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

{"title":"Beyond structural outcomes: functional and biomechanical considerations in partial foot amputations","authors":"Mingxuan Liu, Hanjun Ma, Ju Liao, Qunqiang Luo","doi":"10.1016/j.surge.2025.09.004","DOIUrl":"10.1016/j.surge.2025.09.004","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 66-67"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132247","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":"Robotic surgery in Ireland: national governance framework and a guide to good practice","authors":"R.A. Keenan ,&nbsp;D.A. O'Keeffe ,&nbsp;A. O'Neill ,&nbsp;C.A. Fleming ,&nbsp;R. McVey ,&nbsp;T. Moran ,&nbsp;G. Fitzmaurice ,&nbsp;E. Okereke ,&nbsp;F.E. Rowan ,&nbsp;K. Barry ,&nbsp;B.B. McGuire ,&nbsp;RCSI National Robotic Surgery Leads Group","doi":"10.1016/j.surge.2025.10.007","DOIUrl":"10.1016/j.surge.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>and methods: Robotic-assisted surgery has become a cornerstone of modern surgical innovation, offering enhanced precision, minimal invasiveness, and improved recovery compared with conventional techniques. Its rapid adoption across multiple specialties in Ireland has brought substantial benefits for patients but also challenges regarding surgeon training, programme oversight, and patient safety. Until recently, Ireland lacked a unified national governance framework for robotic surgery. In recognition of this, the Royal College of Surgeons in Ireland (RCSI) established the National Robotic Surgery Leads Group in 2023, tasked with creating national standards for governance, training, and safe practice.</div></div><div><h3>Results</h3><div>This paper outlines the framework developed by the Leads Group, presenting a model that balances innovation with robust clinical governance. Central to this approach is the establishment of hospital-based Robotic Surgery Governance Committees (RSGCs), responsible for credentialing, training oversight, and monitoring key safety indicators. Training is structured around vendor-led pathways, mentorship, modular component training, and telementoring, with hybrid approaches recommended to optimise safety. Safety monitoring includes key performance indicators such as case volume, console times, transfusion rates, conversion to open surgery, ICU admissions, and morbidity and mortality outcomes. Additional considerations addressed include recognition of surgeon vulnerability during the early learning curve, emergency preparedness, case-mix management, consent processes, and the safe introduction of new robotic platforms.</div></div><div><h3>Conclusion</h3><div>A national survey of all robotic surgeons in Ireland, with a 76 % response rate, demonstrated overwhelming support for the establishment of RSGCs and KPI monitoring. This framework represents Ireland's first national governance model for robotic surgery and positions the country as a leader in fostering a culture of safety, innovation, and excellence in surgical care.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 31-38"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472420","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":"Mapping equity at the gateway to surgical training: National CST selection outcomes in 2024","authors":"Jaspreet Kaur Seehra ,&nbsp;Ricky Ellis ,&nbsp;Brett Doleman ,&nbsp;Esther McLarty ,&nbsp;Jonathan Lund","doi":"10.1016/j.surge.2025.10.005","DOIUrl":"10.1016/j.surge.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Differential attainment (DA), defined as unexplained variation in educational outcomes, persists throughout medical training. This study investigates whether demographic characteristics are associated with differences in the likelihood of receiving a Core Surgical Training (CST) offer during the 2024 UK national selection round.</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional analysis of anonymised applicant-level data from UK-wide CST recruitment was performed. All applicants with complete demographic and outcome data were included. The primary outcome was the offer of a CST training post. Logistic regression evaluated associations between offer outcomes with gender, ethnicity, nationality, age, country of qualification, and disability status.</div></div><div><h3>Results</h3><div>Applicants applying directly from FY2 were significantly more likely to receive CST offers than those from other backgrounds (RR = 1.73, 95 % CI: 1.51–2.00). Female applicants had higher odds of receiving an offer compared to male applicants (aOR = 1.44, 95 % CI: 1.19–1.74, p &lt; 0.001). Applicants identifying as Asian (OR = 0.54), black (OR = 0.31), and other/Chinese (OR = 0.67), as well as non-UK nationals (OR = 0.24), non-UK graduates (OR = 0.68), and applicants aged &gt;30 (OR = 0.39) had significantly lower odds of receiving an offer (all p &lt; 0.001). Applicants reporting disabilities had increased odds of success (OR = 3.36, 95 % CI: 1.53–7.38, p = 0.002). No significant difference was observed related to sexual orientation or pregnancy/maternity leave.