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const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Journal Club";
pres.title = "Rouviere's Sulcus - Journal Club";

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// ═══════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════
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  sl.addText("Morphological Variants of Rouviere's Sulcus\nand Its Significance in Patients Undergoing\nLaparoscopic Cholecystectomy:\nAn Emerging Paradigm", {
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// ═══════════════════════════════════════════════════════════════
// SLIDE 2 — AGENDA
// ═══════════════════════════════════════════════════════════════
{
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  addHeader(sl, "Agenda", "What we will cover today");
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    { text: "Background & Clinical Problem", bold: false },
    { text: "Why Rouviere's sulcus matters", bold: false },
    { text: "Study Design & Methods", bold: false },
    { text: "Key Findings — Morphological Classification", bold: false },
    { text: "Statistical Summary & Data", bold: false },
    { text: "Context from the Literature (Meta-analysis & Multicenter data)", bold: false },
    { text: "Strengths, Limitations & Bias", bold: false },
    { text: "Clinical Implications & Practice Change", bold: false },
    { text: "Discussion Questions", bold: false }
  ];
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// ═══════════════════════════════════════════════════════════════
// SLIDE 3 — BACKGROUND: THE PROBLEM
// ═══════════════════════════════════════════════════════════════
{
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  addHeader(sl, "Background — The Clinical Problem", "Bile duct injury in laparoscopic cholecystectomy");
  addFooter(sl);

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    { text: "Laparoscopic cholecystectomy (LC) is the gold-standard treatment for symptomatic cholelithiasis", bold: true },
    { text: "Over 1 million LCs performed per year in the USA alone" },
    { text: "Iatrogenic bile duct injury (IBDI) remains the most feared complication", bold: true },
    { text: "Incidence: 0.3-0.7% — significantly higher than open cholecystectomy (~0.1-0.2%)" },
    { text: "Consequences: biliary strictures, hepatic atrophy, portal hypertension, reduced QoL, medicolegal burden" },
    { text: "Root cause: misidentification of biliary anatomy — particularly in the hepatocystic triangle" },
    { text: "Safe dissection requires a reliable anatomic LANDMARK independent of biliary anatomy" }
  ], { y: 1.3, h: 3.85 });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 4 — WHAT IS ROUVIERE'S SULCUS
// ═══════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeader(sl, "What is Rouviere's Sulcus?", "Anatomy & landmark significance");
  addFooter(sl);

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    { text: "A fissure on the inferior surface of the right liver lobe, to the right of the hepatic hilum, running in the caudate process", options: { breakLine: true, fontSize: 14, color: DARKGRAY } },
    { text: " ", options: { breakLine: true } },
    { text: "Described by Henri Rouviere (1924)", options: { bold: true, color: TEAL, breakLine: true, fontSize: 15 } },
    { text: "Later confirmed as a reliable extrahepatic surface landmark", options: { breakLine: true, fontSize: 14, color: DARKGRAY } },
    { text: " ", options: { breakLine: true } },
    { text: "Surgical Significance", options: { bold: true, color: TEAL, breakLine: true, fontSize: 15 } },
    { text: "Indicates the plane of the right portal pedicle — dissection ABOVE this level avoids bile duct injury", options: { fontSize: 14, color: DARKGRAY } }
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    { text: " — 38% of cases", options: { breakLine: true, color: DARKGRAY } },
    { text: "Right posterior portal pedicle", options: { bullet: true, breakLine: true, bold: true, color: TEAL } },
    { text: " — 37% of cases", options: { breakLine: true, color: DARKGRAY } },
    { text: "Right posteroinferior pedicle", options: { bullet: true, breakLine: true, bold: true, color: TEAL } },
    { text: " — 23.5% of cases", options: { breakLine: true, color: DARKGRAY } },
    { text: " ", options: { breakLine: true } },
    { text: "Prevalence (meta-analysis of 6,661 cases):", options: { bold: true, breakLine: true, color: NAVY } },
    { text: "Present in ~80% of patients", options: { bold: true, fontSize: 16, color: TEAL } }
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 5 — STUDY DESIGN
// ═══════════════════════════════════════════════════════════════
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  sl.background = { color: WHITE };
  addHeader(sl, "Study Design & Methods", "Prospective observational study");
  addFooter(sl);

