Zentralblatt fur Chirurgie最新文献

{"title":"[The ACO Curriculum - Advanced Training Program in Surgical Oncology].","authors":"Tim Vilz, Simone Wesselmann, Roger Wahba, Helmut Witzigmann, Jörg Kleeff","doi":"10.1055/a-2859-8243","DOIUrl":"https://doi.org/10.1055/a-2859-8243","url":null,"abstract":"<p><strong>Abstract: </strong>The increasing centralisation of complex oncological procedures and the established relationship between surgical experience and patient outcomes necessitate new approaches in surgical training. The ACO curriculum provides a structured program that systematically integrates surgical expertise, interdisciplinary collaboration, and continuous professional development. Qualification requires defined clinical experience, theoretical knowledge, and successful completion of a standardised European examination. Upon completion, participants are awarded a certificate that is recognised within the certification processes of oncological centres. The curriculum thus represents a robust framework for quality-assured specialisation in surgical oncology.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Local Versus General Anaesthesia for Carotid Surgery: a Multicentre Study Matched by Propensity Score].","authors":"Radu Tabac, Shervin Taheripour, Corneliu Lisii, Mareike Ruckert, Carlotta Linder, Igor Cebotari, Daniel Kleinschmidt, Jessica Nentwig, Marie Schroeder, Sebastian Debus, Reinhart T Grundmann","doi":"10.1055/a-2845-6778","DOIUrl":"https://doi.org/10.1055/a-2845-6778","url":null,"abstract":"<p><strong>Purpose: </strong>Carotid endarterectomy (CEA) was performed under either local anaesthesia (LA) or general anaesthesia (GA) in patients with carotid artery stenosis. The perioperative outcome after 30 days was investigated using propensity score matching.</p><p><strong>Patients and methods: </strong>In this retrospective multicentre study, 1966 patients with symptomatic (37.9%) and asymptomatic (62.1%) carotid stenosis from eight German vascular surgery centres were included. Procedures were performed under LA in 918 cases (46.7%) and under GA in 1,048 cases (53.3%). After propensity score matching, 836 patients remained in each group (LA and GA).</p><p><strong>Results: </strong>In the unadjusted analysis, no significant differences were found in postoperative complications (LA vs. GA: death 0.7% in both groups; stroke 1.3% vs. 1.7%; myocardial infarction 0.6% vs. 0.3%; major adverse cardiovascular events [MACE] 2.9% vs. 2.3%). Multivariate analysis likewise showed no significant difference in the risk of major complications (stroke, myocardial infarction, death, reoperation) for LA compared with GA (OR: 1.17 [95% CI: 0.65-2.10]; p = 0.596). There was also no statistically significant difference for minor complications (haematoma, cranial nerve injury, restenosis; OR: 1.30 [95% CI: 0.70-2.42]; p = 0.401). Postoperative length of hospital stay (mean 4.7 ± 3.0 days) did not differ between groups. In the matched overall cohort, age > 80 years was associated with an increased risk of major complications (OR: 1.65 [95% CI: 1.05-2.59]; p = 0.030). For minor complications, male sex was associated with a significantly lower risk (OR: 0.69 [95% CI: 0.49-0.96]; p = 0.027), as was symptomatic stenosis (OR: 0.59 [95% CI, 0.42-0.83]; p = 0.003). Longer operative time, however, was associated with an increased risk (per 10 min: OR: 1.08 [95% CI: 1.03-1.14]; p = 0.004). The type of anaesthesia (local vs. general) was not significantly associated with the occurrence of complications in either model.</p><p><strong>Conclusion: </strong>This study supports current guideline recommendations to base the choice of anaesthesia for CEA on the experience of the surgeon and anaesthesiologist as well as on patient preference.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[TIVA or Volatile Anaesthesia: Pros and Cons in Thoracic Surgery].","authors":"Jonas Weber, Frank Wappler, Mark Schieren, Jérôme Defosse","doi":"10.1055/a-2841-7020","DOIUrl":"https://doi.org/10.1055/a-2841-7020","url":null,"abstract":"<p><p>Thoracic surgical procedures present specific challenges in anaesthesiology. One lung ventilation (OLV) regularly required in this context does improve surgical exposure, but leads to characteristic pathophysiological changes: the right-to-left shunt increases, dead space ventilation rises, and hypoxic pulmonary vasoconstriction (HPV) elevates pulmonary vascular resistance. These mechanisms have a direct impact on gas exchange and haemodynamics and demand a differentiated anaesthesiological strategy. A comparison between the performance of total intravenous anaesthesia (TIVA) and balanced general anaesthesia shows that both techniques exhibit specific advantages and disadvantages, which must be carefully weighed under the conditions of OLV, as well as with consideration of individual patient factors. While TIVA may offer benefits through less influence on HPV and reduced environmental burden, volatile anaesthesia, combining volatile inhalational anaesthetics such as desflurane or sevoflurane with intravenously administered drugs (opioids, muscle relaxants, hypnotics), enables more precise