</div></div><div><h3>Conclusions</h3><div>Despite structured recruitment processes and individual portfolio scoring, differential attainment persists across multiple demographic groups in CST selection. Targeted early support is essential to improve equity, especially for international medical graduates, older applicants and applicants from minoritised ethnic backgrounds.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 8-13"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379559","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":"Psoas abscess management: A multimodal approach to treatment modalities, predictors of clinical outcomes and a novel treatment algorithm\"","authors":"Tarek Khalil ,&nbsp;Nadeen Ismahel ,&nbsp;James Lucocq ,&nbsp;Lea Ng ,&nbsp;Girivasan Muthukumarasamy","doi":"10.1016/j.surge.2025.12.002","DOIUrl":"10.1016/j.surge.2025.12.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Psoas muscle abscess (PMA) is a condition with high morbidity and mortality due to diagnostic delays and varied management strategies. Standardized treatment guidelines are lacking, leading to inconsistent clinical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analysed 100 adult patients (≥18 years) diagnosed with PMA and treated at our Hospital, Dundee, between 2012 and 2022. Patients were categorized into three groups: conservative management (n = 39), CT-guided IR drainage (n = 51), and open surgery (n = 10). Data on demographics, laboratory values, microbiological findings, and clinical outcomes were collected. The primary outcome was recurrence of PMA. Secondary outcomes included mortality and factors predicting poor prognosis, such as comorbidities and microbiological findings.</div><div>Statistical analyses included logistic regression and receiver operating characteristic (ROC) analysis.</div></div><div><h3>Results</h3><div>Recurrence rates were highest in the conservative group (58.9 %) compared to the IR drainage (37.3 %, p = 0.01) and open surgery groups (30.0 %, p = 0.03). Negative cultures were associated with higher recurrence (p &lt; 0.01) and mortality (p = 0.01). <em>Staphylococcus aureus</em> was the most frequently isolated pathogen and was linked to higher mortality (p = 0.01). Chronic kidney disease (CKD ≥3) (p = 0.01) and immune suppression (p = 0.03) were significant predictors of poor outcomes.</div></div><div><h3>Conclusions</h3><div>This study highlights the limitations of conservative management for PMA, particularly in patients with negative cultures, immunosuppression, or CKD ≥3. The findings support early image-guided drainage or surgical intervention in high-risk cases. A novel treatment algorithm is proposed to enhance clinical decision-making and improve outcomes.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 43-49"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812128","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":"Does cross-sectional imaging diminish the utility of surgical handover for trainee assessment?","authors":"Liam Costello,&nbsp;Conor Toale,&nbsp;Farah Mohammed,&nbsp;Paul F. Ridgway","doi":"10.1016/j.surge.2025.04.053","DOIUrl":"10.1016/j.surge.2025.04.053","url":null,"abstract":"<div><h3>Introduction</h3><div>Workplace-based assessments have been widely adopted by surgical training bodies to assess surgical trainees. In this study, we used a handover tool to assess the diagnostic accuracy of admitting surgical trainees, and whether this was impacted by cross-sectional imaging.</div></div><div><h3>Methods</h3><div>Data was retrospectively reviewed from a prospectively maintained database. Details of 979 patients over a 7-month period were reviewed. The primary outcome was concordance between the admitting and discharge diagnoses, as recorded using the surgical handover tool.</div></div><div><h3>Results</h3><div>The concordance between the admitting and discharge diagnoses was 81.4 %. A positive association was found between diagnostic accuracy and pre-referral cross-sectional imaging (r = 0.67). Obtaining a CT scan before handover was significantly associated with higher diagnostic accuracy (p &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>Cross-sectional imaging positively affects the diagnostic accuracy of surgical trainees. Given the availability of cross-sectional imaging, this calls into question whether surgical handovers can be used to assess surgical trainees in the workplace.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 50-55"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037925","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":"Massive ingestion of water-absorbent polymer beads in an adult requiring surgical management","authors":"Solange Belinha ,&nbsp;Elizabeth Hanna ,&nbsp;Amira Orabi,&nbsp;Shayanthan Nanthakumaran,&nbsp;Campbell Macleod","doi":"10.1016/j.surge.2025.08.006","DOIUrl":"10.1016/j.surge.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of intentional foreign body ingestion is rising in the UK, with water-absorbent polymer beads (WAPBs) increasingly implicated in children. While commonly used in horticulture and as toys, WAPBs can pose serious risks when ingested. This report details a unique case of massive WAPB ingestion in an adult, emphasizing the potential complications and management challenges.