SummaryTrauma hybrid operating rooms (THORs) integrate diagnostic imaging with open surgical capabilities to provide both surgical and interventional radiology procedures, such as may be required by exsanguinating patients, in a single physical location. The world's first trauma program-designed THOR, designated the Resuscitation with Angiography, Percutaneous Treatments, and Operative Repair (RAPTOR) suite, opened in Calgary in 2013. It was considered to be paradigm shifting at the time; however, the physical space has become largely obsolete and is now disfavoured by key multidisciplinary users who are essential to RAPTOR functionality. Many health care systems worldwide are considering building such THORs, and lessons learned from early adopters may be invaluable to other planners. We critically evaluated the physical, operational, and administrative components of our RAPTOR experience in the context of the published literature. While the concept has great merit in saving lives, future-proofing such resources is critical.

SummaryHenry Thomas Hadley Williams, known professionally as Hadley Williams, was a surgeon and teacher whose career illustrates the transformation of surgery in Canada from a craft learned by apprenticeship to a university and hospital discipline. Born in Devon, England, in 1864 and educated in southwestern Ontario, Williams returned to Britain for advanced surgical training and became a Fellow of the Royal College of Surgeons of England in 1899. In 1911 he succeeded John Wishart, the University of Western Ontario's first professor of clinical surgery, and consolidated a pre-Flexner surgical inheritance within the post-Flexner university. His own papers on suprapubic cystostomy, peripheral nerve injury, internal fixation, and perforated gastroduodenal ulcer show a practical surgeon concerned with infection, tissue handling, anatomic repair, timing, and functional recovery. His career at Victoria Hospital, St. Joseph's Hospital, and the University of Western Ontario (rebranded Western University in 2012) places him within the first generation of organized North American specialist surgery and helps explain how modern surgical standards took local institutional form in Canada.

SummaryAnesthesia workforce shortages are an increasingly important contributor to operating room closures and surgical delays. These gaps disproportionately affect rural and regional hospitals, limiting equitable access to surgery. This commentary outlines how Canada can modernize the anesthesia care team (ACT) model to sustain surgical capacity while maintaining patient safety. Anesthesia assistants (AAs), trained professionals working under anesthesiologist supervision, already support perioperative care in many centres but remain underutilized. Standardizing AA credentials, defining supervision based on case conditions rather than fixed ratios, and implementing transparent safety reporting could expand access responsibly. Surgeons, as procedural leaders whose productivity depends on anesthesia workforce availability, should understand the ACT framework and its safeguards. Strengthening collaboration between surgical and anesthesia leadership offers a practical path to preserve access to surgery and reduce wait times without compromising safety.

SummaryReprocessing single-use arthroscopic instruments - particularly radio-frequency devices and suture-passing devices - has become standard practice in Zhejiang Province, China. Although this approach offers substantial economic advantages, emerging evidence suggests that reuse of certain items may pose elevated risks of thermal injury and mechanical failure. Here, we discuss the prevalence of this practice within China, outline documented hazards, propose evidence-based mitigation strategies, and explore the ethical dimensions of resource-limited surgical care.