Zentralblatt fur Chirurgie最新文献

{"title":"[Analogue vs. Digital: Gendered Perceptions of Endovascular Simulation-based Training].","authors":"David Wippel, Miar Ouaret, Maximilian Lutz, Laura Schönherr, Kristina Grassl, Juliana Heidler, Inez Ohashi Torres, Elke R Gizewski, Florian K Enzmann, Sabine Wipper","doi":"10.1055/a-2651-3266","DOIUrl":"10.1055/a-2651-3266","url":null,"abstract":"<p><p>Despite the increasing number of female medical graduates, women remain underrepresented in surgical leadership roles. Previous studies have highlighted gender disparities in operative autonomy, self-assessment, and psychological burden. Simulation-based training may offer a means to reduce such disparities. This study aimed to assess gender-specific differences in the evaluation of various endovascular training models.Between March and August 2024, 32 physicians (16 female, 16 male) from vascular surgery and radiology departments participated in a prospective study at the University Hospital in Innsbruck. Each participant performed a standardised iliac artery procedure using three training models: a flexible and a stiff 3D-printed vascular model, and a digital simulator. A structured questionnaire evaluated face validity, construct validity, and concurrent validity. Gender differences were analysed statistically.There were no significant gender differences in face validity ratings or model preferences. However, female participants consistently rated the construct validity of all models significantly higher (p < 0.05). Male participants had greater procedural experience, despite similar durations of professional experience. Both genders expressed strong support for regular simulation-based training.Simulation-based training is broadly recognised as a key educational tool across genders. The higher construct validity ratings by female participants suggest that simulation is perceived as a compensatory method for developing procedural skills. Structured implementation of simulation training may help reduce disparities in endovascular education.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"446-451"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Transposition of the Superior Mesenteric Artery at the Infrarenal Segment of the Aorta in \"Nut Cracker Syndrome\"].","authors":"Stephan Arndt, Frank Meyer, Udo Barth, Maciej Pech, Zuhir Halloul","doi":"10.1055/a-2636-2267","DOIUrl":"10.1055/a-2636-2267","url":null,"abstract":"<p><p>The nut cracker syndrome (NCS) can be considered as an under-diagnosed disease, which the patients have usually suffered from for a prolonged time prior to correct diagnosis and subsequent initiation of adequate therapy. There are several possible therapies, the most promising - transposition of the superior mesenteric artery (SMA) - from the perspective of its aetiopathogenesis - has rarely been used.Based on selective references from the scientific medical literature and our own clinical experiences in vascular medicine, the important characteristics of the \"nut cracker\" phenomenon and syndrome are described.A topic-related narrative review has been based on a literature search in PubMed using the key words \"Nut cracker syndrome\", \"May-Turner syndrome\", \"Wilkie syndrome\", \"aorto-mesenteric angle\", \"pelvic congestion syndrome\".There are diverse symptoms in NCS, which is unspecific; however, in particular, the combination of signs and symptoms associated with a suspicious pathological urine finding may indicate NCS. Duplex ultrasonography and CT-scan are very accurate diagnostic procedures and include an adequate search for simultaneously occurring vascular anomalies. Taken together, clinical findings and laboratory parameters may lead to a patient-specific and graduated therapeutic plan, in which transposition of SMA is a causal, effective and safe procedure, particularly when there are combined vascular anomalies, e.g., the combination of NCS with May-Turner syndrome in young patients.The nutcracker syndrome as venous congestion of the kidney may be a \"hard nut\". Modern medicine aims at achieving evidence for the best approach by case reports and retrospective cohort studies and can - in the meanwhile - provide a verified diagnostic work-up. In addition, is a therapeutic algorithm comprising a spectrum of highly effective measures, particularly for young patients, who frequently exhibit additional vascular anomalies.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"420-431"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Correction: The Reconstruction of Complex Thoracic Defects with Free Flaps and the Choice of the Appropriate Recipient Vessel].","authors":"Florian Falkner, Rebecca Luisa Schäfer, Simon Mayer, Nicolas Ewerbeck, Riccardo Giunta, Denis Ehrl, Nicholas Möllhoff, Wolfram Demmer, Vanessa Masalov, Emre Gazyakan, Julian Vogelpohl, Ulrich Kneser, Felix Hubertus Vollbach","doi":"10.1055/a-2697-8476","DOIUrl":"https://doi.org/10.1055/a-2697-8476","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125819","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 Free Functional Latissimus dorsi Flap for the Reconstruction of Complex Abdominal Wall Defects: Anatomy, Technique and Approach for Interdisciplinary Treatment].","authors":"Sinan Mert, Benedikt Fuchs, Alexander Burges, Thomas Blankenstein, Wolfram Demmer, Nikolaus Wachtel, Markus Albertsmeier, Riccardo Giunta, Felix Hubertus Vollbach, Nicholas Möllhoff","doi":"10.1055/a-2694-8301","DOIUrl":"https://doi.org/10.1055/a-2694-8301","url":null,"abstract":"<p><p>Complex abdominal wall defects lead to significant