Updates in Surgery最新文献_第6页

The efficacy and safety of different negative-pressure wound therapy gradients on flaps outcomes.

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-23 DOI: 10.1007/s13304-025-02156-7

O H Elbanna, A Salah Eldine, A M Sayed, A K Mousa

{"title":"The efficacy and safety of different negative-pressure wound therapy gradients on flaps outcomes.","authors":"O H Elbanna, A Salah Eldine, A M Sayed, A K Mousa","doi":"10.1007/s13304-025-02156-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02156-7","url":null,"abstract":"Negative pressure wound therapy (NPWT) has been shown to be beneficial for improving the wound healing process and reducing flap complications. However, the ideal NPWT settings, especially the pressure levels and application modes, are still debatable. This study examines the efficacy and safety of NPWT at different pressure gradients, namely, high (HNPWT) and low (LNPWT), to determine the optimal conditions for improving flap outcomes and minimizing complications. Over a 30-month period, 65 patients who underwent flap reconstruction were randomly assigned to three groups: HNPWT (75-125 mmHg, continuous mode), LNPWT (50-75 mmHg, intermittent mode), and conventional wound dressing (CWD). Patients were evaluated prospectively for post-operative complications, flap viability, infection, edema, and wound dehiscence. Complications were more common in the CWD group than in the HNPWT group, while the HNPWT group had the highest incidence of flap ischemia (41%). NPWT significantly reduced post-operative edema (P = 0.003) and lower infection and dehiscence rates than the CWD group (P = 0.015 and P = 0.029, respectively). Compared with HNPWT, LNPWT showed superior safety and efficacy, with fewer ischemic events, lower pain scores, faster wound healing times, and better esthetic and function outcomes. Although NPWT offers benefits over conventional wound dressing in flap reconstructions, pressure settings should be carefully adjusted. LNPWT is safer and has more satisfactory outcomes than HNPWT, with reduced ischemia and better overall healing. These findings suggest that LNPWT in the intermittent mode is most favorable for improving flap viability and minimizing adverse effects.Registration identification number NCT06080958- July 22, 2024. \"Retrospectively registered\" URL for the registry: http://www.clinicaltrials.gov/.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mesoappendix position variations in laparoscopic appendicectomy; a new anatomical classification to guide surgical strategy.

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-21 DOI: 10.1007/s13304-025-02172-7

Ernest Cheng, Raphael Shamavonian, Jasmine Mui, Zachary Bunjo, Amer Matar, Jon Barnard, Amit Sarkar, Wilson Petrushnko

{"title":"Mesoappendix position variations in laparoscopic appendicectomy; a new anatomical classification to guide surgical strategy.","authors":"Ernest Cheng, Raphael Shamavonian, Jasmine Mui, Zachary Bunjo, Amer Matar, Jon Barnard, Amit Sarkar, Wilson Petrushnko","doi":"10.1007/s13304-025-02172-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02172-7","url":null,"abstract":"Dissection of the mesoappendix from the appendix is a crucial step in laparoscopic appendicectomies. Variation in the position of the mesoappendix during this common operation has not been previously described. We propose a classification system for the mesoappendix position seen laparoscopically and evaluate the impact each position has on operative difficulty and surgical approach. The mesoappendix positions in laparoscopic appendicectomies between January 2023 and January 2024 were classified into four categories from M1 to M4. Patients were grouped according to their mesoappendix positions. Outcomes evaluated included operative time, need for additional ports, use of energy devices, deviations from standard operative approach. Various mesoappendix positions were correlated with the intra-operative appendix position and histopathological findings. 104 laparoscopic appendicectomy cases were reviewed. 30 were classified as M1, 31 as M2, 27 as M3, and 16 as M4. Mean operative time was significantly longer for cases where the mesoappendix was in the M3 position (p > 0.001). This position was also more likely to require an additional port and deviate from the standard operative approach including need for retrograde dissection and staple cecectomy. We introduce a potentially surgical important classification system of the mesoappendix in laparoscopic appendicectomies. In this study, we attempt to validate the differences each position has on operative approaches and outcomes. We found that the M3 position is of greater difficulty to approach when dissecting the mesoappendix. This classification may serve as a valuable tool in guiding intra-operative surgical decision-making.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Robotic stapled cardioplasty, an alternative before esophagectomy.