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    { text: " Prospective observational", options: { breakLine: true } },
    { text: "Setting:", options: { bold: true, breakLine: false, color: NAVY } },
    { text: " Multiple tertiary centers, New Delhi & Bihar, India", options: { breakLine: true } },
    { text: "Period:", options: { bold: true, breakLine: false, color: NAVY } },
    { text: " Not explicitly stated (2024 submission)", options: { breakLine: true } },
    { text: "Primary endpoint:", options: { bold: true, breakLine: false, color: NAVY } },
    { text: " Morphological classification of RS", options: { breakLine: true } },
    { text: "Secondary endpoint:", options: { bold: true, breakLine: false, color: NAVY } },
    { text: " Correlation with hepatobiliary anatomy & surgical safety", options: { breakLine: true } },
    { text: "Data collected:", options: { bold: true, breakLine: false, color: NAVY } },
    { text: " Intraoperative observations during LC" }
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    { text: "330 patients enrolled", options: { bold: true, breakLine: true, color: TEAL, fontSize: 16 } },
    { text: "28 excluded", options: { bold: true, breakLine: true, color: GOLD } },
    { text: " — dense adhesions preventing sulcus visualization", options: { breakLine: true } },
    { text: "302 patients analyzed", options: { bold: true, breakLine: true, color: TEAL, fontSize: 15 } },
    { text: "Indication:", options: { bold: true, breakLine: false, color: NAVY } },
    { text: " Symptomatic cholelithiasis requiring LC", options: { breakLine: true } },
    { text: "Exclusion:", options: { bold: true, breakLine: false, color: NAVY } },
    { text: " Dense adhesions (28/330 = 8.5%)" }
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 6 — PROPOSED CLASSIFICATION
// ═══════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeader(sl, "Proposed Classification of Rouviere's Sulcus", "7-type morphological system — Kanhaiya et al., 2026");
  addFooter(sl);

  const types = [
    { label: "ABSENT",  pct: "24.1%", color: MIDGRAY,  desc: "No visible sulcus" },
    { label: "OPEN",    pct: "28.8%", color: TEAL,     desc: "Widely patent groove" },
    { label: "GROOVE",  pct: "24.8%", color: "1E8B6D",  desc: "Shallow trough without lips" },
    { label: "CLOSE",   pct: "14.4%", color: "2C6FAC",  desc: "Lips approximated, lumen present" },
    { label: "SLIT",    pct: "8.7%",  color: "5B4A91",  desc: "Very narrow opening, slit-like" },
    { label: "PIT",     pct: "8.2%",  color: "A0522D",  desc: "Blind-ended pit, no lateral extent" },
    { label: "SCAR",    pct: "10.0%", color: DARKGRAY, desc: "Fibrosed, obliterated sulcus" },
    { label: "FUSED",   pct: "4.8%",  color: NAVY,     desc: "Lips fused together" }
  ];

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  sl.addText("* Percentages are of the 302 visualized cases. Absent type = 24.1% of the full 302-patient cohort.", {
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 7 — DATA SUMMARY / STATS
// ═══════════════════════════════════════════════════════════════
{
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  sl.background = { color: LTGRAY };
  addHeader(sl, "Key Results at a Glance", "Summary of findings from 302 patients");
  addFooter(sl);

  addStatCard(sl, "Patients Enrolled", "330",  0.3,  1.3, 2.0, 1.2);
  addStatCard(sl, "Patients Analyzed", "302",  2.5,  1.3, 2.0, 1.2);
  addStatCard(sl, "RS Present", "75.8%",       4.7,  1.3, 2.0, 1.2);
  addStatCard(sl, "RS Absent", "24.1%",        6.9,  1.3, 2.0, 1.2);

  addStatCard(sl, "Most Common Type: OPEN",   "28.8%", 0.3,  2.65, 2.9, 1.1);
  addStatCard(sl, "2nd Most Common: GROOVE",  "24.8%", 3.35, 2.65, 2.9, 1.1);
  addStatCard(sl, "Least Common: FUSED",       "4.8%", 6.4,  2.65, 3.3, 1.1);

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    { text: "Safe surgery achieved in 100% of cases ", options: { bold: true, fontSize: 18, color: WHITE } },
    { text: "(302/302)", options: { fontSize: 14, color: GOLD } },
    { text: " by using RS as a dissection-level landmark — no bile duct injuries reported in this cohort.", options: { fontSize: 14, color: WHITE } }
  ], { x: 0.35, y: 3.9, w: 9.2, h: 0.95, fontFace: "Calibri", align: "center", valign: "middle" });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 8 — CONTEXT FROM LITERATURE
// ═══════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeader(sl, "Context from the Literature", "How this study compares to prior evidence");
  addFooter(sl);