morbidity and require interdisciplinary therapeutic approaches. Plastic surgical techniques and the evolvement of microsurgery can provide a reliable means of reconstruction. For large defects involving the M. rectus abdominis, the free functional M. latissimus dorsi flap serves as a workhorse. Through microsurgical tissue transplantation, the abdominal wall can be functionally reinforced and reinnervated, while also covering the associated soft tissue defect.This study presents an interdisciplinary approach to complex abdominal wall reconstruction using a case example.Particularly as a chimeric flap, in combination with the scapular/parascapular flap, even exceptionally large defects can be reconstructed safely. By utilising a common vascular pedicle, these flaps can be transferred together via the subscapular vessel axis. The coaptation of the thoracodorsal nerve, which innervates the latissimus dorsi muscle, with a motor nerve branch leading to the rectus abdominis muscle enables functional muscular stabilisation of the abdominal wall following reinnervation.To achieve the best possible outcome and reduce hospitalisation, the early integration of plastic surgery into interdisciplinary treatment concept is essential.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087466","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":"[Complication Management in Thoracic Surgery - Results of a Delphi Consensus Conference of the German Society for Thoracic Surgery].","authors":"Dominik Lobinger, Johannes Bodner, Hans Hoffmann, Robert Scheubel","doi":"10.1055/a-2682-2348","DOIUrl":"https://doi.org/10.1055/a-2682-2348","url":null,"abstract":"<p><p>In order to ensure a good outcome after thoracic surgical procedures and to minimise the complication rate, prompt and adequate complication management is of fundamental importance.After a questionnaire had been compiled by a working group of three thoracic surgical experts of the German Society of Thoracic Surgery (DGT) in leading positions, an attempt was made to develop a consensus recommendation (> 75%) for adequate complication management in thoracic surgery, within the framework of a multi-stage \"Delphi process\" among suitable experts. In this process, after conducting two anonymous online question rounds, a final discussion and summary of the results took place within a DGT expert conference.Of 93 selected experts, 63 (68%) participated in the 1st and 41 (44%) in the 2nd online question round. 54 experts participated in the final TED voting at the 2020 expert conference. After division into the different categories \"haemorrhage\", \"parenchymal fistulae\", \"bronchial stump insufficiency\", \"nerve lesions\" and \"varia\", consensus was achieved on a recommended course of action for a large number of the questions.This paper is a summary of the \"Delphi consensus process\" of the Expert Conference 2020 of the German Society for Thoracic Surgery for the management of peri-operative complications.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971510","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":"[Pedicled Perforator-based Flaps for Reconstruction of Trunk Wall Defects].","authors":"Selim Atay, Adrien Daigeler, Joerg Fuchs, Claudius Illg, Vladyslav Kavaka, Henrik Lauer, Katarzyna Rachunek-Medved, Dominik Steiner, Johannes Tobias Thiel","doi":"10.1055/a-2636-2764","DOIUrl":"10.1055/a-2636-2764","url":null,"abstract":"<p><p>The management of trunk wall defects can be a challenge in surgical practice, especially when conventional methods such as primary wound closure or skin grafts are insufficient due to the size and depth of the defect, its location, location, or lack of adequate skin and soft tissue coverage. In recent years, perforator-based local flaps have emerged as a modern, muscle-sparing alternative to traditional local myocutaneous or free microsurgical flaps. Particularly in the back region, suitable recipient vessels for free flaps are often unavailable due to vascular anatomy. At the same time, compared to conventional random-pattern flaps, perforator-based flaps offer increased reliability, as they are based on targeted vascular perforators. This allows them to be designed beyond the classic 2:1 length-to-width ratio and enables greater reach with improved perfusion. By utilising perforating vessels, functionally important musculature can largely be preserved, which may lead to reduced postoperative morbidity and faster rehabilitation.This article is aimed at surgically active colleagues without specialised training in plastic-reconstructive surgery who are nonetheless regularly confronted with complex wound situations-for example, following tumour resections, chronic infections, pressure ulcers, or postoperative wound healing disorders. The goal is to provide a practical overview of the principles, indications, and limitations of perforator-based local flaps. In addition to an introduction to the underlying vascular anatomy (angiosome and perforasome theory), preoperative diagnostic procedures, various flap techniques, and typical clinical courses-including potential surgical complications-are presented.A particular focus is placed on the selection of appropriate flap types based on defect location and the presence of local perforators, with the goal of achieving the simplest, safest, and most sustainable soft tissue coverage possible. Clinical case examples illustrate operative approaches in different regions of the trunk wall.