BMJ Surgery Interventions Health Technologies最新文献

{"title":"Middle meningeal artery embolization for chronic subdural hematoma.","authors":"Malgorzata Maciaszek, Brendan Steinfort, Timothy Harrington, Ken Faulder, Nazih Assaad, Mark Dexter, Alice Ma","doi":"10.1136/bmjsit-2024-000290","DOIUrl":"10.1136/bmjsit-2024-000290","url":null,"abstract":"<p><strong>Objectives: </strong>To assess recurrence rates, procedural outcomes and patient outcomes following middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematomas (cSDH).</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Two tertiary neurosurgical referral centers in Sydney, Australia.</p><p><strong>Participants: </strong>13 adult patients (mean age±SD, 68.5±9.5 years, 11 male) with 17 cSDHs (measuring 13.8±4.5 mm) undergoing MMA embolization alone (8/13) or with surgical evacuation (5/13) for cSDH. There were no exclusion criteria.</p><p><strong>Interventions: </strong>Embolization was performed via femoral access, using either liquid embolic, polyvinyl alcohol particles, coils, or a combination of agents. Embolization was done either as the sole treatment or with surgical evacuation.</p><p><strong>Main outcome measures: </strong>Primary outcomes were recurrence or increase in hematoma size requiring surgical evacuation. Secondary outcomes included procedural complications, hematoma size at follow-up, and patient clinical outcomes.</p><p><strong>Results: </strong>No procedural complications occurred. 12 patients were discharged home at baseline neurological function, and one was discharged to an aged care facility with significant disability. At follow-up (mean=8.7 weeks), combined embolization with surgical evacuation led to hematoma size reduction (14.3±2.6 mm to 5.7±6.5 mm, p<0.01), while embolization alone showed a stable hematoma size (13.3±5.7 mm to 10.0±8.8 mm, p=0.20). Recurrence or increase in hematoma size requiring surgical evacuation occurred in 2/13 (15.4%) patients, one of whom received only unilateral embolization, and the other received partial coiling due to the presence of dangerous collaterals.</p><p><strong>Conclusions: </strong>MMA embolization is a safe procedure that may reduce recurrence rates of cSDH when used as an adjunct to surgery or as a sole treatment. Possible reasons for treatment failure may include unilateral embolization, partial coiling, and absence of distal penetration of embolic agent. Large randomized control trials are currently in progress to assess the safety and efficacy of MMA embolization for this purpose.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000290"},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of visual guidance and instrument choice on symptom recurrence following adenoidectomy: a systematic review of randomized controlled trials.","authors":"Martin Mølhave, Therese Ovesen, Adnan Madzak","doi":"10.1136/bmjsit-2024-000370","DOIUrl":"10.1136/bmjsit-2024-000370","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the impact of visual guidance and instrument choice on obstructive sleep apnea (OSA) and otitis media with effusion (OME) symptom recurrence and reoperation rates following adenoidectomy in pediatric patients.</p><p><strong>Design: </strong>Systematic review of randomized controlled trials (RCTs).</p><p><strong>Setting: </strong>A comprehensive literature search was conducted in Embase, PubMed/Medline, the Cochrane Library, and Scopus, with the final search on September 23, 2024. Reference lists were also screened.</p><p><strong>Participants: </strong>Eligible studies included RCTs published from 2000 onwards, with ≥25 pediatric patients undergoing adenoidectomy for OSA or OME. Comparisons included visually guided versus blinded and cold versus hot adenoidectomy techniques. Studies involving concurrent procedures, craniofacial abnormalities, or non-primary adenoidectomy cases were excluded.</p><p><strong>Main outcome measures: </strong>The primary outcomes were OSA and OME symptom recurrence and reoperation rates following adenoidectomy. Risk of bias was assessed using Cochrane Risk of Bias tool, and evidence quality was evaluated using Grading of Recommendations Assessment, Development and Evaluation.