pharmacological monitoring. In addition, volatile inhalational anaesthetics can be advantageous, particularly in patients with impaired cardiocirculatory function. Furthermore, operating theatres contribute significantly to the CO₂ emissions of the healthcare system, with desflurane, and to a lesser extent sevoflurane, accounting for a relevant share. Low-flow techniques can reduce emissions, yet intravenous or regional anaesthesia are considered more ecologically favourable. Moreover, there are burdens from the high consumption of disposable materials as well as the considerable energy demand of the infrastructure. The current evidence in this regard is, however, heterogeneous, so further systematic investigations are required. The choice of anaesthetic technique is therefore not only a medical, but increasingly also an ecological decision. The aim of the present work is to systematically analyse and compare the available evidence from randomised controlled trials and systematic reviews on TIVA and balanced general anaesthesia in thoracic surgery. In addition to clinical endpoints, ecological, inflammatory, and patient-specific aspects are also considered, in order to provide a sound basis for future decision-making processes.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Minimally Invasive Paediatric Thoracic Surgery in Infants, Children and Adolescents].","authors":"Caroline Fortmann, Fritz Kahl, Elisabeth Ammer, Christian Kruppa, Oliver J Muensterer, Rim Kiblawi","doi":"10.1055/a-2836-2606","DOIUrl":"https://doi.org/10.1055/a-2836-2606","url":null,"abstract":"<p><p>The aim of this video paper is to provide an overview of typical thoracoscopic techniques in infants, children and adolescents in paediatric surgery. The surgical steps are explained, along with practical tips and tricks.Thoracoscopic procedures are presented, including lobectomy for congenital pulmonary malformations, resection of bronchogenic cysts and management of subpleural bullae.Five thoracoscopic procedures are explained in detail in our video. The accompanying manuscript describes the individual surgical steps and provides numerous practical considerations related to thoracoscopic procedures in infants, children and adolescents.Thoracoscopic surgical procedures are generally safe in infants, children and adolescents when the proposed precautions are followed. A minimal invasive approach offers numerous short- and long-term advantages compared to the open technique. Our video may serve as a practical guide and make a valuable contribution to education and training in paediatric thoracoscopic surgery.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bedeutung und Therapie der Tumorkachexie für die onkologische Chirurgie.","authors":"Anna Anita Quarder, Resa Puffert, Marie Thoren, Amine Önel, Linda Feldbrügge, Moritz Schmelzle, Franziska Köhler","doi":"10.1055/a-2723-0605","DOIUrl":"https://doi.org/10.1055/a-2723-0605","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Assistance und die chirurgische Prozessqualität.","authors":"Dietmar Pennig","doi":"10.1055/a-2746-8923","DOIUrl":"https://doi.org/10.1055/a-2746-8923","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Emergency Aortic Care at a Newly Established University Aortic Centre - Outcome Treatment Comparison of Acute Thoracic/Thoracoabdominal Pathologies to an Earlier Cohort at the Same Site].","authors":"Paula R Keschenau, Jan Brükkenkamp, Michael Maurer, Ursula Vigelius-Rauch, Horst-Detlef Litzlbauer, Gabriele Krombach, Jörn Pons-Kühnemann, Daniel Palacios, Johannes Kalder","doi":"10.1055/a-2817-4428","DOIUrl":"https://doi.org/10.1055/a-2817-4428","url":null,"abstract":"<p><p>Managing complex aortic emergencies is challenging. During the establishment phase of a new aortic centre, outcomes might be additionally affected by limited team experience and varying levels of individual expertise. The aim was to analyse outcomes after treatment of acute thoracic/thoracoabdominal aortic pathologies during the establishment phase of a new university aortic centre, in comparison to an earlier reference cohort at the same site.The single centre study included all patients treated as emergency/urgently for an acute thoracic/thoracoabdominal aortic pathology during two time periods. Time-periods 1 (establishment phase, 2020-2022) and 2 (earlier reference cohort, 2007-2019) were compared regarding in-hospital morbidity/mortality, and the duration of hospital and intensive care unit (ICU) stay. Potential factors influencing those outcome parameters were analysed using logistic regression.197 patients were included. 