Innovative Surgical Sciences最新文献

{"title":"Early enteral nutrition (EEN) following intestinal anastomosis in pediatric patients - what's new?","authors":"Sabine Drossard, Louisa Schuffert","doi":"10.1515/iss-2024-0017","DOIUrl":"10.1515/iss-2024-0017","url":null,"abstract":"<p><strong>Introduction: </strong>Abdominal surgery in children may disrupt normal gut function, necessitating prolonged fasting, which can lead to complications such as dehydration and nutritional deficits. Early enteral nutrition (EEN) after surgical procedures can enhance wound healing, prevent malnutrition, and expedite recovery. Although concerns exist regarding the risk of complications associated with EEN, current evidence suggests that it is not linked to increased perioperative complications.</p><p><strong>Content: </strong>This scoping review provides an overview of the role of EEN in pediatric abdominal surgery, exploring its benefits and risks within the context of recent literature from 2021 to 2024. A systematic literature search was conducted using the PubMed database in April 2024 and the identified studies were compared. The search revealed 586 results, wherefrom eight studies (three systematic reviews and five clinical studies) fulfilled the inclusion criteria. Five studies were added since 2021. Overall, EEN may reduce the length of hospital stay, time to full oral intake, and return of bowel function. It does not seem to increase the rate of anastomotic leakage. EEN is associated with lower rates of surgical site infections and wound dehiscence as well as fewer septic complications. One study showed an increase in nausea/vomiting and abdominal distension in the EEN group, which did not lead to further complications.</p><p><strong>Summary and outlook: </strong>Current evidence suggests that EEN after abdominal surgery in pediatric patients is not associated with a higher rate of complications. In fact, EEN seems to be beneficial and lead to improved patient outcomes and shorter hospital stays. Emphasis on patient and parent comfort, individualized feeding initiation based on clinical factors, and standardized postoperative feeding protocols are recommended to optimize outcomes in pediatric abdominal surgery.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"9 4","pages":"167-173"},"PeriodicalIF":1.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830320","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":"Management of subepithelial esophageal tumors.","authors":"Marcel A Schneider, Diana Vetter, Christian A Gutschow","doi":"10.1515/iss-2023-0011","DOIUrl":"10.1515/iss-2023-0011","url":null,"abstract":"<p><p>Subepithelial esophageal tumors (SET) are normally benign intramural esophageal lesions of mesenchymal origin. Although rare, the incidence of SET has increased in recent decades due to the more widespread use of endoscopy and diagnostic imaging. The current review aims to provide an overview of the histopathologic spectrum and the most frequent entities including leiomyoma and gastrointestinal stromal tumor (GIST), diagnostic workup, and multidisciplinary treatment options. Staging for SET should include endoscopy, endoscopic ultrasonography (EUS), and tissue sampling. Current consensus guidelines recommend that SET suggestive of gastrointestinal stromal tumor (GIST) larger than 20 mm or lesions with high-risk stigmata should undergo tissue sampling. Most SET have an excellent long-term outcome, but malignancy may be present in certain subtypes. Asymptomatic SET without high-risk stigmata discovered incidentally usually do not require specific treatment. However, depending on the size and location of the lesion symptoms may occur. Therapeutic interventions range from endoscopic interventional resections to major surgical procedures. Enucleation via minimally invasive or robotic-assisted access remains the standard of care for most SET sub-entities.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"10 1","pages":"21-30"},"PeriodicalIF":1.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721865","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":"Deep learning for automated boundary detection and segmentation in organ donation photography.","authors":"Georgios Kourounis, Ali Ahmed Elmahmudi, Brian Thomson, Robin Nandi, Samuel J Tingle, Emily K Glover, Emily Thompson, Balaji Mahendran, Chloe Connelly, Beth Gibson, Lucy Bates, Neil S Sheerin, James Hunter, Hassan Ugail, Colin Wilson","doi":"10.1515/iss-2024-0022","DOIUrl":"10.1515/iss-2024-0022","url":null,"abstract":"<p><strong>Objectives: </strong>Medical photography is ubiquitous and plays an increasingly important role in the fields of medicine and surgery. Any assessment of these photographs by computer vision algorithms requires first that the area of interest can accurately be delineated from the background. We aimed to develop deep learning segmentation models for kidney and liver organ donation photographs where accurate automated segmentation has not yet been described.</p><p><strong>Methods: </strong>Two novel deep learning models (Detectron2 and YoloV8) were developed using transfer learning and compared against existing tools for background removal (macBGRemoval, remBGisnet, remBGu2net). Anonymised photograph datasets comprised training/internal validation sets (821 kidney and 400 liver images) and external validation sets (203 kidney and 208 liver images). Each image had two segmentation labels: whole organ and clear view (parenchyma only). Intersection over Union (IoU) was the primary outcome, as the recommended metric for assessing segmentation performance.