</p><p><strong>Results: </strong>Of 2302 screened articles, 35 underwent full-text review, and 4r studies (373 participants) met inclusion criteria. All studies compared hot and cold techniques, with hot techniques being visually guided. Only one study directly compared both hot and cold techniques under visual guidance, reporting lower OSA recurrence rates with the hot technique, though with a high risk of bias. Other studies found no significant differences, and none reported reoperation rates. Study heterogeneity prevented meta-analysis. Overall risk of bias and evidence quality were moderate.</p><p><strong>Conclusions: </strong>There is insufficient evidence to determine whether visual guidance reduces symptom recurrence following adenoidectomy. Further high-quality RCTs are needed to provide more sound conclusions.</p><p><strong>Prospero registration number: </strong>CRD42024513408.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000370"},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"At the cutting edge: the potential of autonomous surgery and challenges faced.","authors":"Raghav Khanna, Nicholas Raison, Alejandro Granados Martinez, Sebastien Ourselin, Francesco Montorsi, Alberto Briganti, Prokar Dasgupta","doi":"10.1136/bmjsit-2024-000338","DOIUrl":"10.1136/bmjsit-2024-000338","url":null,"abstract":"","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000338"},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of ICG and non-ICG-guided laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis at a single center.","authors":"Nguyen Van Du, Nguyen Anh Tuan, Luong Ngoc Cuong","doi":"10.1136/bmjsit-2024-000313","DOIUrl":"10.1136/bmjsit-2024-000313","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objectives: </strong>To investigate the effectiveness of indocyanine green (ICG) lymphography in improving lymph nodes (LNs) harvesting during laparoscopic radical distal gastrectomy for gastric cancer.</p><p><strong>Design: </strong>Non-randomized trial, prospective study compared ICG and non-ICG group using 1:1 propensity score matching (PSM) method.</p><p><strong>Setting: </strong>Preoperative clinical characteristics, operative outcomes, and follow-up results.</p><p><strong>Participants: </strong>242 patients who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer between 2019 and 2023. After exclusion and PSM, 160 patients (Pts) were included, paired in two groups: ICG (80 Pts) and non-ICG (80 Pts).</p><p><strong>Interventions: </strong>Patients in the ICG group underwent ICG injection submucosal via endoscopy 1 day before surgery.</p><p><strong>Main outcome measures: </strong>Comparison of the number of retrieved LNs and complications between the ICG and non-ICG group.</p><p><strong>Results: </strong>There were no significant differences in age, sex, height, tumor size, pathological Tumor-stage, histological differentiation, and complications between the two groups. There was a shorter operative time in the ICG group compared with the non-ICG group (median: 118 mins (IQR, 105-135) vs 146 mins (IQR, 120-180), respectively). Regarding the effectiveness of LN dissection: the ICG group had a higher median of retrieved LNs than the non-ICG group (36 LNs (IQR, 29-46) vs 27 LNs (IQR, 21-31); p<0.001). The mean number of metastatic LNs in the ICG group was significantly higher than in the non-ICG group, with 2.6±5.4 LNs compared with 0.9±3.1 LNs, respectively (p=0.018). The proportion of patients with more than 25 and 30 retrieved LNs was higher in the ICG group compared with the non-ICG group, with rates of 86% and 71% versus 64% and 31%, respectively (p<0.001).</p><p><strong>Conclusions: </strong>Using ICG fluorescence-guided LNs dissection has increased both the number of total LNs and metastatic LNs dissection without increasing complications in laparoscopic distal gastrectomy for gastric cancer.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000313"},"PeriodicalIF":2.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allocation of seed-stage investments for paediatric health technology.","authors":"Juliana R Perl, Marta Arenas-Jal, Janene H Fuerch, James Kennedy Wall","doi":"10.1136/bmjsit-2024-000368","DOIUrl":"10.1136/bmjsit-2024-000368","url":null,"abstract":"","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000368"},"PeriodicalIF":2.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hidden costs of surgical complications: a retrospective cohort study.","authors":"François-Xavier Ladant, Yann Parc, Morgan Roupret, Edward Kong, Ljubica Ristovska, Aurélia Retbi, Emmanuel Chartier Kastler, Jalal Assouad, Harry Etienne, Alain Sautet, Victor Mardon, Maxim Scrumeda, Abou Kane Diallo, Julien Hedou, Pierre Rufat, Franck Verdonk","doi":"10.1136/bmjsit-2024-000323","DOIUrl":"10.1136/bmjsit-2024-000323","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify how surgical complications impact hospital revenue when their effect on the volume of admissions is considered.