{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T08:12:17Z","timestamp":1778487137668,"version":"3.51.4"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008814","name":"Universidade do Minho","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008814","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Surg Int"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate whether supervised pediatric surgery trainees can safely perform laparoscopic pyloromyotomy (LP) and to assess the influence of trainee participation within the institutional learning curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective single-center cohort included all infants undergoing LP between June 2011\u20132025. Cases were categorized as specialist- or trainee-performed (eight pediatric surgery specialists, three supervised trainees). Baseline characteristics, operative variables, surgery-related complications, incomplete pyloromyotomy, postoperative recovery, reintervention, and readmission were compared. Temporal trends and institutional CUSUM analysis were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-seven infants were included (45 specialist-operated, 32 trainee-operated). Baseline characteristics were similar. Operative time was longer for trainees (45 versus 40\u00a0min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.037).\u00a0Surgery-related complications occurred in 11.1% of specialist cases and in none of the trainee cases\u00a0(p=0.07). All five complications (two wound infections, one incisional omental exteriorization, and two mucosal perforations) occurred with specialists. One incomplete pyloromyotomy occurred (trainees). The composite adverse outcome rate was 11.1% (specialists) versus 3.1% (trainees)\u00a0(p = 0.39). Feeding progression, length of stay, reoperations and readmissions were comparable. CUSUM analysis demonstrated no adverse drift after trainee integration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Supervised trainees safely performed LP with outcomes comparable to specialists. Slightly longer operative time did not impact recovery. Early trainee involvement did not compromise patient safety or institutional performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00383-026-06435-1","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T07:59:42Z","timestamp":1778486382000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trainee involvement in laparoscopic pyloromyotomy does not compromise outcomes: evidence from a longitudinal institutional experience"],"prefix":"10.1007","volume":"42","author":[{"given":"Sofia","family":"Martinho","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"N\u00f3brega","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catarina","family":"Barroso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Correia-Pinto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"6435_CR1","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1053\/J.SEMPEDSURG.2016.05.004","volume":"25","author":"M Jobson","year":"2016","unstructured":"Jobson M, Hall NJ (2016) Contemporary management of pyloric stenosis. Semin Pediatr Surg W B Saunders 25:219\u2013224. https:\/\/doi.org\/10.1053\/J.SEMPEDSURG.2016.05.004","journal-title":"Semin Pediatr Surg W B Saunders"},{"key":"6435_CR2","doi-asserted-by":"publisher","first-page":"1904","DOI":"10.1016\/J.JPEDSURG.2021.05.009","volume":"56","author":"M Mazurak","year":"2021","unstructured":"Mazurak M, Patkowski D, W.B. Saunders (2021) A history of the surgical correction of pyloric stenosis. J Pediatr Surg 56:1904\u20137. https:\/\/doi.org\/10.1016\/J.JPEDSURG.2021.05.009","journal-title":"J Pediatr Surg"},{"key":"6435_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32284-5","author":"PKH Tam","year":"2017","unstructured":"Tam PKH, Chung PHY, St