Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"Pitfalls of crude pooling in assessing diagnostic accuracy: A cautionary note.","authors":"Javier Arredondo Montero","doi":"10.1016/j.surge.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.surge.2025.05.005","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318480","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":"Ultrasound-guided versus laparoscopic-guided transversus abdominus plane block for laparoscopic cholecystectomy - A systematic review and meta-analysis of randomised clinical trials.","authors":"Matthew G Davey, Gordon R Daly, Noel E Donlon, Nuala A Healy, Arnold D K Hill","doi":"10.1016/j.surge.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.surge.2025.05.003","url":null,"abstract":"<p><strong>Background: </strong>The use of transversus abdominus plane (TAP) blocks have come into vogue in recent times, with the ambition to reduce post-operative pain following laparoscopic cholecystectomy. TAP block is commonly performed using an ultrasound-guided approach (US-TAP), with emerging data indicating that laparoscopic-guided (L-TAP) approach may also be useful.</p><p><strong>Aim: </strong>To perform a systematic review and meta-analysis of randomised clinical trials (RCTs) comparing outcomes following US-TAP and L-TAP block in patients undergoing laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>A systematic review was performed in accordance with PRISMA guidelines. Meta-analysis was performed using Review Manager version 5.4.</p><p><strong>Results: </strong>6 RCTs including 428 patients were included. Overall, 212 patients were randomised to US-TAP (49.5 %) and 216 to L-TAP (50.5 %) respectively. A non-significant difference was observed between groups for mean age, gender, mean body mass indices, and American Society of Anesthesiologists grades (all P > 0.050). At meta-analyses, a non-significant difference was observed for US-TAP and L-TAP with respect to 2-, 6-, 12-, 24-, and 48-h post-operative visual analogue scores. A non-significant difference was also observed in relation to intraoperative duration, breakthrough opioid consumption, and post-operative vomiting, at meta-analysis. Patients who underwent US-TAP had longer anesthetic administration times (mean difference: 6.38, 95 % confidence interval: 2.77-10.00, P < 0.001) compared to those randomised to undergo L-TAP.</p><p><strong>Conclusion: </strong>L-TAP and US-TAP provided similar post-operative pain scores, intraoperative duration, breakthrough opioid consumption, and post-operative vomiting following laparoscopic cholecystectomy. However, the time taken to perform L-TAP was significantly shorter. Should expertise allow, L-TAP should be considered in patients undergoing laparoscopic cholecystectomy.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227376","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":"Knowledge gaps and radiation exposure concerns: Time for a revamp of radiation training structures for trainee surgeons.","authors":"Lylas Aljohmani, Aoife Gaffney, Linda Kelly, Lucy-Anne O'Sullivan, Eunice Leyva, Michael O'Connor, Jackie McCavana, Eric Heffernan, Christine Quinlan, Roisin Dolan","doi":"10.1016/j.surge.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.surge.2025.05.002","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess surgical trainee knowledge of occupational radiation exposure, personal protection equipment (PPE) compliance, and prior radiation protection training.</p><p><strong>Design: </strong>A cross-sectional quantitative study using a questionnaire-based survey.</p><p><strong>Setting: </strong>Tertiary care hospitals in Ireland.</p><p><strong>Participants: </strong>79 surgical trainees across six surgical disciplines, with a 70 % response rate.</p><p><strong>Results: </strong>Seventy-nine of 112 surgical trainees (70 %) completed the survey. Most were specialist registrars (47 %), with orthopaedics, plastic surgery, and urology comprising 70 % of respondents. Although 78 % had attended a radiation safety course, 40 % lacked fluoroscopy-specific training. Knowledge gaps were evident-60 % of questions were commonly answered incorrectly, with only 11 % correctly identifying CT radiation dose. Despite frequent fluoroscopy use, dosimeter use was poor: only 7.6 % always wore one. Prior training correlated with increased PPE use and awareness of long-term radiation risks, including fertility concerns. While 67 % expressed concern about exposure, only 21.5 % said it influenced speciality choice. The most used PPE was lead skirt/top (72 %), followed by thyroid shield (52 %), while lead glasses and gloves were rarely worn.</p><p><strong>Conclusion: </strong>Significant knowledge gaps and low PPE compliance were observed amongst surgical trainees. Given the strong desire for further training, we recommend a modernised, interactive national radiation safety training program tailored to surgical specialities.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188385","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":"POSE-UK: Paediatric orthopaedic surgery exposure in the UK.","authors":"Chloe Jane Lowe, Jun Wei Lim, Stephanie Buchan, Anouska Ayub, Felicity Pease, Emily Baird","doi":"10.1016/j.surge.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.surge.2025.04.003","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to investigate the early exposure of orthopaedic trainees to paediatric orthopaedics and explore their training experiences, focusing on the factors influencing their decision to either select or deselect paediatric orthopaedics as a subspecialty.</p><p><strong>Method: </strong>A national survey was distributed electronically to members of the British Orthopaedic Trainees' Association following a pilot survey sent to British Society of Children's Orthopaedic Surgery members. The survey concentrated on trainees' experiences and interest in paediatric orthopaedics. It included open, closed, and free-text questions, with the responses thematically analysed using NVivo software.