</p><p><strong>Design: </strong>Retrospective analysis of comprehensive administrative data.</p><p><strong>Setting: </strong>Three university hospitals in France.</p><p><strong>Participants: </strong>54 637 inpatient stays between 2017 and 2023 in 4 surgical departments (abdominal, orthopedics, thoracic, and urology).</p><p><strong>Main outcome measures: </strong>Stays were categorized by their diagnosis-related group and occurrence of one or more complications, according to International Classification of Diseases, 10th revision diagnosis codes. First, data were aggregated monthly to determine the impact of variation in the monthly mean length of stay (LOS) on the monthly volume of admissions, using an instrumental variable strategy. Second, LOS and revenue per patient were compared for patients with and without complications. Finally, an estimation of the impact of complications on total revenue was performed.</p><p><strong>Results: </strong>A total of 54 637 stays were analyzed, with 9735 (17.8%) experiencing at least one complication. The mean LOS was 8.7 days and the mean revenue per patient was €7602. The instrumental variable analysis, designed to account for unobserved confounders, showed that a decrease of 10% in the monthly mean LOS increased the monthly volume of admissions by 9% (95% CI (5.1% to 13.0%), p<0.01). Complications increased the LOS by 10.9 days (95% CI: (8.95 to 13.1), p<0.01) and revenue per patient by €7912 (95% CI: (6420 to 9087), p<0.01), but decreased daily revenue per patient by €211 (95% CI: (-384 to -83.0), p<0.01). Over the study period, the estimated potential loss induced by complications ranged from 6.6% (95% CI (6.3% to 7.0%), p<0.01) to 9.1% (95% CI (8.8% to 9.4%), p<0.01) of actual revenue. Departments with higher complication rates incurred larger potential losses.</p><p><strong>Conclusions: </strong>Surgical complications reduce total revenue by crowding out short stays that generate more daily revenue. This challenges the consensus that complications are a boon for hospital revenue, instead implying that they shrink hospital net margins (ie, revenue minus costs).</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000323"},"PeriodicalIF":2.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capacity assessment for EHR-based medical device post-market surveillance for synthetic mid-urethral slings among women with stress urinary incontinence: a NEST consortium study.","authors":"Michael E Matheny, Amy M Perkins, Kimberly Rieger-Christ, Joseph S Ross, Jialin Mao, Art Sedrakyan, Nilay D Shah, Robert Winter, W Stuart Reynolds, Arthur Mourtzinos, Wade L Schulz, Victoria Bartlett, Michael Solotke, Sameer Pandya, Suvekshya Aryal, Ahra Cho, Edward A Frankenberger, Daniel Park, Danielle Bostrom, Susan Robbins, Aron Yustein, Bilal Chughtai, Emanuel C Trabuco","doi":"10.1136/bmjsit-2023-000193","DOIUrl":"10.1136/bmjsit-2023-000193","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility for use of electronic health record (EHR) data in conducting adverse event surveillance among women who received mid-urethral slings (MUS) to treat stress urinary incontinence (SUI) in five health systems.</p><p><strong>Design: </strong>Retrospective observational study using EHR data from 2010 through 2021. Women with a history of MUS were identified using common data models; a common analytic code was executed at each site. A manual chart review was conducted in a per-site random patient subset to establish a reference standard. Automated text processing (Text Processed Integrated (TPI)) was developed and evaluated at each site to determine the surgical approach and synthetic mesh implantation. Patients were characterized and surgical outcomes were ascertained over 730 subsequent days.</p><p><strong>Setting: </strong>Five large tertiary care academic medical centers.</p><p><strong>Participants: </strong>Across five health systems, 9,906 eligible patients (mean age 57-60 per site) were identified.</p><p><strong>Main outcome measures: </strong>Determination of surgical approach, synthetic mesh implantation, and assessment of the duration of surveillance for mortality and reoperation rates following MUS implantation.