Peter SD, Gayer CP, Ford HR, Tam GCH, Lancet Publishing Group et al (2017) Advances in paediatric gastroenterology. Lancet 390:1072\u201382. https:\/\/doi.org\/10.1016\/S0140-6736(17)32284-5","journal-title":"Lancet"},{"key":"6435_CR4","doi-asserted-by":"publisher","first-page":"3380","DOI":"10.1007\/S00464-018-6060-0","volume":"32","author":"WC Kethman","year":"2018","unstructured":"Kethman WC, Harris AHS, Hawn MT, Wall JK (2018) Trends and surgical outcomes of laparoscopic versus open pyloromyotomy. Surg Endosc 32:3380\u20133385. https:\/\/doi.org\/10.1007\/S00464-018-6060-0","journal-title":"Surg Endosc"},{"key":"6435_CR5","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012827.PUB2","author":"RF Staerkle","year":"2021","unstructured":"Staerkle RF, Lunger F, Fink L, Sasse T, Lacher M, von Elm E et al (2021) Open versus laparoscopic pyloromyotomy for pyloric stenosis. Cochrane Database Syst Rev Cochrane Database Syst Rev. https:\/\/doi.org\/10.1002\/14651858.CD012827.PUB2","journal-title":"Cochrane Database Syst Rev Cochrane Database Syst Rev"},{"key":"6435_CR6","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.jss.2022.12.034","volume":"285","author":"RM Parikh","year":"2023","unstructured":"Parikh RM, Ata A, Edwards MJ (2023) A contemporary review of surgical approach and outcomes in pediatric hypertrophic pyloric stenosis. J Surg Res Acad Press Inc 285:142\u2013149. https:\/\/doi.org\/10.1016\/j.jss.2022.12.034","journal-title":"J Surg Res Acad Press Inc"},{"key":"6435_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/J.JSS.2021.12.042","volume":"274","author":"F Lunger","year":"2022","unstructured":"Lunger F, Staerkle RF, Muff JL, Fink L, Holland-Cunz SG, Vuille-dit-Bille RN (2022) Open versus laparoscopic pyloromyotomy for pyloric stenosis-a systematic review and meta-analysis. J Surg Res 274:1\u20138. https:\/\/doi.org\/10.1016\/J.JSS.2021.12.042","journal-title":"J Surg Res"},{"key":"6435_CR8","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/S0140-6736(09)60006-4","volume":"373","author":"NJ Hall","year":"2009","unstructured":"Hall NJ, Pacilli M, Eaton S, Reblock K, Gaines BA, Pastor A et al (2009) Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet Elsevier B V 373:390\u2013398. https:\/\/doi.org\/10.1016\/S0140-6736(09)60006-4","journal-title":"Lancet Elsevier B V"},{"key":"6435_CR9","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1097\/01.SLA.0000234647.03466.27","volume":"244","author":"SD St. Peter","year":"2006","unstructured":"St. Peter SD, Holcomb GW, Calkins CM, Murphy JP, Andrews WS, Sharp RJ et al (2006) Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg 244:363\u20137. https:\/\/doi.org\/10.1097\/01.SLA.0000234647.03466.27","journal-title":"Ann Surg"},{"key":"6435_CR10","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1007\/S00383-016-4030-Y","volume":"33","author":"C Sathya","year":"2017","unstructured":"Sathya C, Wayne C, Gotsch A, Vincent J, Sullivan KJ, Nasr A (2017) Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis. Pediatr Surg Int 33:325\u201333. https:\/\/doi.org\/10.1007\/S00383-016-4030-Y","journal-title":"Pediatr Surg Int"},{"key":"6435_CR11","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1016\/j.jpedsurg.2009.02.067","volume":"44","author":"L Perger","year":"2009","unstructured":"Perger L, Fuchs JR, Komidar L, Mooney DP (2009) Impact of surgical approach on outcome in 622 consecutive pyloromyotomies at a pediatric teaching institution. J Pediatr Surg J Pediatr Surg 44:2119\u20132125. https:\/\/doi.org\/10.1016\/j.jpedsurg.2009.02.067","journal-title":"J Pediatr Surg J Pediatr Surg"},{"key":"6435_CR12","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.jpedsurg.2007.09.029","volume":"43","author":"GH Cosper","year":"2008","unstructured":"Cosper GH, Menon R, Hamann