Peter MacCallum Cancer Centre

Background The adoption of robotic-assisted surgery (RAS) in colorectal procedures is growing rapidly, driven by advancements in technology and recognition of its clinical benefits. The dissemination of RAS technology relies heavily on robotic proctors, who are tasked with training and guiding their peers in adopting these advanced techniques. Despite their critical role, there is limited understanding of the training, responsibilities, and challenges faced by robotic proctors. A qualitative study was conducted using focus groups to understand the experiences, challenges, and training approaches of robotic colorectal surgery proctors in the UK and Ireland. Established proctors were invited to participate in the focus groups and to share insights into their practices, training methods, and the current state of robotic proctorship. The data were analysed thematically using NVivo software. Ten expert robotic surgeons participated in our study, with the majority working with Intuitive Surgical® platforms (n = 9, 90%). Over 60% had been robotic trainers for more than 6 years and 60% were considered high-volume proctors, having proctored over 30 surgeons, and conducted more than 20 proctored cases annually. Thematic analysis revealed eight interconnected themes: proctor selection, proctor responsibilities, proctored training, accreditation, challenges, industry-proctor partnerships, emerging technologies, and network and support. Robotic proctoring is essential for scaling RAS adoption, however, it is a complex arena, with significant gaps in training frameworks and support systems. Establishing standardised guidelines and professional support structures is critical to ensure consistency, quality, and safety in robotic surgical training.

With the rapidly increasing use of robotic-assisted surgery in gynecology, there is a clear need for a structured robotic hysterectomy curriculum. To develop an effective training program, valid performance metrics that reliably assess skill level is required. As part of robotic curriculum development with IMRA using Kern’s framework, this systematic review aims to identify proposed metrics of competence and assess their validity within the context of robotic hysterectomy training. A systematic literature search of OVID MEDLINE and EMBASE was conducted following the PRISMA guidelines, with keywords related to ‘hysterectomy’, ‘robot-assisted’, and ‘metric’. The study aims, methods, outcomes, description of metrics, measurements of metrics, and metrics validity were extracted and analyzed. The initial search yielded 531 articles, of which 3 were included. Three additional articles were identified through citation and website searching, resulting in a total of six articles being included in this review. Development and identification of both simulator and intraoperative metrics greatly varied between the studies. Several studies utilized an expert consensus-based methodology, such as a modified Delphi methodology, to develop performance metrics. All metrics were assessed for content, construct, and predictive validity. Two studies were able to demonstrate predictive validity; however, there was limited correlation between virtual reality simulator metrics and intraoperative scores. This review highlights the lack of standardized and validated metrics specific to robotic hysterectomy, as well as the inability of established assessment tools to differentiate between robotic surgical skill level. This forms the context for ongoing work at IMRA to develop a granular assessment tool to assess skill acquisition as part of a robotic hysterectomy curriculum.

Immune checkpoint inhibitors, a type of intravenous immunotherapy targeting T cells, are being increasingly used in cancer treatment. They work by increasing the immune system’s response to tumour cells, through blockade of inhibitory “checkpoint” receptors. Immune checkpoint inhibitors commonly induce immune-related adverse events (irAEs) affecting multiple organ systems. Hypophysitis is strictly an endocrine irAE, but is the most common irAE identified on neuroimaging. True neurologic irAEs are rare and widely varied. Examples include meningitis, encephalitis, vasculitis, demyelinating syndromes and neuritis. Some neurologic irAEs are not associated with neuroimaging findings (for example, neuromuscular junction disorders), while in others, imaging findings are present in only a proportion of patients (for example, encephalitis). Diagnosing, or at least considering, a neurologic irAE is important for instigating the appropriate management and optimising patient outcomes. This educational review illustrates irAEs that may be identified on neuroimaging and provides practical tips for optimising diagnosis, including relevant clinical considerations. Critical relevance statement Immune checkpoint inhibitors, which are being increasingly used in cancer treatment, commonly induce immune-related adverse events. This educational review illustrates the range of immune-related adverse events for which neuroimaging plays a key role in diagnosis. Key Points Immune checkpoint inhibitors commonly result in immune-related adverse events (irAEs) affecting multiple organ systems. Hypophysitis, the most common irAE identified on neuroimaging, is characterised by transient pituitary enlargement. True neurologic irAEs are rare and include meningitis, encephalitis, vasculitis, demyelination and neuritis. An understanding of the overall clinical picture is important for supporting the diagnosis. Graphical Abstract

Improved biomarkers of treatment response are needed for patients with high-grade serous ovarian cancer (HGSC). A challenge is substantial anatomical site-to-site variation in expression. We completed data-independent acquisition–mass spectrometry (DIA-MS) analysis of 404 fresh frozen and 78 formalin-fixed, paraffin-embedded HGSC tissue samples from the ovary (adnexal) and a common secondary site (omentum) in 11 patients. This was compared with mutation testing, gene expression, and whole-genome copy number profiling. Proteins with relatively stable intra- and variable inter-individual expression ( n = 1651), included a 52-protein module reflecting interferon-mediated tissue inflammation, indicative of a cGAS-STING pathway cytosolic double-stranded (ds) DNA response. The dsDNA sensing/inflammation score was higher in the omentum compared with the ovary. Ovarian HGSC samples showed marked inter-individual differences in inflammatory and immune responses to DNA damage. Stable discriminative features of the HGSC proteome, a prerequisite for clinical predictive biomarkers, are detectable in ovary (adnexal) tissue samples.

This retrospective analysis of Hedgehog inhibitor treatment in 32 patients with Gorlin syndrome, locally advanced and metastatic basal cell carcinoma (BCC) at three tertiary referral centres in Victoria, Australia from April 2017 until 30 June 2024 demonstrated an 84% overall objective response rate (partial and complete response combined). However, 90% of patients experienced adverse effects impacting quality of life. Secondary acquired drug resistance occurred in 77% (10/13) of locally advanced and metastatic BCC patients after a median duration of 13 months. Further work is needed to optimise the neoadjuvant use of Hedgehog inhibitors with radiotherapy or surgery given poor long‐term Hedgehog inhibitor tolerability and to develop strategies to counteract the issue of acquired resistance.