystectomy (RR 0.61, 95% CI 0.50-0.75; I2 = 44%). No significant differences were observed between robotic and laparoscopic approaches for intra-operative complications (RR 0.72, 95% CI 0.38-1.36; I2 = 40%), bile duct injury (RR 0.97, 95% CI 0.77-1.21; I2 = 0%), overall postoperative complications (RR 1.10, 95% CI 0.80-1.52; I2 = 95%), 30-day readmission (RR 0.88, 95% CI 0.50-1.54; I2 = 18%), reintervention or return to theatre (RR 0.33, 95% CI 0.04-2.48; I2 = 78%), or 30-day mortality (OR 1.28, 95% CI 0.86-1.90; I2 = 0%). Event rates for bile duct injury, major complications, reintervention, and mortality were uniformly low across all cohorts, limiting the precision of pooled estimates. Risk-of-bias assessment using ROBINS-I indicated a moderate to serious overall risk of bias in six of the seven studies, primarily due to residual confounding, non-random treatment allocation, and incomplete reporting of disease severity and operative complexity.

CONCLUSION: Robotic cholecystectomy is a safe and feasible alternative to laparoscopy for acute cholecystitis, demonstrating a consistent reduction in conversion to open surgery and comparable intra-operative and postoperative safety outcomes. However, as current evidence is limited to heterogeneous observational studies with incomplete clinical detail, robust prospective research-with detailed severity grading, surgeon-experience assessment, workflow evaluation, and cost-effectiveness analysis-is needed to more clearly define its role in emergency biliary surgery.

DOI: 10.1007/s11701-026-03145-7

Vascular Eagle's syndrome: difficult diagnosis in patient with recurrent transient ischaemic attack. (2026)

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Type of publication:

Journal article

Author(s):

Lyons, T; *Saunders, T; Littleton, E; Monksfield, P; Tiwari, A.

Citation:

Annals of the Royal College of Surgeons of England. 2026 Jan 12.

Abstract:

Eagle's syndrome describes the elongation of the styloid process. The condition has been recognised for over 90 years and causes a wide range of symptoms depending on the level of compression. Compression of the internal carotid artery by the styloid process is referred to in the literature as 'stylocarotid syndrome' or 'vascular Eagle's syndrome' (VES), presenting most commonly as arterial dissection and cerebrovascular events. We present the case of a 53-year-old patient who presented with multiple cerebrovascular events over a six-month period. Computed tomography angiography (CTA) suggested VES; however, magnetic resonance imaging (MRI) of the neck revealed no arterial wall abnormalities, including dissection. Despite the escalation of medical therapy, the patient continued to experience multiple transient ischaemic attacks. Following multidisciplinary team discussion and exclusion of other sources of emboli, a transcervical styloidectomy was performed freeing compression of the carotid artery, resulting in the complete resolution of symptoms. VES should be considered in patients with recurrent or unexplained cerebrovascular or cervical neurogenic symptoms even in the absence of arterial injury. We recommend early styloidectomy when there is a strong clinical suspicion of VES to achieve definitive symptom resolution.

DOI: 10.1308/rcsann.2025.0113

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Root causes of surgical never-events: a systematic review (2026)

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Type of publication:

Systematic Review

Author(s):

Parmar, Dilen; *Patel, Neil; Kenneth-Ogah, Catherine; Yazdouni, Sadat; Desai, Chaitya; Raveshia, Dimit; Patel, Ravi.

Citation:

Patient Safety in Surgery [Electronic Resource]. 2026 Jan 08.

Abstract:

Background
Never-events represent serious and preventable patient safety incidents within surgical practice, despite increasing national and international efforts to reduce them. Persistent concerns regarding wrong site surgery, retained surgical items, and incorrect implants highlight the need to understand contributory human factors and system-level weaknesses.