42 (27 male, mean age 66 ± 14 years) were treated in period 1 and 155 (103 male, mean age 69 ± 12 years) in period 2. In-hospital mortality was 9.5% vs. 17.2% in period 1 vs. 2, despite higher proportions of extensive thoracoabdominal (69.2% vs. 40.4%) and rupture pathologies (57.1% vs. 47.3%). Perioperative stroke and spinal cord ischaemia occurred in 0% and 2.3% vs. 12.7% and 3.8% in periods 1 and 2, respectively. Median durations of hospital and ICU stay were 15 (4-56) vs. 14 (0-123) and 5 (0-42) vs. 5 (0-52) days in period 1 vs. 2. The confounders 1.) operation duration (p = 0.0032), 2.) neurological complication (p = 0.0051) and 3.) prolonged ventilation (p = 0.009), neurological complication (p = 0.0493) as well as need for blood transfusion (p = 0.0125) showed statistically significant associations with the outcome parameters 1.) in-hospital mortality, 2.) duration of hospital stay and 3.) duration of ICU stay. No statistically significant influence of the time-period on mortality, durations of hospital and ICU stay were detected (p = 0.146; p = 0.128; p = 0.430).Reduced mortality and neurological complication rates compared with the earlier reference cohort demonstrate that, even during the establishment phase of a university aortic centre, high level care for thoracic and thoracoabdominal aortic emergencies is achievable.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Role and Experience of a Research Fellow Abroad: Academic Development and Surgical Education].","authors":"Lorenzo Mazzucchelli, Armin Kraus, Frank Meyer","doi":"10.1055/a-2825-1766","DOIUrl":"https://doi.org/10.1055/a-2825-1766","url":null,"abstract":"<p><p>International research fellowships are associated with a broad spectrum of hopes, expectations, chances, potentials and developmental possibilities for each fellow, the institution of origin and their interaction during its course.This narrative review explores the role of surgical Research Fellows abroad and examines their impact on academic progression and surgical teaching.The review is based on personal experience of fellowships and a selective literature search via PubMed and Google Scholar, using keywords such as \"research fellowship\", \"surgical education\", and \"international academic career\".Fellowships vary by country and institution but generally require scientific curiosity, research interest, clinical training and institutional affiliation. In addition to research and publishing, Fellows often engage enthusiastically and skillfully in student and resident teaching. The fellowship can support academic advancement, such as \"habilitation\" (specific academic/doctoral degree in German-speaking countries) or equivalent degrees, but also in achieving suitable, reasonable, and useful qualifications, such as special methods, approaches, and evaluation skills. International experiences and unconventional teaching methods like simulation, mentoring and E-learning can substantially enhance local surgical education. Fellows face challenges, including system adaptation, language, and reintegration into clinical practice.International research fellowships are increasingly seen as key steps in surgical academic careers. Beyond scientific training, they foster personal growth, international collaboration, and teaching skills. The Research Fellow operates at the intersection of clinical competence, research, education, and clinical development.An international Research Fellowship is a valuable opportunity within surgical training. It strengthens academic qualifications, broadens perspectives, and enriches surgical education. Greater institutional support and integration into training pathways are warranted.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zertifizierung in der Onkologie: Mehrwert oder nur Mehraufwand?","authors":"Marie Crede, Johannes Riebeling, Michael Ghadimi, Marian Grade","doi":"10.1055/a-2759-1973","DOIUrl":"https://doi.org/10.1055/a-2759-1973","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Postoperative Pain Syndromes After Thoracoscopy and Thoracotomy - Prevention and Management].","authors":"Lisa-Lisett Schwarze, Robert Werdehausen, Bastian Fakundiny, Max Wacker","doi":"10.1055/a-2816-4930","DOIUrl":"https://doi.org/10.1055/a-2816-4930","url":null,"abstract":"<p><p>Despite minimally invasive techniques, chronic pain after thoracic surgery - often referred to as post-thoracoscopy/post-thoracotomy pain syndrome (PTPS) - remains an important clinical challenge.This narrative review summarises current evidence on the epidemiology, pathophysiology, prevention and treatment of chronic postoperative pain (CPSP) following thoracic surgical procedures. The focus is placed on analgesic strategies in the context of early mobilisation and fast-track concepts.Acute postoperative pain is the most important predictor of pain chronification. Multimodal analgesia with paracetamol, NSAIDs/COX-2 inhibitors and opioid-sparing adjuncts form the basis of therapy. In thoracotomy, thoracic epidural analgesia (TEA) and paravertebral blockade provide the most reliable results. In thoracoscopy, single-shot techniques combined with multimodal analgesia are often sufficient, while catheter-based techniques offer advantages in high-risk patients or more extensive procedures. Alternative approaches, such as surgically placed intercostal catheters, may be pragmatic adjuncts.Prevention of chronic pain after thoracic surgery is primarily achieved through adequate acute pain management. Continuous regional techniques are crucial for early mobilisation and fast-track protocols, while established PTPS/CPSP requires a multimodal and interdisciplinary treatment.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}