  // Row 1 — meta-analysis
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    x: 0.35, y: 1.3, w: 9.3, h: 1.4,
    fill: { color: LTGRAY }, line: { color: TEAL, pt: 1.5 }, rectRadius: 0.08
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  sl.addText("Manatakis et al. 2022 — Systematic Review & Meta-analysis (PMID: 34542789)", {
    x: 0.5, y: 1.35, w: 9.0, h: 0.38,
    fontSize: 12, bold: true, color: TEAL, fontFace: "Calibri"
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  sl.addText("27 surgical + 11 cadaveric studies | n = 6,661 cases | Pooled RS prevalence = 80% | Open type 64.5% vs Fused 35.5% | Proposed simplified 3-tier classification (groove / slit / scar). Note: erratum issued (PMID 34657247).", {
    x: 0.5, y: 1.75, w: 9.0, h: 0.85,
    fontSize: 12, color: DARKGRAY, fontFace: "Calibri"
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  // Row 2 — Italian multicenter
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    fill: { color: LTGRAY }, line: { color: NAVY, pt: 1.5 }, rectRadius: 0.08
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  sl.addText("Cirocchi et al. 2025 — Italian Multicenter Observational Study (PMID: 39648626)", {
    x: 0.5, y: 2.9, w: 9.0, h: 0.38,
    fontSize: 12, bold: true, color: NAVY, fontFace: "Calibri"
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  sl.addText("n = 111 patients | RS present in 83.8% | Singh-Prasad type 1A = 48.4% | Dahmane open 48.4% vs fused 51.6% | Concludes RS reduces IBDI when used as landmark.", {
    x: 0.5, y: 3.3, w: 9.0, h: 0.85,
    fontSize: 12, color: DARKGRAY, fontFace: "Calibri"
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  // Row 3 — comparison note
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    fill: { color: GOLD }, line: { color: GOLD }, rectRadius: 0.08
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  sl.addText("This study adds 7 novel sub-types (vs prior binary or 3-tier systems) and is the only prospective Indian population study documenting all variants intraoperatively in a single cohort.", {
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    fontSize: 12, bold: true, color: NAVY, fontFace: "Calibri", valign: "middle"
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 9 — STRENGTHS & LIMITATIONS
// ═══════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeader(sl, "Strengths & Limitations", "Critical appraisal");
  addFooter(sl);

  // Left: Strengths
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    x: 0.3, y: 1.3, w: 4.6, h: 3.9,
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  sl.addText("STRENGTHS", {
    x: 0.3, y: 1.3, w: 4.6, h: 0.4,
    fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri",
    align: "center", valign: "middle", fill: { color: "27AE60" }
  });
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    { text: "Prospective study design — reduces recall bias", options: { bullet: true, breakLine: true } },
    { text: "Large Indian population cohort (n=330) — underrepresented in prior literature", options: { bullet: true, breakLine: true } },
    { text: "Intraoperative documentation — direct visualization vs retrospective imaging", options: { bullet: true, breakLine: true } },
    { text: "7-type classification adds granularity over prior binary/3-tier systems", options: { bullet: true, breakLine: true } },
    { text: "100% surgical safety reported — no IBDI in cohort", options: { bullet: true } }
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    { text: "28 patients excluded (adhesions) — may skew prevalence data", options: { bullet: true, breakLine: true } },
    { text: "No long-term outcomes (biliary complications, strictures) tracked", options: { bullet: true, breakLine: true } },
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// ═══════════════════════════════════════════════════════════════
// SLIDE 10 — CLINICAL IMPLICATIONS
// ═══════════════════════════════════════════════════════════════
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    { text: "Always identify RS before beginning cystic duct / artery dissection — it is an extra-biliary landmark that does not require bile duct visualization", bold: true },
    { text: "Dissection should be conducted ABOVE the plane of RS to remain in the safe zone" },
    { text: "In 24.1% of patients RS is absent — a missing sulcus should prompt extra caution, not reassurance" },
    { text: "The scar and fused types (combined ~14.8%) may mimic absence — tactile exploration + traction assist visualization" },
    { text: "This classification aids surgical documentation and intraoperative teaching — name the type seen in your operative note" },
    { text: "RS should be used alongside the Critical View of Safety (CVS), not as a replacement" },
    { text: "Future multicentre prospective RCTs should assess whether mandatory RS identification reduces IBDI rates vs CVS alone" }
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// ═══════════════════════════════════════════════════════════════
// SLIDE 11 — DISCUSSION QUESTIONS
// ═══════════════════════════════════════════════════════════════
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    "4.  This study is from India. Are there reasons to expect RS morphology to differ across ethnicities or BMI distributions — and does that affect generalizability?",
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// ═══════════════════════════════════════════════════════════════
// SLIDE 12 — SUMMARY / CONCLUSION
// ═══════════════════════════════════════════════════════════════
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    { text: "7 distinct morphological types described — open & groove are most common (>50% combined)", bg: "1E8B6D" },
    { text: "Using RS as a dissection landmark achieved safe surgery in all 302 visualizable cases", bg: "2C6FAC" },
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// ── Write file ─────────────────────────────────────────────────
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