</p><p><strong>Results: </strong>In the TPI cohort analysis, 3,331 patients were identified. Surgical approach per site was retropubic (42% to 77%), transobturator (6% to 44%), single incision (0% to 24%), and adjustable sling (0% to <4%). Concordance rates for TPI using chart review were 71%-90% at each site for the surgical approach and 28%-85% for synthetic mesh implantation. Patient follow-up observation rates for mortality and reoperation ranged from 22% to 36% at 90 days, 15% to 30% at 365 days, and 8% to 19% at 730 days.</p><p><strong>Conclusion: </strong>Using EHR data alone, identification of medical devices and surgical approaches was feasible among women with MUS surgery for SUI, but long-term follow-up ascertainment rates were low. Medical device surveillance using EHR data should be evaluated in the context of the clinical use case, as applicability may vary.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000193"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insular infraorbital neurovascular pedicle labial salivary gland transplantation for the treatment of severe dry eye disease: an IDEAL stage 0, 1 and 2a study.","authors":"Ke Yang, Jing Zhou, Yinghui Wang, Yingshi Piao, Mei Li, Yun Cheng, Xiaohong Chen, Ying Jie","doi":"10.1136/bmjsit-2024-000324","DOIUrl":"10.1136/bmjsit-2024-000324","url":null,"abstract":"<p><strong>Objectives: </strong>To address the lack of nerve and blood supply after labial salivary gland transplantation (LSGT) resulting in glandular atrophy. We designed a modified LSGT, called insular infraorbital neurovascular pedicle LSGT, and evaluated the postoperative efficacy.</p><p><strong>Design: </strong>This is a prospective, single-centre, self-contained study.</p><p><strong>Setting: </strong>The research was conducted at Beijing Tongren Hospital, Capital Medical University from July 2019 to March 2024.</p><p><strong>Participants: </strong>Eight patients (nine eyes) with severe dry eye disease (DED) were enrolled in this study.</p><p><strong>Interventions: </strong>All patients underwent insular infraorbital neurovascular pedicle LSGT and were followed up for at least 6 months postoperatively.</p><p><strong>Main outcome measure: </strong>Key evaluation indices were best-corrected visual acuity (BCVA), Ocular Surface Disease Index (OSDI) score, tear break-up time (TBUT), Corneal Fluorescence Staining (CFS) score, and Schirmer I test (SIT).</p><p><strong>Results: </strong>With a mean follow-up of 17.56±11.72 months, BCVA improved in four eyes and stabilized in five. OSDI score decreased from 59.33±14.37 to 26.27±10.14 (p<0.001). SIT improved from 0.00±0.00 mm to 5.44±2.01 mm (p<0.0001). TBUT increased from 0.23±0.48 s to 5.48±4.67 s (p=0.008). CFS scores decreased from 12.56±2.65 to 7.56±3.09 (p<0.001). All glands remained viable with good blood supply, and no serious complications were observed.</p><p><strong>Conclusion: </strong>Insular infraorbital neurovascular pedicle LSGT for severe DED is a feasible and effective treatment, maintaining good secretory capacity and blood supply long-term.</p><p><strong>Trial registration number: </strong>ChiCTR2200056015.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000324"},"PeriodicalIF":2.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits, problems, and optimal timing of administration of indocyanine green fluorescence cholangiography in laparoscopic cholecystectomy.","authors":"Shinichi Kinami, Kaori Maruyama, Yuta Sannomiya, Hitoshi Saito, Hiroyuki Takamura","doi":"10.1136/bmjsit-2024-000310","DOIUrl":"10.1136/bmjsit-2024-000310","url":null,"abstract":"<p><strong>Objectives: </strong>The advantages of indocyanine green (ICG) fluorescence cholangiography have been emphasized, but its disadvantages remain unclear. This study investigated the advantages and disadvantages of this modality, particularly the optimal timing of administration of ICG fluorescence.</p><p><strong>Design: </strong>This was a retrospective analysis of prospectively collected patient data.</p><p><strong>Setting: </strong>Data were gathered from a single institution.</p><p><strong>Participants: </strong>69 patients scheduled for cholecystectomy were included.</p><p><strong>Interventions: </strong>We administered intravenous ICG injections at three different times: preoperatively (5 mg/body weight (BW), 15 min before incision), morning of the surgery (12.5 mg/BW 4 hours before surgery), and on the day before the surgery (25 mg/BW, 20 hours before surgery). The PINPOINT or SPY-PHI (Stryker) systems were used for fluorescence imaging.