</p><p><strong>Results: </strong>In whole kidney segmentation, Detectron2 and YoloV8 outperformed other models with internal validation IoU of 0.93 and 0.94, and external validation IoU of 0.92 and 0.94, respectively. Other methods - macBGRemoval, remBGisnet and remBGu2net - scored lower, with highest internal validation IoU at 0.54 and external validation at 0.59. Similar results were observed in liver segmentation, where Detectron2 and YoloV8 both showed internal validation IoU of 0.97 and external validation of 0.92 and 0.91, respectively. The other models showed a maximum internal validation and external validation IoU of 0.89 and 0.59 respectively. All image segmentation tasks with Detectron2 and YoloV8 completed within 0.13-1.5 s per image.</p><p><strong>Conclusions: </strong>Accurate, rapid and automated image segmentation in the context of surgical photography is possible with open-source deep-learning software. These outperform existing methods and could impact the field of surgery, enabling similar advancements seen in other areas of medical computer vision.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498329","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":"Oligometastatic disease - a renaissance for surgery?","authors":"Thorsten Goetze, Mickael Chevallay, Michel Dosch, Jordan Marcelis, Salah-Eddin Al-Batran, Stefan Paul Mönig","doi":"10.1515/iss-2023-0044","DOIUrl":"10.1515/iss-2023-0044","url":null,"abstract":"<p><p>Half of the patients with esophageal cancer, cancer of the gastro-esophageal junction and gastric cancer present metastasis at the time of diagnosis. In addition, even patients originally thought to be free of metastasis will present metachronous metastasis in the course of the disease. These patients are considered incurable and current standard of care for metastatic esophageal, gastro-esophageal junction and gastric cancers is a systemic therapy without curative intention. However, patients presenting only a low metastatic load are now defined as oligometastatic disease and should benefit from an aggressive, multimodal therapy. We present here a review of recent publications investigating multimodal therapies for oligometastatic disease and showing that a systemic therapy combined with a resection of the primary tumor together with metastasis is associated with a better prognosis than a systemic therapy alone. We also give a precise focus on esophageal squamous cell carcinomas and adenocarcinomas of the gastro-esophageal junction and of the stomach. Interestingly, patients with oligometastatic cancer of the esophago-gastric junction can even be treated in curative intention with such a multimodal therapy as we present here in a short case report. In conclusion, new therapeutic strategies including multimodal approaches for oligometastatic disease have shown promising results in the last years and ongoing randomized prospective trials will provide us the evidence to include them in future European guidelines.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"10 1","pages":"51-59"},"PeriodicalIF":1.7,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721868","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":"Augmented reality and optical navigation assisted orbital surgery: a novel integrated workflow.","authors":"Nikolay Tonchev, Giulia Renieri, Klaus-Peter Stein, Belal Neyazi, Max Willgerodt, Hagen Thieme, I Erol Sandalcioglu, Karl Hartmann","doi":"10.1515/iss-2023-0064","DOIUrl":"10.1515/iss-2023-0064","url":null,"abstract":"<p><strong>Objectives: </strong>Due to the close topographical relationship of functional relevant anatomic structures, limited space and cosmetic aspects orbital surgery will remain a challenging discipline. Therefore, novel technical capabilities are necessary for further surgical progress. We here tested the integration of augmented reality and optical navigation in one workflow for interdisciplinary decision-making, feasibility and intraoperative guidance.</p><p><strong>Methods: </strong>High-resolution contrast-enhanced MRI and CT scans were automated and manual-assisted segmented to achieve a detailed three-dimensional (3D) model of the individual patho-anatomical relationships. Augmented reality was used for interdisciplinary preoperative planning and intraoperative intuitive navigation. Mayfield clamp head holder in combination with optical surface matching registration assured navigation assisted microsurgery.</p><p><strong>Results: </strong>Combinations of different MRI-sequences and CT-scans were necessary for detailed 3D-modeling. Modeling was time consuming and only viable in the hands of medical, surgical and anatomical trained staff. Augmented reality assured a quick, intuitive interdisciplinary orientation. Intraoperative surface matching registration enabled precise navigation in the orbital space.</p><p><strong>Conclusions: </strong>Optical Navigation and microscope integration achieved a straightforward microsurgical workflow and should be implemented regularly. Augmented reality represented a useful tool for preoperative interdisciplinary planning and intraoperative intuitive orientation. It further stated an excellent educational tool.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"10 2","pages":"91-98"},"PeriodicalIF":1.2,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800492","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":"Registry or randomization - must it be evidence or could it be coincidence?","authors":"Olga Radulova, Florian Oehme, Sandra Korn, Christian Praetorius, Marius Distler, Jürgen Weitz","doi":"10.1515/iss-2022-0028","DOIUrl":"10.1515/iss-2022-0028","url":null,"abstract":"<p><p>Over the years, clinical registries and randomized controlled trials gained acceptance. With increasing experience, it was possible to obtain knowledge of benefits and limitations in both designs. During the last years, the research focus was placed on new study concepts such as register-based randomized controlled trials intending to merge the benefits of evidence obtained by RCTs and clinical registers. In this review, we aim to provide an overview of the evolution and the present stage of clinical trials. While doing so, we outline past experience and look ahead toward improving models for high-quality clinical trials.