Zentralblatt fur Chirurgie最新文献

{"title":"[Thoracic Surgical Approaches - From Open Thoracotomy to Robot-Assisted Surgery].","authors":"Volkan Kösek, Eyad Al Masri, Kenan Öztürk, Vasile Racovitan, Mahmoud Elghannam, Bassam Redwan","doi":"10.1055/a-2611-3251","DOIUrl":"10.1055/a-2611-3251","url":null,"abstract":"<p><strong>Background: </strong>The choice of surgical approach in thoracic surgery significantly influences postoperative outcomes. Over the past three decades, the spectrum has expanded from classical open thoracotomy to include various minimally invasive and robot-assisted techniques. This CME article provides a comprehensive, evidence-based overview of all relevant thoracic surgical approaches and their indication-specific application.</p><p><strong>Methods: </strong>A narrative review was conducted based on current literature from PubMed, Springer, and Thieme. Open approaches (posterolateral, anterolateral, muscle-sparing, axillary, median sternotomy, mediastinal, thoracoabdominal), minimally invasive approaches (multiportal and uniportal VATS, subxiphoid, RATS, non-intubated VATS), and hybrid techniques were analyzed regarding indications, operative technique, and comparative outcomes.</p><p><strong>Results: </strong>Meta-analyses demonstrate that uniportal VATS is associated with lower complication rates (OR 0.76) and shorter hospital stays compared to multiportal VATS. The VIOLET trial confirmed non-inferiority of VATS lobectomy versus open lobectomy regarding lymph node dissection. Robot-assisted surgery offers enhanced 3D visualization and seven degrees of instrument freedom but has not demonstrated survival advantages over VATS. ERAS protocols reduce perioperative morbidity (OR 0.72 per 10% compliance increase).</p><p><strong>Conclusion: </strong>Modern thoracic surgery requires individualized approach selection considering tumor characteristics, patient factors, and institutional expertise. The integration of mediastinal staging techniques, thoracoabdominal approaches, and advanced minimally invasive methods has expanded the surgical armamentarium substantially.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"151 S 01","pages":"S71-S95"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798720","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 Care, Perioperative Risks, and the Continuum of Care in Thoracic Surgery: A Comprehensive AI-Augmented Review of Evidence.","authors":"Nora Jahn, Maria Theresa Völker, Hans-Michael Hau, Henning Starke, Sven Laudi","doi":"10.1055/a-2875-5967","DOIUrl":"https://doi.org/10.1055/a-2875-5967","url":null,"abstract":"<p><strong>Background: </strong>Thoracic surgery remains essential for lung cancer treatment, yet postoperative pulmonary complications (PPCs) affect up to 50% of patients, driving up mortality and prolonging hospital stays. As the surgical population ages and frailty increases, optimising perioperative care is critical to improving outcomes.</p><p><strong>Methods: </strong>This narrative review utilised an AI-augmented drafting and verification workflow. Initial drafts were generated using large language models (Antigravity/Google Gemini 3 Pro, Anthropic Claude), with systematic evidence verification carried out with the Consensus.app. The search focused on high-quality trials, meta-analyses, and guidelines published between 2016 and 2026. All clinical interpretations remained under human control.</p><p><strong>Results and discussion: </strong>Preoperative frailty and nutritional screening identify high-risk patients for targeted optimisation. Prehabilitation significantly reduces PPCs and length of hospital stay. Intraoperative strategies, including individualised PEEP titration and erector spinae plane blocks, offer safer alternatives to traditional methods. Recent evidence supports high-flow nasal oxygen over non-invasive ventilation for most patients and highlights the efficacy of digital drainage systems and restrictive fluid management. Furthermore, procalcitonin-guided antibiotic stewardship reduces exposure, while the \"Failure to Rescue\" framework, bolstered by continuous wearable monitoring, is essential for preventing ICU readmissions.</p><p><strong>Conclusion: </strong>Improving thoracic surgery outcomes requires shifting from reactive management to proactive, individualised care. Integrating risk stratification, prehabilitation, modern ventilation, and AI-assisted monitoring are fundamental to advancing precision medicine in thoracic surgery.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"151 S 01","pages":"S28-S45"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798670","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":"[Digital Twins in Surgery].","authors":"Alexandra Scheibert, Marco Horn, Tobias Keck, Michael Thomaschewski","doi":"10.1055/a-2856-4955","DOIUrl":"10.1055/a-2856-4955","url":null,"abstract":"<p><strong>Purpose: </strong>The digital twin describes the virtual, dynamic representation of a real system that is updated through continuous data exchange with its physical counterpart. Although originally established in industrial applications, the concept is also becoming increasingly important in surgery.