MS, Nakayama DK (2008) Residency training in pyloromyotomy: a survey of 331 pediatric surgeons. J Pediatr Surg 43:102\u20138. https:\/\/doi.org\/10.1016\/j.jpedsurg.2007.09.029","journal-title":"J Pediatr Surg"},{"key":"6435_CR13","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1001\/JAMASURG.2016.0261","volume":"151","author":"F Abdullah","year":"2016","unstructured":"Abdullah F, Salazar JH, Gause CD, Gadepalli S, Biester TW, Azarow KS et al (2016) Understanding the operative experience of the practicing pediatric surgeon: implications for training and maintaining competency. JAMA Surg 151:735\u201341. https:\/\/doi.org\/10.1001\/JAMASURG.2016.0261","journal-title":"JAMA Surg"},{"key":"6435_CR14","doi-asserted-by":"publisher","first-page":"E475","DOI":"10.1097\/SLA.0000000000005114","volume":"277","author":"Z Farooqui","year":"2023","unstructured":"Farooqui Z, Cortez AR, Potts JR, Tiao GM, Von Allmen D, Quillin RC et al (2023) 10 year analysis of pediatric surgery fellowship match and operative experience: concerning trends? Ann Surg 277:E475-82. https:\/\/doi.org\/10.1097\/SLA.0000000000005114","journal-title":"Ann Surg"},{"key":"6435_CR15","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1093\/BJS\/ZNAD245","volume":"110","author":"M Markel","year":"2023","unstructured":"Markel M, Lacher M, Hall NJ, Martynov I, Hinojosa AS, de Augustin Asensio JC et al (2023) Training in minimally invasive surgery: experience of paediatric surgery trainees in Europe. Br J Surg 110:1397\u20139. https:\/\/doi.org\/10.1093\/BJS\/ZNAD245","journal-title":"Br J Surg"},{"key":"6435_CR16","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/J.JPEDSURG.2007.09.028","volume":"43","author":"RN Haricharan","year":"2008","unstructured":"Haricharan RN, Aprahamian CJ, Celik A, Harmon CM, Georgeson KE, Barnhart DC (2008) Laparoscopic pyloromyotomy: effect of resident training on complications. J Pediatr Surg 43:97\u2013101. https:\/\/doi.org\/10.1016\/J.JPEDSURG.2007.09.028","journal-title":"J Pediatr Surg"},{"key":"6435_CR17","doi-asserted-by":"publisher","first-page":"2080","DOI":"10.1016\/j.jpedsurg.2019.11.023","volume":"55","author":"P Heye","year":"2020","unstructured":"Heye P, Russell KW, Laje P, W.B. Saunders (2020) Laparoscopic pyloromyotomy can be performed safely by senior pediatric surgery trainees without supervision at high volume centers. J Pediatr Surg 55:2080\u20132. https:\/\/doi.org\/10.1016\/j.jpedsurg.2019.11.023","journal-title":"J Pediatr Surg"},{"key":"6435_CR18","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1001\/JAMAPEDIATRICS.2013.25","volume":"167","author":"JP McAteer","year":"2013","unstructured":"McAteer JP, LaRiviere CA, Drugas GT, Abdullah F, Oldham KT, Goldin AB (2013) Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review. JAMA Pediatr JAMA Pediatr 167:468\u2013475. https:\/\/doi.org\/10.1001\/JAMAPEDIATRICS.2013.25","journal-title":"JAMA Pediatr JAMA Pediatr"},{"key":"6435_CR19","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1016\/j.jpedsurg.2011.06.033","volume":"46","author":"C Evans","year":"2011","unstructured":"Evans C, Van Woerden HC (2011) The effect of surgical training and hospital characteristics on patient outcomes after pediatric surgery: a systematic review. J Pediatr Surg 46:2119\u201327. https:\/\/doi.org\/10.1016\/j.jpedsurg.2011.06.033","journal-title":"J Pediatr Surg"},{"key":"6435_CR20","doi-asserted-by":"publisher","DOI":"10.3389\/FPED.2017.00207","author":"C Barroso","year":"2017","unstructured":"Barroso C, Etlinger P, Alves AL, Os\u00f3rio A, Carvalho JL, Lamas-Pinheiro R et al (2017) Learning curves for laparoscopic repair of inguinal hernia and communicating hydrocele in children. Front Pediatr. https:\/\/doi.org\/10.3389\/FPED.2017.00207","journal-title":"Front