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-19 DOI: 10.1007/s13304-025-02161-w

Elisenda Garsot, Arantxa Clavell, Pau Moreno, Marta Viciano

引用次数: 0

Survival benefit and impact of adjuvant chemotherapy following neoadjuvant therapy in patients with locally advanced rectal cancer.

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-19 DOI: 10.1007/s13304-025-02175-4

Pengwen Zheng, Mengzhen Xu, Dening Ma, Longhai Feng, Jing Qin, Xinyi Gao

{"title":"Survival benefit and impact of adjuvant chemotherapy following neoadjuvant therapy in patients with locally advanced rectal cancer.","authors":"Pengwen Zheng, Mengzhen Xu, Dening Ma, Longhai Feng, Jing Qin, Xinyi Gao","doi":"10.1007/s13304-025-02175-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02175-4","url":null,"abstract":"The controversy surrounding the continuation of postoperative adjuvant chemotherapy (AC) for locally advanced rectal cancer patients who underwent neoadjuvant therapy (NAT) still existed. The study aimed to identify the individuals that would benefit from AC from those with stage ypII/III rectal cancer. Data for this retrospective study were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and the local database. Subgroup differentiation of the beneficiary population by classification and regression tree analysis. The primary endpoint was overall survival (OS). 15,671 patients were included from the SEER database and 508 patients from local database. The proportions receiving AC were 41.9% in the SEER database and 77.6% in local database, respectively. Analysis results illustrated that the AC benefited population in the SEER database was characterized as: stage ypT4/N + patients (HR 0.75, 95% CI 0.69-0.82, p < 0.001); stage ypT3N0 patients aged 70 years or older (HR 0.69, 95% CI 0.56-0.83, p < 0.001). Moreover, stage ypT4/N + patients also significantly benefited from AC in local database (HR 0.48, 95% CI 0.31-0.74, p < 0.001). The analysis of the two databases showed that stage ypT3N0 patients aged < 70 years could not significantly benefit from AC (HR 0.90, p = 0.114 in the SEER database; HR 0.90, p = 0.960 in local database). Postoperative adjuvant chemotherapy provides a significant benefit in patients with stage ypT4/N + rectal cancer following neoadjuvant therapy. Our study discovered that locally advanced rectal cancer patients with aggressive tumors might benefit from postoperative adjuvant chemotherapy and prolonged the survival.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Current state-of-the-art of adrenal surgery in Italy: the cancer risk in surgical adrenal lesions (CRISAL) survey.

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-17 DOI: 10.1007/s13304-025-02139-8

Diletta Corallino, Roberto Passera, Marco Inama

{"title":"Current state-of-the-art of adrenal surgery in Italy: the cancer risk in surgical adrenal lesions (CRISAL) survey.","authors":"Diletta Corallino, Roberto Passera, Marco Inama","doi":"10.1007/s13304-025-02139-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02139-8","url":null,"abstract":"Adrenalectomies are growing worldwide because of the frequent diagnosis of incidentaloma and the use of minimally invasive surgery (MIS). The factors used to identify a malignant lesion and the best surgical technique are uncertain. In this context, the definition of high-volume center and expert surgeon is under debate. The Italian Society of Endoscopic Surgery and New Technologies (SICE) developed a nationwide survey to investigate the state-of-the-art of adrenal surgery in Italy. A web-based survey comprising 37 questions was developed and distributed to Italian surgeons involved in adrenal surgery. Two hundred forty-eight answers were analyzed. Consensus was reached among the survey participants regarding local infiltration (83%) and rapid growth of the lesion (81%) as markers of malignancy. Nearly 30% of the participants used MIS in case of malignant adrenal lesions. The lateral (50%) and anterior transperitoneal (44%) approaches were the most common among Italian surgeons. Approximately 40% of participants believe that 20-40 adrenalectomies/year are needed to define an expert surgeon and at least 20 procedures/year to define a high-volume center. Approximately half of participants performed < 10 adrenalectomies/year in centers with a median volume < 10 procedures/year. Based on participant feedback, this survey highlights local infiltration and rapid growth as the most significant markers of malignant adrenal lesions. While open adrenalectomy remains the gold standard for suspected malignant lesions, nearly 30% of the participants practice MIS even in these cases. The lateral and anterior transperitoneal approaches emerge as the most familiar for Italian surgeons. A substantial proportion of Italian patients with adrenal lesions undergo surgery performed by surgeons with an annual case volume < 10 procedures, at centers with a low annual volume of adrenalectomies. Moreover, there is a lack of standardized definitions for 'expert surgeon' and 'high-volume center' in this context.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring women representation in major surgical society annual meetings in Italy.