</p><p><strong>Material and methods: </strong>Digital twins integrate multimodal patient data - including imaging data, physiological measurements, and intraoperative sensor data - into patient-specific models. These can be used in preoperative planning, intraoperative decision support, and postoperative follow-up.</p><p><strong>Results: </strong>Initial applications, particularly in oncological and vascular surgery, show great potential for improving surgical precision and reducing complications. In addition, digital twins open up new possibilities in surgical training and telesurgery.</p><p><strong>Conclusion: </strong>Despite promising approaches, digital twins in surgery are still largely in the early stages of development. Challenges exist in particular in data quality, model validation, and ethical and legal issues. Overall, digital twins have the potential to change surgical processes in the long term.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"379-386"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438107","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":"[Are you Alright? - Well-being, Stress and Surgical Training].","authors":"Carolina Vogel, Dannik Haas, Tina Histing, Eva-Marie Braun, Benedikt J Braun","doi":"10.1055/a-2856-4905","DOIUrl":"10.1055/a-2856-4905","url":null,"abstract":"<p><strong>Background: </strong>We all want to be well - in our private life, as well as at work. Current surveys however point towards an increasing Burn-out rate amongst young surgeons. The results suggest, that a relevant number of young colleagues suffer from critically low well-being. Within this article, we want to explore the current status of well-being and stress during surgical training.</p><p><strong>Materials and methods: </strong>An online survey was performed amongst the members of the \"Berufsverband der Deutschen Chirurgie\" who were still in residency training, that entailed various training related questions, as well as the WHO5 Well Being Index, and the Perceived Stress Scale.</p><p><strong>Results: </strong>Overall, 121 responses were recorded from 1200 members who were contacted (response rate 10.1%). More than 50% of the responses for the WHO-5 Well-Being Index were in the lower half of the response range. For the Perceived Stress Scale, approximately 20% of participants consistently ranked in the lowest two response categories for questions associated with both helplessness and self-efficacy.</p><p><strong>Conclusion: </strong>The results suggest that a significant number of young colleagues suffer from a critically low well-being status. With this study, we wish to raise awareness for this important issue. The survey will be continued, in order to broaden the data base for further evaluation, and also to tailor specific offers for help.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"387-392"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975946","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":"10.1055/a-2841-7020","url":null,"abstract":"<p><strong>Abstract: </strong>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":"S17-S27"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","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":"[Preventing Complications in Hepatopancreatobiliary Surgery].","authors":"Ulrich Friedrich Wellner, Tobias Keck","doi":"10.1055/a-2896-1368","DOIUrl":"https://doi.org/10.1055/a-2896-1368","url":null,"abstract":"<p><strong>Abstract: </strong>Hepatopancreatobiliary (HPB) surgery is among the most complex fields in visceral surgery, and is associated with significant morbidity and mortality rates. This article provides a brief overview of current evidence-based strategies for the prevention of typical complications: post-hepatectomy liver failure (PHLF), bile leaks, postoperative pancreatic fistulas (POPF), delayed gastric emptying (DGE), and post-pancreatectomy haemorrhage (PPH). In the context of the definitions of the International Study Group of Liver Surgery (ISGLS) and the International Study Group of Pancreatic Surgery (ISGPS), preoperative conditioning measures, modern functional imaging, intraoperative surgical techniques, and pharmacological interventions are briefly outlined.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413205","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":"[Treatment of Vocal Fold Paralysis].","authors":"Andreas H Müller","doi":"10.1055/a-2887-2043","DOIUrl":"https://doi.org/10.1055/a-2887-2043","url":null,"abstract":"<p><strong>Abstract: </strong>Vocal cord paralysis significantly impairs the quality of life of those affected. Unilateral paresis primarily causes glottal closure insufficiency, weak voice, and hoarseness. Bilateral paresis, on the other hand, impairs breathing and limits physical capacity. For over a hundred years, various biomaterials have been used to treat unilateral vocal cord paralysis, including tissue transfer, injection materials, implants, and nerve transfer. According to current scientific findings, early augmentation can reduce the need for later invasive treatment and speed up the patient's voice rehabilitation. In cases of bilateral paralysis, laser resection is currently the most common treatment for glottal enlargement, but this requires a trade-off between improved breathing and preserved voice quality. In the future, laryngeal pacemakers and selective reinnervation could restore vocal fold function in a targeted manner, thereby significantly improving quality of life.