Diego Iván Jaramillo García

Organ transplantation remains the definitive treatment for many patients with end-stage organ failure, significantly improving survival and quality of life. Nevertheless, the persistent shortage of donor organs continues to limit access to transplantation worldwide, creating an urgent need for alternative strategies capable of expanding the donor pool. This review aimed to analyze current advances in organ transplantation and xenotransplantation, with emphasis on surgical innovations, immunological developments, clinical outcomes, and bioethical implications. A narrative review was conducted using the Scientific Method as a methodological framework. Scientific evidence was obtained from major biomedical databases, including PubMed, Scopus, Web of Science, ScienceDirect, Google Scholar, and the Cochrane Library. The selected literature was analyzed according to four major domains: surgical innovation, immunological and genetic advances, clinical outcomes, and bioethical considerations. The findings demonstrated that conventional transplantation continues to achieve favorable graft survival and patient outcomes due to improvements in surgical techniques, organ preservation, and immunosuppressive therapy. Furthermore, recent clinical experiences involving genetically modified porcine organs have demonstrated the growing feasibility of xenotransplantation as a potential solution to organ scarcity. However, important challenges remain regarding long-term graft survival, immunological compatibility, infectious disease transmission, animal welfare, informed consent, and equitable access to transplantation services. The review concludes that xenotransplantation represents one of the most promising emerging strategies for addressing the global organ shortage, although its successful integration into clinical practice will require continued scientific advancement, ethical oversight, regulatory preparedness, and international collaboration.

Advanced thyroid cancer remains a significant clinical challenge despite major advances in endocrine oncology. Although conventional management based on surgery and radioactive iodine therapy continues to provide favorable outcomes for many patients, locally advanced, recurrent, metastatic, and radioiodine-refractory disease often require more complex therapeutic approaches. The objective of this review was to analyze contemporary surgical innovations, molecular-targeted therapies, and nuclear medicine strategies used in the management of advanced thyroid cancer throughout the Americas. A narrative literature review was conducted using the Scientific Method as the methodological framework. Scientific evidence was retrieved from PubMed, Scopus, Web of Science, ScienceDirect, Cochrane Library, and Google Scholar, focusing on studies published between 2014 and 2026. The findings demonstrated that molecularly targeted therapies have become a central component of treatment, particularly in tumors harboring BRAF, RET, and NTRK alterations. Lenvatinib, sorafenib, cabozantinib, selpercatinib, pralsetinib, and dabrafenib-trametinib have significantly expanded therapeutic options for patients with advanced disease. Surgical intervention remains essential for local disease control and management of recurrent or invasive tumors, while nuclear medicine continues to play a critical role through radioactive iodine therapy, PET/CT, SPECT/CT, and emerging redifferentiation strategies. The review also identified important challenges related to molecular testing accessibility, targeted therapy availability, specialized surgical services, and nuclear medicine infrastructure across different healthcare systems. Overall, the evidence supports a transition toward precision medicine and multidisciplinary management as the foundation of contemporary advanced thyroid cancer care. Continued efforts to improve access to innovative technologies and specialized treatment resources will be necessary to optimize patient outcomes throughout the American continent.

Hepatobiliary surgery remains one of the most technically demanding areas of modern surgical practice due to the complexity of hepatic and biliary anatomy, the need for precise lesion localization, and the risk of major intraoperative complications. In recent years, advances in artificial intelligence (AI), intraoperative imaging, and radiological navigation technologies have introduced new opportunities to improve surgical planning, procedural accuracy, and patient safety. This review analyzes the current evidence regarding the integration of AI-assisted technologies and intraoperative radiological navigation in hepatobiliary surgery. A narrative literature review was conducted using scientific publications retrieved from major international databases, including PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, SpringerLink, Wiley Online Library, and Google Scholar. The reviewed literature demonstrated a substantial increase in research activity during the last decade, particularly in areas involving machine learning, deep learning, computer vision, three-dimensional reconstruction, fluorescence-guided imaging, augmented reality, robotic-assisted surgery, and intelligent navigation systems. The findings indicate that these technologies contribute to improved preoperative planning, enhanced anatomical visualization, greater intraoperative precision, and more effective decision-making. Furthermore, increasing integration among artificial intelligence platforms, advanced imaging modalities, and robotic technologies suggests the emergence of comprehensive digital surgical ecosystems designed to support precision surgery. Although challenges related to implementation costs, technological accessibility, infrastructure, and clinical validation remain, current evidence supports the growing incorporation of these innovations into hepatobiliary surgical practice. Continued research and international collaboration will be essential for optimizing their clinical application and expanding access to advanced surgical technologies worldwide.

Decision-making in general surgery frequently occurs under conditions of uncertainty, where surgeons must integrate clinical judgment, risk assessment, timing, and system-level factors to optimize patient outcomes. This review aims to analyze current evidence on decision-making processes in general surgery, focusing on risk stratification, timing of intervention, and perioperative strategies. A structured narrative review was conducted using high-impact literature indexed in international databases, including multicenter cohort studies, systematic reviews, and validated predictive models. The findings demonstrate that higher preoperative risk is consistently associated with worse postoperative outcomes, particularly in urgent and emergency surgical settings. Timing of intervention emerged as a critical determinant, with elective procedures showing significantly lower mortality and complication rates compared to non-elective surgery. Additionally, structured perioperative strategies, including enhanced recovery protocols and safety systems, were associated with reduced complications and shorter hospital stays. The results also highlight that postoperative outcomes follow an interconnected pattern, where complications contribute to prolonged hospitalization, readmission, and mortality. Furthermore, the analysis underscores the importance of system-level factors, particularly in middle-income countries such as Mexico, Colombia, and Ecuador, where variability in resources and infrastructure influences surgical outcomes. The integration of data-driven tools and multidisciplinary approaches was identified as a key component in improving decision-making under uncertainty. In conclusion, optimizing surgical decision-making requires an integrated approach that combines objective risk assessment, timely intervention, structured perioperative care, and adaptation to local healthcare contexts. This framework supports improved patient outcomes and advances the quality of surgical care in diverse clinical settings.