Methods
A systematic search of PubMed/Medline, Google Scholar, and the Cochrane Library was conducted. Evidence published between 2014 and 2024 was screened according to predefined eligibility criteria to identify contemporary data relating to surgical never-events. Studies were assessed using standardised selection methods and relevant findings were extracted and synthesised.

Results
Thirty-seven studies met inclusion criteria. Across international literature, recurring contributory factors included communication breakdowns, reduced situational awareness, fatigue, inadequate staffing, inconsistent team composition, and increasing surgical caseloads. Despite advances in safety practices, these factors continued to contribute to adverse surgical outcomes.

Conclusion
Never-events remain a persistent challenge in surgical care. Strengthening safety management systems, improving awareness of human factors, and prioritising non-technical skills training may help reduce the risk of these events. Ongoing evaluation of interventions and further UK-based research are required to support improvement in patient safety outcomes.

Data availability
All data generated or analysed in this study are derived from published articles and are included within this manuscript and its supplementary materials.

DOI: 10.1186/s13037-025-00474-8

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Evaluation of inpatient physiotherapy groups on functional ability, self-reported psychological scales, and length of stay (LOS) in acute stroke patients: A service review of current provision at the Princess Royal Hospital (2026)

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Type of publication:

Service evaluation report

Author(s):

*Emily Farla

Citation:

Shrewsbury and Telford Hospital NHS Trust, January 2026

Abstract:

Purpose: The Shrewsbury and Telford NHS trust’s acute stroke rehabilitation therapy
team set up weekly circuit class therapy (CCT) groups in 2024, running alongside
individual therapy (IT) to improve stroke rehabilitation. Physiotherapists, occupational
therapists, speech and language therapists and therapy support workers delivered
both methods of rehabilitation. The service aimed to provide quality therapy to
improve motor and psychological outcomes in the acute stroke population, supported
by results reported in current literature. Anecdotal evidence was obtained from
attendees that suggested CCT to be a positive addition and so a formal review was
indicated. This service review aimed to answer; does attending additional inpatient
CCT groups up to three times per week in addition to standard therapy for inpatient
stroke patients at the Princess Royal Hospital (PRH), influence motor function,
psychological wellbeing scores and impact hospital length of stay (LOS)?
Methods: The service evaluation reviewed notes retrospectively between the months
of May and July 2025. All consenting adult patients diagnosed with a stroke in the
last 30 days and admitted on to the Stroke and Rehabilitation wards at PRH who
were receiving active treatment and referred to therapy were included. The review
aimed to collect 30-50 sets of data. Notes were screened to collect inpatient
demographics; including gender, age, height, weight, diagnosis, number of groups
attended, length of stay, and discharge destination and outcome measures; Modified
Rivermead Mobility Index, Distress Thermometer, and Stroke Recovery Perception
from baseline and discharge time points. Data was inputted into Excel and SPSS to
complete descriptive and inferential analysis. Patient identifiable data was removed
to ensure anonymity throughout analysis.
Results: 38/50 stroke inpatients admitted to the stroke rehabilitation ward were found
to have complete sets of data (n=38). Of the 38 inpatients nine received IT and 19
attended IT with additional CCT groups. Significant motor improvements were seen
in both the IT and additional CCT groups. Significant increases in psychological
outcomes and self-perceived improvement scores were seen in the additional CCT
group compared to the IT group. There appeared to be no relationship between CCT
attendance and LOS.
Conclusions: This service evaluation has shown additional CCT groups delivered
alongside IT on the stroke rehabilitation unit at the PRH is a significantly better
service in terms of patient perceived improvement and psychological outcomes with
an equivalent benefit to IT for motor outcomes. Though no impact of group
attendance on LOS was seen, it may be due to the external factors delaying
discharge. The findings from this service review support continuing provision of the
CCT service and has provided data for comparison with future service reviews.
Further research is needed to understand the relationship between CCT attendance
and becoming therapy fit for discharge and the impact of inpatient total treatment
time by adding CCT to IT for achievement of stroke therapy guidance.

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