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875503","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":"[Lateral Thoracolumbar Interbody Fusion for Traumatic Fractures (Trauma LLIF) - Description of Technique and Summary of Scientific Evidence].","authors":"Stefan Motov, Benjamin Martens, Martin N Stienen","doi":"10.1055/a-2652-4704","DOIUrl":"10.1055/a-2652-4704","url":null,"abstract":"<p><p>Thoracolumbar A3 and A4 fractures involving the anterior column are at greater risk of correction loss and implant failure than with stand-alone posterior fixation. The LLIF technique, established in degenerative spine surgery, may offer advantages in selected trauma cases.We describe the surgical technique and our own experience with it. A retrospective single centre cohort study included 61 neurologically intact patients with thoracolumbar fractures (T10-L3) treated over 12 years using circumferential surgery (posterior + LLIF). The anterior reconstruction was performed either primarily or secondarily via retroperitoneal (lumbar) or transthoracic (thoracic) approaches. Primary endpoints were segmental correction, fusion, complications, and clinical outcome.Segmental Cobb angle significantly improved (preoperative 14.6°, postoperative 6.7°, final follow-up 8.1°; p < 0.001). The fusion rate was 98.4%. The overall complication rate was moderate (18%), mostly related to the posterior approach. According to MacNab criteria, 95.1% of patients achieved a good or excellent outcome. No adjacent segment degeneration was observed.LLIF provides a reliable anterior reconstruction in unstable thoracolumbar fractures, with good correction maintenance, high fusion rates, and favourable clinical results. It may be a valuable addition to posterior instrumentation in selected trauma cases.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875502","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":"Die präoperative Evaluation erwachsener thoraxchirurgischer Patientinnen und Patienten mit onkologisch resektablen Lungentumoren– eine gemeinsame Empfehlung der DGAI, DGT und DGP.","authors":"Jérôme Michel Defosse, Vera von Dossow, Wojciech Dudek, Michael Halank, Torsten Loop, Erich Stoelben, Michael Westhoff","doi":"10.1055/a-2665-0498","DOIUrl":"https://doi.org/10.1055/a-2665-0498","url":null,"abstract":"<p><p>The increasing incidence of malignant lung diseases, neoadjuvant therapies, and the expected detection of operable stages through future lung cancer screening require differentiated preoperative decisions regarding functional operability against the background of an increase in respiratory diseases, especially COPD, but also interstitial lung diseases. Since the postoperative risk of cardiovascular and pulmonary complications after lung resection increases with the extent of lung parenchymal resection and the pre-existing impairment of organ function of the heart, lungs, kidneys, and metabolism, these also require special attention. Given the increasing number of elderly patients over 75 years of age, this also applies to frailty, which represents another key parameter in structured evaluation.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804994","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":"[Perioperative Therapy for Locally Advanced Non-small Cell Lung Cancer: Delphi Expert Consensus of the German Society for Thoracic Surgery].","authors":"Florian Eichhorn, Mohamed Zaatar, Melanie Oggiano, Stefan Welter, Aris Koryllos, Laura Klotz","doi":"10.1055/a-2654-6282","DOIUrl":"https://doi.org/10.1055/a-2654-6282","url":null,"abstract":"<p><p>The recent introduction of chemoimmunotherapy has permanently changed the multimodal therapeutic options for operable non-small cell lung cancer (NSCLC). The aim of the working group of the German Society for Thoracic Surgery (DGT) was to develop consensus-based practical recommendations for the perioperative treatment of locally advanced NSCLC.A questionnaire was formulated by defined working groups, which was answered in two electronic rounds by Germany's leading thoracic surgeons. Controversial results with less than 75% agreement were subsequently discussed in an expert conference and a Delphi survey was conducted.Patients with confirmed N1 or N2 lymph node metastasis should be treated in a perioperative regimen. Technical and oncological operability are obligate criteria as well as negative molecular status (at least EGFR and ALK wild type). Mediastinal invasive restaging is not required in the absence of radiological progression after induction therapy. Even with a good radiological response, surgery cannot be avoided. Because of a lack of evidence, it cannot be concluded to what extent a reduction in the extent of resection below a lobectomy is oncologically justifiable. The participants agreed that adjuvant radiotherapy has no value in patients with complete mediastinal downstaging. Patients with persistent mediastinal lymph node metastases (ypN2) should be discussed for adjuvant radiotherapy on a risk-adapted individual basis.A broad consensus was reached at the expert conference on the topics discussed in the context of the new perioperative therapy concepts. These can therefore serve as practice-oriented support for the members of the DGT.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800454","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":"Editorial.","authors":"Jan Philipp Hering","doi":"10.1055/a-2662-0602","DOIUrl":"https://doi.org/10.1055/a-2662-0602","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"150 S 01","pages":"S11"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971566","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}