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-17 DOI: 10.1007/s13304-025-02154-9

Roberta Tutino, Andrea Tamburini, Roberta Dimalio, Beatrice Salmaso, Bruno Scotto, Roberto Passera, Paola De Nardi

{"title":"Exploring women representation in major surgical society annual meetings in Italy.","authors":"Roberta Tutino, Andrea Tamburini, Roberta Dimalio, Beatrice Salmaso, Bruno Scotto, Roberto Passera, Paola De Nardi","doi":"10.1007/s13304-025-02154-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02154-9","url":null,"abstract":"Gender diversity is increasing in medical schools and among physicians, including in surgical residency and among surgeons. However, leadership roles do not appear to be growing proportionately. To assess whether gender equality within the surgical community is improving, we analyzed gender representation in leading roles at two major events within the field in Italy in 2023. Of the 1,566 participants in leadership roles, 199 (12.71%) were women and 1,368 (87.29%) were men. Women consistently made up less than 25% of session invited speakers, with the highest representation in breast (23.5%), peritoneum (21.6%), endocrine (21.5%), and emergency (20.1%) sessions. Female speakers accounted for less than 10% of the presentations in bariatric, colon, esophageal, and stomach sessions. Moreover, women made up just 5.1% and 21% of scientific secretaries in the two conferences, respectively. Gender representation was found to be independently associated with conference participation (p < 0.001), role (p < 0.001), and topic (p < 0.001). The underrepresentation of women at major annual surgical society meetings in Italy reflects a larger issue of gender disparity within the surgical field. To prevent this gender gap from perpetuating into future generations, the surgical community must prioritize this issue. A shift is needed from simply \"tolerating diversity\" to actively recognizing and promoting its importance.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

EasyVis: a real-time 3D visualization software system for laparoscopic surgery box trainer.

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-16 DOI: 10.1007/s13304-025-02153-w

Yung-Hong Sun, Jianwei Ke, Jayer Fernandes, Jiangang Chen, Hongrui Jiang, Yu Hen Hu

{"title":"EasyVis: a real-time 3D visualization software system for laparoscopic surgery box trainer.","authors":"Yung-Hong Sun, Jianwei Ke, Jayer Fernandes, Jiangang Chen, Hongrui Jiang, Yu Hen Hu","doi":"10.1007/s13304-025-02153-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02153-w","url":null,"abstract":"EasyVis is an emerging immersive 3D laparoscopic visualization system for improving the efficiency of laparoscopic surgery. It integrates multiple micro-cameras and light sources with the surgical ports to provide intra-abdominal stereo vision of surgery at a desired viewpoint. In this work, we develop a visualization algorithm using the EasyVis micro-camera array assembly in a laparoscopic surgery training box environment with simplified training tasks to validate the feasibility of this novel technology. Since most laparoscopic surgical tools are rigid-body objects, their 3D shape may be acquired offline. We developed 2D object detection and track algorithms to acquire the 2D pose of each object and a 3D fusion algorithm to estimate and track the 3D pose of each object using estimated 2D poses. Then, together with the acquired 3D model of each object, we are able to render each object at a desired view using the 3D surface model (acquired offline) and images acquired from individual micro-cameras. In addition to the foreground rigid objects, the background 3D model is acquired using structured lights and structure from motion. The background is assumed to be slowly varying compared to the rapid motion of the foreground objects. As such, the background 3D model needs to be updated only occasionally. Our rendering algorithm is capable of integrating the foreground and background 3D models to facilitate image-based rendering from a desirable viewing angle. We performed experiments to validate the accuracy and quality of the rendered images.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Training in the use of basic functions of the daVinci Xi^® robot: a comparative study of residents' skills.