</p><p><strong>Results: </strong>133 responses were received from trainees across the UK and Ireland. The findings showed significant variation in the timing of the first exposure to paediatric orthopaedics, with 25 % not encountering it until Specialty Trainee level 6 or later. Most participants had mixed placements involving both adult and paediatric orthopaedics. Limited theatre exposure and insufficient emphasis on paediatric orthopaedic surgery during training may contribute to a lack of interest. A worrying lack of confidence was noted amongst trainees in performing standard emergency paediatric orthopaedic procedures, which are expected competencies for newly appointed consultants, regardless of their intended subspecialty. Furthermore, many trainees indicated that they might not meet the required work-based assessments and indicative numbers necessary to complete training.</p><p><strong>Conclusion: </strong>Earlier and more extensive exposure to paediatric orthopaedics during training could help foster greater interest in the subspecialty. Enhanced training in standard emergency paediatric orthopaedic presentations is essential to ensure trainees are confident in performing these procedures as newly appointed general orthopaedic consultants.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182950","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":"Intern involvement in emergency general surgical handover and implications for patient care.","authors":"Niall Murnaghan, Jessica M Ryan, William P Duggan, Deborah A McNamara","doi":"10.1016/j.surge.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.surge.2025.05.004","url":null,"abstract":"<p><strong>Background: </strong>Surgical handover is a key risk area in patient care, yet the impact of junior team member involvement in the process is not well understood. This study aims to assess the level of intern involvement in emergency general surgery (EGS) handover and its impact on daily tasks.</p><p><strong>Methods: </strong>Overt, structured, non-participant observations of morning EGS handover meetings were carried out to assess intern involvement. The same interns were then observed over the course of the day-shift immediately following the handover. During these observation periods, details of all patient care queries addressed to the interns were recorded.</p><p><strong>Results: </strong>Five general surgery interns (42%) were observed across six EGS handover meetings. A total of 100 clinical queries were recorded during 25 h of observation. Only 2/6 handover meetings had full intern involvement. While all appeared to be actively listening during handover, questions were asked, and readbacks were provided by interns during 4/6 and 3/6 handovers, respectively. Clinical queries directed at interns who were fully involved in the morning handover were more likely to be answered immediately (96.6 %,n = 29 vs. 78.6 %,n = 55; p = 0.024) and using memory of the verbal handover (50 %,n = 15 vs 24.3 %,n = 17; p = 0.012). One incidence of negligible harm occurred, due to omission of a patient's allergy information from the handover.</p><p><strong>Conclusion: </strong>Interns who are fully involved in handover show evidence of learning and are more likely to respond to queries faster and from memory. Reduced involvement in the post-call handover process has the potential to delay, and therefore negatively impact, patient care.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163456","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 impact of direct consultant-to-consultant referrals on the spinal care pathway: A clinical audit.","authors":"Arnav Barve, Paul McCarroll, Kevin Clesham, Harry Marland, Jake M McDonnell, Stacey Darwish, Marcus Timlin, Sam Lynch, Seamus Morris, Joseph S Butler, Keith Synnott","doi":"10.1016/j.surge.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.surge.2025.05.001","url":null,"abstract":"<p><strong>Background: </strong>The institution in focus is a tertiary referral centre for all spinal pathology in the country. Traditionally, referrals to this centre have been reviewed by an on-call resident at the referring hospital. However, on May 10, 2023, this changed to a direct consultant-to-consultant referral protocol. This study aims to evaluate the impact of this change in protocol on the spinal care pathway.</p><p><strong>Methods: </strong>A retrospective review was conducted based on patients with spinal pathology referred to the tertiary centre from February 2023 to August 2023. Referrals made using the traditional referral system ('Before' from 08/02/2023-09/05/2023) were compared to referrals made through the consultant-led referral system ('After' from 10/05/2023-08/08/2023). Parameters such as the number of referrals, number of surgically managed patients, and patients with complete imaging at the time of referral (TOR) were statistically compared between the groups.</p><p><strong>Results: </strong>There were 31.2 % fewer referrals in the 'After' group (223) than in the 'Before' group (324). The proportion of patients with complete imaging at TOR increased significantly (67.3 % vs. 81.6 %, p < 0.05). Also, the number of patients who were treated surgically increased significantly (33.3 % vs. 40.4 %, p < 0.05). Furthermore, the number of patients referred for follow-up to the outpatient department (OPD) decreased significantly (5.2 % vs. 0.9 %; p < 0.05).</p><p><strong>Conclusion: </strong>The consultant-to-consultant referral protocol decreased the overall referral numbers, increased the number of patients with complete imaging, increased the surgical yield, and decreased the rates of OPD follow-up. This can be attributed to more efficient consultant-led local decision-making, which fortifies the benefits of this referral protocol.