Pediatr"},{"key":"6435_CR21","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1007\/S00464-003-9075-Z","volume":"18","author":"JDW Van Der Bilt","year":"2004","unstructured":"Van Der Bilt JDW, Kramer WLM, Van Der Zee DC, Bax NMA (2004) Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: impact of experience on the results in 182 cases. Surg Endosc 18:907\u20139. https:\/\/doi.org\/10.1007\/S00464-003-9075-Z","journal-title":"Surg Endosc"},{"key":"6435_CR22","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/S00464-007-9395-5","volume":"22","author":"EAT Velde","year":"2008","unstructured":"Velde EAT, Bax NMA, Tytgat SHAJ, De Jong JR, Travassos DV, Kramer WLM et al (2008) Minimally invasive pediatric surgery: increasing implementation in daily practice and resident\u2019s training. Surg Endosc 22:163\u20136. https:\/\/doi.org\/10.1007\/S00464-007-9395-5","journal-title":"Surg Endosc"},{"key":"6435_CR23","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1016\/J.JAMCOLLSURG.2015.11.034","volume":"222","author":"S Talutis","year":"2016","unstructured":"Talutis S, McAneny D, Chen C, Doherty G, Sachs T (2016) Trends in pediatric surgery operative volume among residents and fellows: improving the experience for all. J Am Coll Surg 222:1082\u20138. https:\/\/doi.org\/10.1016\/J.JAMCOLLSURG.2015.11.034","journal-title":"J Am Coll Surg"},{"key":"6435_CR24","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.jpedsurg.2020.09.038","volume":"56","author":"CB Cummins","year":"2021","unstructured":"Cummins CB, Bowen-Jallow KA, Tran S, Radhakrishnan RS (2021) Education of pediatric surgery residents over time: examining 15 years of case logs. J Pediatr Surg 56:85\u201398. https:\/\/doi.org\/10.1016\/j.jpedsurg.2020.09.038","journal-title":"J Pediatr Surg"},{"key":"6435_CR25","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.jpedsurg.2003.09.004","volume":"39","author":"G Gollin","year":"2004","unstructured":"Gollin G, Moores D, Baerg JC (2004) Getting residents in the game: an evaluation of general surgery residents\u2019 participation in pediatric laparoscopic surgery. J Pediatr Surg W B Saunders 39:78\u201380. https:\/\/doi.org\/10.1016\/j.jpedsurg.2003.09.004","journal-title":"J Pediatr Surg W B Saunders"},{"key":"6435_CR26","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/J.JPEDSURG.2018.10.092","volume":"54","author":"HD Baumgarten","year":"2019","unstructured":"Baumgarten HD, Brown EG, Russell KW, Adzick NS, Laje P (2019) Laparoscopic appendectomy - outcomes of senior trainees operating without supervision versus experienced pediatric surgeons. J Pediatr Surg 54:276\u20139. https:\/\/doi.org\/10.1016\/J.JPEDSURG.2018.10.092","journal-title":"J Pediatr Surg"},{"key":"6435_CR27","doi-asserted-by":"publisher","first-page":"2925","DOI":"10.1007\/S00464-025-11657-W","volume":"39","author":"K Ota","year":"2025","unstructured":"Ota K, Tainaka T, Hinoki A, Shirota C, Makita S, Yasui A et al (2025) Young pediatric surgeons without endoscopic surgical skill qualification safely perform advanced endoscopic surgery under the supervision of expert qualified surgeons. Surg Endosc 39:2925\u201330. https:\/\/doi.org\/10.1007\/S00464-025-11657-W","journal-title":"Surg Endosc"},{"key":"6435_CR28","doi-asserted-by":"publisher","DOI":"10.1007\/S00383-025-06095-7","author":"P Zahradn\u00edkov\u00e1","year":"2025","unstructured":"Zahradn\u00edkov\u00e1 P, Babala J, Lind\u00e1k M, Pechanov\u00e1 R, Hnilicov\u00e1 S, Moln\u00e1r M et al (2025) Systematic review of the training process of minimally invasive surgery in neonates and infants. Pediatr Surg Int. https:\/\/doi.org\/10.1007\/S00383-025-06095-7","journal-title":"Pediatr Surg Int"},{"key":"6435_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.sempedsurg.2020.150905","author":"M Pacilli","year":"2020","unstructured":"Pacilli