# Nanotechnology-Enhanced Materials and Smart Implants in General Surgery: A Systematic Review of Human Clinical Outcomes

## TL;DR

This systematic review evaluates how nanotechnology-enhanced materials and smart implants affect clinical outcomes in general surgery, finding them promising for infection prevention and cancer staging.

## Contribution

The study systematically reviews human clinical outcomes of nanotechnology-enhanced materials and smart implants in general surgery, comparing them to conventional methods.

## Key findings

- Silver-based topical creams improved wound healing and bacterial clearance.
- Carbon nanoparticle suspensions enhanced lymph node detection in cancer staging.
- Adverse effects of these technologies were minimal or absent.

## Abstract

Nanotechnology-enhanced materials and smart implants are emerging technologies that have shown promise in addressing various challenges in general surgery, including infection management, oncologic staging, and complication monitoring. In this systematic review, we aimed to examine the safety and efficacy of these technologies compared with conventional methods in patients undergoing general surgical procedures. A comprehensive search was conducted in MEDLINE (via PubMed), Embase, Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, WHO ICTRP, IEEE Xplore/Inspec, and Google Scholar according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, using standardized keywords related to nanotechnology, surgery, and clinical outcomes. The included studies were categorized according to intervention class and procedural type. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for nonrandomized studies, while outcome certainty was evaluated using GRADE. Nine eligible studies were included, comprising a total of 2,250 participants (infection prevention: 974; mapping/staging: 1,244; sensing: 32 drain-fluid samples). Due to heterogeneity among the studies, a meta-analysis could not be performed, and the results were therefore synthesized narratively. Silver-based topical creams and dressings demonstrated early bacterial clearance and improved wound healing. Carbon nanoparticle (CNP) suspensions enhanced lymph node detection sensitivity and preserved parathyroid hormone in thyroid cancer and nearly doubled sensitivity to micrometastatic lymph nodes in gastric cancer. Silver-ion-impregnated tracers in breast cancer showed comparable sensitivity for sentinel lymph node detection. Silver-ion-impregnated meshes showed no significant difference compared with conventional meshes. Overall, adverse effects were minimal or absent. In conclusion, nanotechnology-enhanced materials and smart implants show substantial potential to improve infection prevention, oncologic staging, and perioperative monitoring in general surgery, with minimal adverse effects. Silver-based topical antimicrobials, CNP suspensions, superparamagnetic iron oxide tracers, and innovative biosensor technologies were either comparable or superior to conventional alternatives. However, a clear knowledge gap regarding long-term outcomes and the heterogeneity of comparators highlights the need for larger, rigorously designed studies to guide clinical adoption.