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163530","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":"Small bowel obstruction secondary to peritoneal tuberculosis: A case report.","authors":"Marcus James Renshaw, Pete John Webster","doi":"10.1016/j.surge.2025.04.027","DOIUrl":"https://doi.org/10.1016/j.surge.2025.04.027","url":null,"abstract":"<p><p>Extrapulmonary Tuberculosis (EPTB) can affect many organ systems, including the gastrointestinal (GI) tract. Here, it may manifest as intestinal, peritoneal, hepato-pancreato-biliary TB, or as TB lymphadenitis. We report a case of small bowel obstruction secondary to peritoneal TB deposits in a patient who had previous received BCG vaccination. The patient was managed with emergency laparotomy and received TB treatment post-operatively. This article highlights the innocuous presentation of peritoneal TB and difficulties obtaining a diagnosis. Furthermore, we review the efficacy of the BCG vaccine and remind the reader of the importance of a travel history in the acute abdomen setting.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144230","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":"Fit for Purpose: Does radiation personal protective equipment provision match the requirements of our trauma and orthopaedics surgical workforce?","authors":"Hannah Sevenoaks ,&nbsp;Joanna Richards ,&nbsp;Sophie Howles ,&nbsp;Louise McMenemy ,&nbsp;Robyn Brown ,&nbsp;Lorraine Murphy ,&nbsp;Deepa Bose ,&nbsp;David S. Johnson ,&nbsp;North West Orthopaedic Research Collaborative ,&nbsp;West Midlands Orthopaedic Research Collaborative ,&nbsp;Wessex Orthopaedic Learning Forum ,&nbsp;Bristol Orthopaedic Registrars Group","doi":"10.1016/j.surge.2025.04.028","DOIUrl":"10.1016/j.surge.2025.04.028","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of ionising radiation for fluoroscopic interventions is widespread across many surgical specialities. Employers have a legal responsibility to ensure healthcare workers are appropriately protected from this hazard, with one component of this being provision of radiation personal protective equipment (PPE).</div></div><div><h3>Methods</h3><div>Independent studies were undertaken across four regions of England in 2023 (North West (NW), Wessex, West Midlands and Severn) in 35 hospital trusts to catalogue and evaluate radiation PPE provision in theatres. Size and appropriateness of radiation PPE for surgeon use (i.e. wrap-around protection and ≥0.25 mm lead weight equivalence (LWE)) was correlated with size requirements of the workforce.</div></div><div><h3>Results</h3><div>For all radiation PPE in orthopaedic theatres 67.4 % (n = 844/1253) did not meet the standard of providing 0.25 mm LWE wrap around torso protection. Approximately one third (33.9 %) of all surgeons (n = 294/865) in NW, Wessex or West Midlands were unable to access a wrap around gown of size appropriate to them. We found a mismatch in the size of the radiation PPE provision and the size requirements of all surgeons irrespective of gender, which particularly affected those using the larger and smaller sizes of gown.</div></div><div><h3>Conclusions</h3><div>Provision of radiation PPE for orthopaedic surgeons across four large regions of England is inadequate. We encourage all trusts and surgeons to appraise their current provision.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 4","pages":"Pages 225-228"},"PeriodicalIF":2.3,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095497","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":"List of editors","authors":"","doi":"10.1016/S1479-666X(25)00104-0","DOIUrl":"10.1016/S1479-666X(25)00104-0","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 3","pages":"Page i"},"PeriodicalIF":2.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071920","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":"Call Yourself a Surgeon? The use of the title surgeon among non-surgical cosmetic practitioners in the United Kingdom.","authors":"James Olding, Rohan Shankarghatta, Bachun Cheema, Nafeesa Hussain, Hassan Hussain, Alessandra Kuhn Dall'Magro, Ashraf Messiha","doi":"10.1016/j.surge.2025.04.050","DOIUrl":"https://doi.org/10.1016/j.surge.2025.04.050","url":null,"abstract":"<p><strong>Background: </strong>The global growth in cosmetic procedures has generated ongoing debate around what constitutes a medical procedure. Non-surgical procedures account for the majority of all cosmetic treatments performed, however in many jurisdictions, regulatory frameworks have not kept pace. In the United Kingdom, the term surgeon has partial protection in law in a medical context, being restricted to medical doctors registered with the General Medical Council (GMC). UK law thus permits all medically qualified doctors to call themselves surgeons. This sets up a conflict with multiple Codes of Conduct and Regulatory guidance documents, which set out clear definitions of what constitutes a surgeon.</p><p><strong>Methods: </strong>We conducted a review of a public database including 350 non-surgical aesthetics doctors, identifying, practitioners presenting as surgeons. Information was checked against the GMC register, and guidance form Advertising Standards Authority Guidance and the Royal College of Surgeons of England.</p><p><strong>Results: </strong>We found that 62 % of practitioners presenting as surgeons did not meet the identified criteria in regulatory guidance. These consisted in practising surgeons without specialist registration (equivalent to board certification), hair restoration surgery practitioners, and practitioners solely offering non-surgical treatments.</p><p><strong>Discussion: </strong>Collaborative dialogue across surgical and medical aesthetics sectors is needed to agree accepted terminology in medical and surgical aesthetics practice. This is crucial to both empower patient choice and to allow aesthetics practitioners to meaningfully convey their previous experience and training, which may have been in a surgical setting. Doctors who have not undertaken surgical training should avoid terminology that could confuse patients.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081511","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}