Updates in Surgery最新文献

{"title":"Ambulatory inguinal hernia repair in Portugal - a multicenter prospective cohort study.","authors":"","doi":"10.1007/s13304-025-02084-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02084-6","url":null,"abstract":"<p><p>Ambulatory surgery is the recommended approach for elective inguinal hernia repair for most people. However, the relative use of this procedure in Portugal and its related outcomes are unknown. We aimed to assess complication rates in patients undergoing ambulatory and inpatient surgery. Prospective multicentric cohort study included consecutive patients undergoing elective inguinal hernia repair in mainland Portugal (October-December 2019). The primary outcome was the post-operative complication rate (any Clavien-Dindo grade) among patients undergoing ambulatory and inpatient surgery. A logistic regression analysis was performed to adjust for patient and disease-related co-variables. Eight hundred twenty-eight patients (89.1% of males) were included from thirty-three hospitals, of which seven hundred sixteen (86.4%) had unilateral hernias. Four hundred thirty-three (52.2%) were operated on as day cases and three hundred ninety-five (47.7%) with overnight stays. There were no significant differences in post-operative complication rate between patients undergoing ambulatory and overnight stay surgery, both in unadjusted (9.9% vs. 11.1%; p = 0.650) and adjusted (odds ratio: 1.08 [95% CI 0.66-1.76]) analyses. Ambulatory surgery was only performed in half of the patients, although this procedure is not associated with an increased risk of complications. These results should promote the expanded use of ambulatory surgery in patients eligible for elective inguinal hernia repair.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711113","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}

{"title":"Protective ileostomy creation after anterior resection of the rectum (PICARR): a decision-making exploring international survey.","authors":"Andrea Balla, Federica Saraceno, Marika Rullo, Salvador Morales-Conde, Eduardo M Targarona Soler, Salomone Di Saverio, Mario Guerrieri, Pasquale Lepiane, Nicola Di Lorenzo, Michel Adamina, Isaias Alarcón, Alberto Arezzo, Jesus Bollo Rodriguez, Luigi Boni, Sebastiano Biondo, Francesco Maria Carrano, Manish Chand, John T Jenkins, Justin Davies, Salvadora Delgado Rivilla, Paolo Delrio, Ugo Elmore, Eloy Espin-Basany, Alessandro Fichera, Blas Flor Lorente, Nader Francis, Marcos Gómez Ruiz, Dieter Hahnloser, Eugenio Licardie, Carmen Martinez, Monica Ortenzi, Yves Panis, Carlos Pastor Idoate, Alessandro M Paganini, Miguel Pera, Roberto Perinotti, Daniel A Popowich, Timothy Rockall, Riccardo Rosati, Alberto Sartori, Daniele Scoglio, Mostafa Shalaby, Vicente Simó Fernández, Neil J Smart, Antonino Spinelli, Patricia Sylla, Pieter J Tanis, Javier Valdes Hernandez, Steven D Wexner, Pierpaolo Sileri","doi":"10.1007/s13304-025-02111-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02111-6","url":null,"abstract":"<p><p>In our previous survey of experts, surgeon's decision-making process (DMP) about protective ileostomy (PI) creation after anterior resection was investigated. Based on our previous data, a multiple choice questionnaire has been developed. The aim is to perform a quantitative analysis of the results obtained from an international survey and to describe the clinical practice worldwide. Ten questions were related to participants' demographics and, 20 questions (of which 17 Likert scale questions) investigated the DMP regarding PI creation. To evaluate the tendency of the answers in the Likert-type questions, the mean of the answers obtained was compared with the mean point of the Likert scale. The survey was completed by 1019 physicians. Neoadjuvant chemoradiotherapy and distance of the anastomosis from the anal verge ≤ 10 cm were each considered alone sufficient to justify creation of a PI, with statistically significant differences in comparison to the mean point of the scales in (p =  < 0.0001 in both cases). Total Mesorectal Excision alone was not considered a factor sufficient to create a PI (p = 0.416). Most of the participants agree to define their approach to create a PI \"tailored\" to patients' risk factors (p =  < 0.0001) and \"influenced by my experience\" in case of patients with low/moderate risk of anastomotic leakage (p =  < 0.0001). This study provides useful insights on the worldwide clinical practice regarding creation of PI following anterior resection. Given the lack of standardization and evidence-based guidelines, this analysis may be helpful to assist surgeons' practice.</p>","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":"143692979","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}

{"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":"<p><p>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/.</p>","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}

{"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":"<p><p>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.</p>","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}

{"title":"Robotic stapled cardioplasty, an alternative before esophagectomy.","authors":"Elisenda Garsot, Arantxa Clavell, Pau Moreno, Marta Viciano","doi":"10.1007/s13304-025-02161-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02161-w","url":null,"abstract":"<p><p>Robotic stapled cardioplasty offers a novel, minimally invasive alternative for treating end-stage achalasia, a rare esophageal motor disorder. Achalasia is characterized by the inability of the lower esophageal sphincter to relax and reduced peristalsis, with about 5% of patients progressing to a stage where esophagectomy is often the only treatment option. This study introduces robotic stapled cardioplasty as a less aggressive, organ-preserving approach. Using a robotic platform, the procedure improves visibility, precision, and careful dissection, making it especially useful in complex revision cases. To our knowledge, this is the first reported case of robotic stapled cardioplasty for end-stage achalasia. It appears to be a safe and effective minimally invasive alternative to esophagectomy and may also serve as a rescue procedure for patients who have exhausted other treatment options before considering organ resection.</p>","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":"143664652","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}

{"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":"<p><p>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.</p>","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}

{"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":"<p><p>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.</p>","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}

{"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":"<p><p>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.</p>","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}

{"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":"<p><p>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.</p>","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}

{"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":"<p><p>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.</p>","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}