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-15 DOI: 10.1007/s13304-025-02150-z

Gaspare Cannata, Nicola Leone, Antonio Salzano, Fabrizio Rebecchi, Mario Morino

{"title":"Training in the use of basic functions of the daVinci Xi® robot: a comparative study of residents' skills.","authors":"Gaspare Cannata, Nicola Leone, Antonio Salzano, Fabrizio Rebecchi, Mario Morino","doi":"10.1007/s13304-025-02150-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02150-z","url":null,"abstract":"The rapid spread of the robotic surgical system has not been accompanied by an equally rapid creation of standardized training courses for the use of this technology.The purpose of our study was to evaluate skill acquisition in the handling and use of the daVinci Xi by comparing two groups of surgical residents. Surgical residents from the University of Turin were enrolled. The participants were divided into two groups: Group A: residents who had participated in at least 8 robotic surgical procedures, and Group B: residents who had never attended robotic surgery. All were administered two instructional videos on the patient cart and console exercises to be performed. Subsequently, the residents were tested and recorded to be evaluated by a senior surgeon experienced in robotic surgery, according to a previously assessed evaluation score. The time of the procedure was also recorded for each test. Patient cart exercises were completed by all participants. We found statistically significant differences between two groups for the first (p = 0.0000) and third (p = 0.0002) patient cart tests and for every test on the surgeon's console except the endoscope handling exercise. Group A scored higher on the patient cart exercises, and the difference reached statistical significance (p = 0.0001). The placement of a single hand-sewn knot on the silicone suture pad was the only exercise that was not fully completed by all participants and showed no statistical difference. The correlation analysis between surgical experience and final score was significant in Group A. The daVinci Xi robotic platform can be properly operated in its basic functions by young surgeons after a short training program even in the absence of previous exposure to robotic clinical procedure.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comment on: "Preoperative hemoglobin to albumin ratio as a prognostic predictor for patients with colorectal cancer surgery".

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-15 DOI: 10.1007/s13304-025-02176-3

Dongxing Zhang, Qifang Shi

引用次数: 0

Early compliance to enhanced recovery protocol as a predictor of complications after liver surgery.

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-03-14 DOI: 10.1007/s13304-025-02148-7

Cristina Ciulli, Alessandro Fogliati, Andrea Scacchi, Mauro Alessandro Scotti, Michele Aprigliano, Marco Braga, Fabrizio Romano, Mattia Garancini

{"title":"Early compliance to enhanced recovery protocol as a predictor of complications after liver surgery.","authors":"Cristina Ciulli, Alessandro Fogliati, Andrea Scacchi, Mauro Alessandro Scotti, Michele Aprigliano, Marco Braga, Fabrizio Romano, Mattia Garancini","doi":"10.1007/s13304-025-02148-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02148-7","url":null,"abstract":"Background: Enhanced Recovery Protocol (ERP) has the purpose of minimising postoperative hospitalisation and expediting the restoration of preoperative patient conditions. This study seeks to investigate the correlation between early non-compliance to postoperative items within ERP and complications in liver surgery.Methods: From January 2019 to December 2022 the ERP was proposed to all consecutive patients undergoing liver surgery. Nasogastric tube removal, resuming oral intake and mobilisation and obtaining an adequate glycaemic control were the postoperative items considered as non-compliance indicators. Data were prospectively collected and analysed.Results: 192 patients were included, comprising 99(51.6%) hepatocellular carcinoma, 58(30.2%) colorectal metastasis and 24(12.5%) benign/other pathology. A minimally invasive approach was adopted in 57.3% of cases. Postoperative morbidities occurred in 44.8% of patients, while major complications in 13% of patients. Cirrhosis (p < 0.001), minimally invasive approach (p < 0.004), early oral intake (p < 0.019) and early mobilisation (p < 0.019) significantly correlated to morbidity at multivariate analysis. The complication rate escalated from 26.9% in fully compliant patients, to 58% in patients with two non-compliance indicators and to 91.2% in fully non-compliant patients (p < 0.001). The same trend was confirmed for major complications (p < 0.001).Conclusions: Early non-compliance to ERP postoperative items in liver surgery was significantly associated with overall and major morbidity.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0