</p><p><strong>Main outcome measures: </strong>The course of the common bile and cystic ducts was identified using fluorescence imaging. The visualization quality was graded on a three-point scale: good, poor, and unobservable.</p><p><strong>Results: </strong>There were 17 patients for preoperative administration, 14 on the morning of the surgery, and 38 on the day before the surgery. The cystic duct could not be visualized in five patients because of insufficient dose, impacted gallstones, cystic duct stones, after endoscopic retrograde biliary drainage (ERBD), and severe cholecystitis. The observations were poor in 14 patients. The reasons for the poor visualization were cholecystitis after ERBD and a low signal-to-noise ratio due to intense light emission from the liver, which is a characteristic of preoperative administration.</p><p><strong>Conclusion: </strong>The cystic and common bile ducts were well visualized using ICG fluorescence cholangiography, except in patients with impacted gallstones, cystic duct stones, ERBD, and severe cholecystitis. The most effective timing for ICG administration was the day before the surgery. ICG fluorescence cholangiography is not a substitute for intraoperative cholangiography or preoperative biliary imaging; however, it would be desirable in all patients who undergo cholecystectomy.</p><p><strong>Trial registration number: </strong>jRCTs041180006.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000310"},"PeriodicalIF":2.1,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial experience of parenchyma-sparing liver resection with systematic selective hepatic vein reconstruction for colorectal metastases.","authors":"Yevhenii Trehub, Åsmund Avdem Fretland, Artem Zelinskyi, Dzmitrii Kharkov, Oleksii Babashev, Dmytro Chieverdiuk, Artem Shchebetun, Kyrylo Khyzhniak, Maksym Pavlovskii, Andrii Strokan, Sergii Zemskov","doi":"10.1136/bmjsit-2024-000302","DOIUrl":"10.1136/bmjsit-2024-000302","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to assess the feasibility and short-term and intermediate-term technical success rate of the concept of systematic selective hepatic vein (HV) reconstruction for parenchyma-sparing hepatectomies (PSHs) in patients with colorectal liver metastases (CRLM) in accordance with stage 2a of the IDEAL framework.</p><p><strong>Design: </strong>The prospective case series of patients deemed eligible and operated on according to the concept.</p><p><strong>Setting: </strong>All patients were treated by a single surgical team in three hospitals in Ukraine from June 2022 to November 2023.</p><p><strong>Participants: </strong>The study included nine cases of resectable CRLM with at least one lesion located in the hepatocaval confluence with HV(s) invasion, for whom reconstruction of the HV(s) allowed for additional parenchyma preservation, being an alternative to major or extended hepatectomy.</p><p><strong>Interventions: </strong>Liver resections with different types of HVs reconstruction (primary closure, patching, end-to-end anastomosis with or without grafting) were performed after a thorough evaluation of the future liver remnant volume, volume of potentially additionally preserved parenchyma and possibility of future repeat hepatectomies.</p><p><strong>Main outcome measures: </strong>Postoperative morbidity, short-term and long-term patency of the reconstructed vessels, and the volume of additionally preserved parenchyma were the focus.</p><p><strong>Results: </strong>Segmental resection was performed in four cases, two with graft interposition. Patch reconstruction was performed for three HVs and two inferior vena cava resections. Two cases required primary closure. No mortality was observed, while the major morbidity rate was 33%. The short-term and long-term patency of the reconstructed HVs was 88.9% and 66.7%, respectively. HV reconstructions allowed the preservation of additional parenchyma (mean 495.4 mL, 95% CI 350.2 to 640.7). A decision-making algorithm to be used within the described approach is proposed.</p><p><strong>Conclusions: </strong>Selective HV reconstruction is a feasible approach for PSH for CRLM. Further studies are needed to compare this approach to convenient major hepatectomies.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"6 1","pages":"e000302"},"PeriodicalIF":2.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}