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377164","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":"Möglichkeiten und Grenzen von Leitlinien in der evidenzbasierten Medizin.","authors":"Vera von Dossow","doi":"10.1055/a-2759-1988","DOIUrl":"https://doi.org/10.1055/a-2759-1988","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319254","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":"Predictive Factors for Mediastinal Lymph Node Metastases in Patients with Non-small Cell Lung Cancer, as Detected by Video-assisted Mediastinoscopic Lymphadenectomy.","authors":"Dominik Herrmann, Santiago Ewig, Daniel Christian Christoph, Tugba Bas Kaya, Katharina Greif, Kolja Milobinski, Melanie Oggiano, Thorsten Walles, Stefan Welter, Erich Hecker","doi":"10.1055/a-2884-4897","DOIUrl":"https://doi.org/10.1055/a-2884-4897","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate mediastinal staging of non-small cell lung cancer is essential for guiding curative treatment strategies, particularly regarding the indication for neoadjuvant therapy. This study evaluated pretherapeutic predictive factors for mediastinal lymph node metastases based on routinely collected clinico-pathological data.</p><p><strong>Patients and methods: </strong>We retrospectively analysed data from all patients who underwent video-assisted mediastinoscopic lymphadenectomy for mediastinal staging before curatively-intended treatment during a 12-year period. Logistic regression and ROC analyses were used to identify independent risk factors for histologically confirmed N2/N3 involvement.</p><p><strong>Results: </strong>Clinical N2 status based on PET/CT was the strongest independent predictor of mediastinal metastasis. However, even patients with cN1 status showed a significantly increased risk. Adenocarcinoma histology (OR 2.3; p < 0.01) and central tumour location (OR 2.1; p < 0.01) were also independently associated with mediastinal involvement. ROC analysis identified a tumour size ≥ 3 cm as a potential cutoff, although discrimination was limited (AUC 0.588).</p><p><strong>Conclusion: </strong>Mediastinal lymph node involvement in NSCLC is not restricted to patients with abnormal PET/CT findings. Central tumours, adenocarcinoma or lesions > 3 cm should undergo invasive staging, regardless of imaging appearance.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266311","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":"[Microvascular Reconstruction of the Laryngotracheal Junction].","authors":"Miguel Goncalves, Stephan Hackenberg, Agmal Scherzad","doi":"10.1055/a-2866-2106","DOIUrl":"https://doi.org/10.1055/a-2866-2106","url":null,"abstract":"<p><strong>Background: </strong>The laryngotracheal junction (LTJ) is a functionally critical zone, due to its narrow anatomy, complex airflow dynamics, and proximity to the glottis and cricoid cartilage. Extensive stenoses, cricoid defects, and stomal anterior wall loss frequently exceed the possibilities of conventional resection and reconstruction.</p><p><strong>Objective: </strong>To outline the current role of microvascular reconstruction at the LTJ, with a focus on indications, techniques, and limitations from the perspective of otolaryngology and thoracic surgery.</p><p><strong>Methods: </strong>Narrative literature review of clinically established flap reconstruction techniques at the LTJ, including recent case series and key publications.</p><p><strong>Results: </strong>For short, non-pretreated defects, cricotracheal resection and segmental tracheal resection with end-to-end anastomosis remain the standard of care. Microvascular reconstructions are mainly used for long, circumferential LTJ defects, extensive cricoid loss, previously irradiated or multiply operated regions, and complex treatment interventions. The radial forearm free flap is currently the best-established option for long tracheal and laryngotracheal defects and can be combined with cartilage reinforcement or a mucosal lining. Osseous flaps such as the medial femoral condyle flap and the thoracodorsal artery scapular tip flap allow larynx-preserving reconstruction, with restoration of a stable ring or posterior framework in selected cases. Prefabricated constructs, ALT-based flaps, jejunal grafts, and pedicled flaps play an adjunctive role in borderline and salvage situations.</p><p><strong>Conclusion: </strong>Microvascular reconstruction extends the therapeutic spectrum for LTJ surgery beyond conventional resection techniques and can provide a functional airway in highly complex situations and with acceptable morbidity. Given the limited evidence base from case series, interdisciplinary planning and centralisation of these procedures in experienced centres are essential.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219840","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}