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"10 2","pages":"65-71"},"PeriodicalIF":1.2,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800494","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":"Influence of medical didactic training on the self-efficacy and motivation of clinical teachers.","authors":"Franziska Schydlo, Jasmina Sterz, Maria-Christina Stefanescu, Martina Kadmon, Sarah König, Miriam Rüsseler, Felix Walcher, Farzin Adili","doi":"10.1515/iss-2023-0073","DOIUrl":"10.1515/iss-2023-0073","url":null,"abstract":"<p><strong>Objectives: </strong>Due to increasing workload and rising expectations for both undergraduate and speciality training in medicine, teaching in a clinical environment can be challenging. The \"Train the Trainer\" course, developed by CAL (Chirurgische Arbeitsgemeinschaft Lehre, Deutsche Gesellschaft für Chirurgie (DGCH)), aims to assist clinical teachers in their task. This study investigates the effect the course has on participants' self-efficacy and teaching motivation.</p><p><strong>Methods: </strong>Prior to attending the course, participants anonymously completed a 50-question pre-course questionnaire using standardised questions to gather information on biographical data teaching experience, and validated tools measuring teaching motivation and self-efficacy (PRE). Directly after completing the course, participants evaluated it using a 25-question post-course questionnaire (POST1). At least 12 months after the course, participants received a follow-up questionnaire (POST2) by mail. This 44-question form aimed to gather biographical data, review the teaching methods participants had used since their training, and reassess their teaching motivation and self-efficacy.</p><p><strong>Results: </strong>Between June 2016 and October 2019, 20 TTT courses were held across six German medical faculties. Data were gathered from 241 participants. After the course, 182 POST2 questionnaires were mailed, 61 of which were returned (equals a 39 % return rate). The findings revealed significant increases in teacher self-efficacy (p=0.0025), identified regulation (p=0.0000), and career motivation (p=0.0044). In contrast, there was a significant decrease in introjected regulation (p=0.0048). When comparing the participants to a reference sample selected from literature, significant differences emerged in intrinsic motivation (p=0.0000) and amotivation (p=0.0025).</p><p><strong>Conclusions: </strong>Course participants already showed strong intrinsic motivation and self-efficacy before taking the course. After completing it, their confidence to meet specific teaching demands based on their abilities had increased. Notably, changes in motivational dimensions identified and introjected regulation point towards a shift in motivational sources, indicating a more self-regulated approach towards participants' teaching activities. Further research is needed to determine how much of this change was due to course participation.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"9 2","pages":"99-108"},"PeriodicalIF":1.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11294303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890308","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":"A note from the Editor-in-Chief.","authors":"","doi":"10.1515/iss-2024-0011","DOIUrl":"https://doi.org/10.1515/iss-2024-0011","url":null,"abstract":"","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"9 1","pages":"1"},"PeriodicalIF":1.3,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11138400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200658","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":"What's new in surgery - essentials 2023: the ISS young surgeon issue.","authors":"Juliane Kröplin","doi":"10.1515/iss-2024-0009","DOIUrl":"10.1515/iss-2024-0009","url":null,"abstract":"","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 4","pages":"195-196"},"PeriodicalIF":1.3,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10949208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177056","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":"Imaging in reconstructive microsurgery - current standards and latest trends.","authors":"Beate Blank, Aijia Cai","doi":"10.1515/iss-2023-0040","DOIUrl":"10.1515/iss-2023-0040","url":null,"abstract":"<p><p>In microsurgery, many different imaging techniques are available in both flap and lymphatic surgery that all come with their own advantages and disadvantages. In flap surgery, CT angiography is considered as the gold standard. Among others, Doppler ultrasound, color Doppler ultrasound, ICG, and smartphone-based thermal cameras are valuable imaging techniques. In lymphatic surgery, photoacoustic imaging, laser tomography, contrast-enhanced magnetic resonance imaging, and high frequency ultrasound stand available to surgeons next to the current standard of lymphoscintigraphy. It is crucial to know the advantages and disadvantages to various techniques and highly adviced to microsurgeons be capable of using a variety of them.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 4","pages":"227-230"},"PeriodicalIF":1.3,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10949116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177055","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}