M, Clarke SA, W.B. Saunders (2020) Simulation-based education for paediatric surgeons: does it really improve technical skills? Semin Pediatr Surg. https:\/\/doi.org\/10.1016\/j.sempedsurg.2020.150905","journal-title":"Semin Pediatr Surg"},{"key":"6435_CR30","doi-asserted-by":"publisher","DOI":"10.1016\/J.SEMPEDSURG.2020.150902","author":"J Breaud","year":"2020","unstructured":"Breaud J, Azzie G (2020) Development and assessment of a simulation-based curriculum in pediatric surgical education: conventional wisdom and lessons learned from the national training program in France. Semin Pediatr Surg. https:\/\/doi.org\/10.1016\/J.SEMPEDSURG.2020.150902","journal-title":"Semin Pediatr Surg"},{"key":"6435_CR31","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1016\/j.jsurg.2017.09.027","volume":"75","author":"P Mota","year":"2018","unstructured":"Mota P, Carvalho N, Carvalho-Dias E, Jo\u00e3o Costa M, Correia-Pinto J, Lima E (2018) Video-based surgical learning: improving trainee education and preparation for surgery. J Surg Educ Elsevier Inc 75:828\u2013835. https:\/\/doi.org\/10.1016\/j.jsurg.2017.09.027","journal-title":"J Surg Educ Elsevier Inc"},{"key":"6435_CR32","doi-asserted-by":"publisher","DOI":"10.1001\/JAMASURG.2021.0031","volume":"156","author":"BK Smith","year":"2021","unstructured":"Smith BK, Rectenwald J, Yudkowsky R, Hirshfield LE (2021) A framework for understanding the association between training paradigm and trainee preparedness for independent surgical practice. JAMA Surg 156:1. https:\/\/doi.org\/10.1001\/JAMASURG.2021.0031","journal-title":"JAMA Surg"},{"key":"6435_CR33","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1177\/00031348251337168","volume":"91","author":"E Aguayo","year":"2025","unstructured":"Aguayo E, Dixon J, Namm J, Benharash P (2025) Great debates: the wave of the future vs tried and true: integrated training in surgery vs general surgery training followed by fellowship. Am Surg Am Surg 91:1594\u20131597. https:\/\/doi.org\/10.1177\/00031348251337168","journal-title":"Am Surg Am Surg"},{"key":"6435_CR34","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/SLA.0000000000003032","volume":"269","author":"EJ Elsey","year":"2019","unstructured":"Elsey EJ, Griffiths G, West J, Humes DJ (2019) Changing autonomy in operative experience through UK general surgery training: a national cohort study. Ann Surg 269:399\u2013406. https:\/\/doi.org\/10.1097\/SLA.0000000000003032","journal-title":"Ann Surg"},{"key":"6435_CR35","doi-asserted-by":"publisher","DOI":"10.1186\/S12909-025-06727-5","author":"S Drossard","year":"2025","unstructured":"Drossard S, Schuffert L (2025) Challenges and opportunities in pediatric surgery training in Germany: a view from the trenches. BMC Med Educ. https:\/\/doi.org\/10.1186\/S12909-025-06727-5","journal-title":"BMC Med Educ"}],"container-title":["Pediatric Surgery International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00383-026-06435-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00383-026-06435-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00383-026-06435-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T07:59:43Z","timestamp":1778486383000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00383-026-06435-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6435"],"URL":"https:\/\/doi.org\/10.1007\/s00383-026-06435-1","relation":{},"ISSN":["1437-9813"],"issn-type":[{"value":"1437-9813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]},"assertion":[{"value":"9 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Confllict of interest"}},{"value":"The study was approved by the institutional ethics board, with waiver of informed consent due to its retrospective design and use of anonymized data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"223"}}