DOI: 10.3897/jbcr.e206944

Authors: Tsanko Yotsov, Martin Karamanliev, Martin Petkov

Abstract: Large language models (LLMs), a type of artificial intelligence (AI), are increasingly popular tools used for everyday and work-related activities and tasks. Their application in medicine is widely researched and has been used recently to help write scientific papers in various fields. LLMs can draft sections of manuscripts or whole papers far more quickly than human writers. However, they need appropriate prompting to draft near-complete and worthwhile papers. In the current study, we used two different LLM models: ChatGPT-4o and Claude 3.5 Sonnet, to test AI’s scientific writing capabilities. We took an article written by the authors of the current study on the topic of fluorescent cholangiograms and ran it through the models to help build prompts for the article to be written by the AI. After that, we loaded the data and references used for the article into both AI tools and prompted them to write sections of the article (or a whole article if possible) on the same topic while allowing for independent choice of statistical analysis. The results of the human-written article and the AI-generated ones were compared, evaluating the information used from the references, the types of statistical analysis methods used, the conclusions drawn, and the time it took to complete the task.

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DOI: 10.3897/jbcr.e206955

Authors: Tsanko Yotsov

Abstract: Common bile duct exploration (CBDE) is a surgical technique that has become a lost art in everyday practice due to the wide availability of endoscopic retrograde cholangiopancreatography (ERCP). Residents nowadays have very poor exposure to this procedure, and even less so to laparoscopic CBDE (LCBDE). Such lack of exposure is unfortunate, because after ERCP the patient will still require laparoscopic cholecystectomy (LC). As a result, the patient will have to undergo two procedures instead of one and will require paid sick leave twice. Besides, the cost of ERCP + LC is also higher than that of LCBDE. Many studies have shown similar outcomes and similar complication rates of LCBDE when compared to ERCP + LC. One of the challenges associated with LCBDE is the relatively demanding training and limited exposure to the procedure, mainly due to the lack of suitable patients, as ERCP is usually preferred. Additionally, LCBDE requires advanced laparoscopic skills to perform successfully.Although LCBDE has similar rates of stone clearance compared to ERCP (97%), there are still cases where a stone is left behind. Then an additional procedure is performed, and the cost of treatment is higher. There are several ways to resolve the issue, with different approaches appropriate for different patients. The skill level of the surgeon and his familiarity with the procedure also play an important role in the decision making. Choledochoscopy, T-tube placement, stenting and ERCP or conversion to open surgery are some of the available options for management of retained stones after LCBDE.We present a case of LCBDE with a retained stone, failed choledochoscopic extraction and an example of successful laparoscopic stone clearance without conversion or the need of an endoscopic procedure.

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DOI: 10.3897/jbcr.e182885

Authors: Kaloyan Tonev, Zhivko Dimitrov, Toni Stoyanov

Abstract: We present three cases of reconstruction of complex skin defects using pedicled flaps (gracilis, pectoralis major, and TRAM), all of which postoperatively exhibited venous congestion, characterized by cyanosis, edema, and dark bleeding on pinprick. While cumulative comorbidities increased the overall risk, potential mechanical causes included pedicle torsion or compression, hematoma, and skin–muscle island mismatch. Empirical treatment included therapeutic anticoagulation, decompression (partial suture removal and punctures), and operative revision when indicated. We compared these measures against existing literature. Because venous congestion led to partial flap loss in our series, we propose prevention and management strategies, including meticulous planning, gentle surgical technique, and early intervention, all of which are crucial for successful flap salvage.

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DOI: 10.3897/jbcr.e183126

Authors: Carla Navarro Moratalla, Antonio Melero Abellán, Toni Ivanov Stoyanov

Abstract: The role of Enterobius vermicularis in the pathogenesis of acute appendicitis remains controversial, as it may be associated with appendiceal colic in the absence of actual histological inflammation. A retrospective study was conducted in two hospitals in Spain between June 2016 and January 2021, including six patients with histologically confirmed E. vermicularis infection. 1 two males and four females with a median age of 20 years. All patients presented with right iliac fossa pain and underwent laparoscopic appendectomy. In all cases, the appendix appeared hyperemic without macroscopic signs of acute inflammation, and histological examination confirmed the absence of acute appendicitis. All patients received postoperative mebendazole. No postoperative complications occurred.Enterobius vermicularis may mimic acute appendicitis by causing appendiceal colic, but it is rarely associated with true inflammatory appendicitis. Appendectomy should therefore be performed with caution when the appendix appears non-inflamed, given the possibility of E. vermicularis infection and the associated risk of intra-abdominal contamination.

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DOI: 10.3897/jbcr.e177463

Authors: Martin Karamanliev, Meri Shoshkova, Stefka Petrova, Dobromir Dimitrov, Stoyan Vezenkov

Abstract: Virtual reality (VR) is increasingly adopted in surgical education as a safe and controlled environment for developing technical and non-technical skills. Parallel to this, physiological biofeedback has emerged as a promising method for assessing stress, workload, and cognitive performance during complex tasks. This review explores the current evidence on VR and biofeedback in surgical training, highlighting their synergistic potential. We discuss how VR simulations replicate operative scenarios with high fidelity and how biofeedback parameters such as heart rate variability and galvanic skin response can provide objective insights into surgeon performance and stress regulation. We then outline a pilot study design in which novice and experienced surgeons are placed in a VR operating room scenario, with biofeedback metrics recorded. We hypothesise that experienced surgeons will demonstrate more stable physiological responses and superior task performance, reflecting greater resilience and expertise. Such findings could inform adaptive, personalised training models that adjust difficulty levels or provide targeted feedback in real time. Integrating VR and biofeedback into surgical education has the potential to enhance skill acquisition, improve stress management, and bridge the gap between simulation and the operating room.

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DOI: 10.3897/jbcr.e119983

Authors: Meri Shoshkova, Martin Karamanliev

Abstract: Rectal stump leak following Hartmann’s procedure resulting in an abscess formation is quite a rare complication. The size of the cavity, the healing process, neoadjuvant radiotherapy, and the patient’s overall condition may play a huge role in the stoma reversal rates, functional outcomes, and the patient’s quality of life. Moreover, it can lead to septic complications if not treated properly. We present a case of a 75-year-old male patient who underwent Hartmann’s procedure due to low rectal carcinoma. He presented one month after the procedure in our office with a fever and anal secretion. He was treated with three different types of antibiotics, drainage of the abscess cavity, and dressing twice a day of the wound with a povidone-iodine solution without success. Amputation of the rectal stump, debridement of the necrotic tissue, and VAC therapy resolved the symptoms and closed the perineal defect. VAC therapy may be used successfully for chronic pelvic inflammatory complications after Hartmann’s procedure.

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