</div></div><div><h3>Case report</h3><div>A 60-year-old male presented with severe abdominal pain, nausea, and vomiting after ingesting an estimated 25,000 WAPBs. CT imaging showed a massive volume of WAPBs throughout the gastrointestinal (GI) tract, and free fluid around the duodenum likely due to reactive pancreatitis. An emergency laparotomy was performed due to the risk of impending perforation. At laparotomy, a gastrostomy and 2 enterotomies were made to remove as many WAPBs as possible. A loop ileostomy was formed due to ongoing retention of the beads and risk of obstruction. Post-operatively, the patient was placed on total parenteral nutrition and the remaining WAPBs passed through the ileostomy. Further imaging revealed ongoing pancreatitis and a peripancreatic collection, which was managed conservatively. The patient was discharged two months after surgery.</div></div><div><h3>Discussion</h3><div>This case represents the first documented instance of massive WAPB ingestion in an adult. It highlights the significant risks associated with ingesting large quantities of WAPBs, including GI obstruction and pancreatitis. Early surgical intervention was critical in preventing further complications, as endoscopic removal was impractical given the volume.</div></div><div><h3>Conclusions</h3><div>Massive ingestion of WAPBs poses significant health risks and may necessitate prompt surgical management. This case underscores the importance of timely intervention to prevent severe outcomes associated with large volumes of ingested WAPBs.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 63-65"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056108","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":"Childcare provision for on-call workers in the NHS: Is the 24/7 service ideal matched by reality?","authors":"David Cain ,&nbsp;Blaise Hickson ,&nbsp;Paul Parker","doi":"10.1016/j.surge.2025.10.004","DOIUrl":"10.1016/j.surge.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>The National Health Service (NHS) in the UK aims to deliver healthcare services around the clock. Major Trauma Centres (MTCs) are crucial in this operation, requiring continual 24/7 operations. Despite efforts to provide on-site nurseries catering to children aged 3 months to 5 years, there remains a significant gap in childcare provision for on-call workers. This shortfall particularly affects surgeons, nurses and military medical personnel whose shifts extend beyond standard nursery operating hours. This discrepancy raises concerns about the sufficiency of support for healthcare professionals with irregular schedules.</div></div><div><h3>Aims</h3><div>This study delves into the existing childcare facilities in NHS major trauma centres, aiming to identify challenges faced by on-call workers and propose strategies to bridge this childcare gap. By addressing these issues, the study contributes to discussions on how to best support healthcare professionals working 24/7 while ensuring the well-being of their children.</div></div><div><h3>Methods</h3><div>The research involved a review of in-house childcare facilities across all 27 MTCs in England. Data from named nurseries affiliated with the MTC official NHS websites were examined, including nursery names, capacity, operating hours, and available services such as weekend placements and emergency out-of-hours cover.</div></div><div><h3>Results</h3><div>Results showed that out of 27 MTCs, 26 had on-site nurseries. However, only a fraction of these operated beyond standard hours, with none offering emergency or weekend services. This highlighted a significant deficit in comprehensive childcare support. The lack of childcare services tailored to the irregular schedules of NHS workers might impact career choices. This discrepancy sharply contrasts with childcare benefits provided in the private sector and government settings.</div></div><div><h3>Conclusion</h3><div>The current NHS childcare provision falls short of meeting the demands of a 24/7 service, posing challenges for on-call workers. This underscores the urgent need for 24-h childcare facilities that align with the operational requirements of the NHS. Reforms in this critical area are imperative to address these shortcomings.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 14-17"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356658","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 role for dedicated Periprosthetic Joint Infection (PJI) specialist centres in Ireland","authors":"Patrick Nolan ,&nbsp;Concepta Merry ,&nbsp;Susie Clarke ,&nbsp;Tom McCarthy ,&nbsp;Joseph Queally ,&nbsp;Andrew J. Hughes","doi":"10.1016/j.surge.2025.09.009","DOIUrl":"10.1016/j.surge.2025.09.009","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 68-69"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497421","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(26)00005-3","DOIUrl":"10.1016/S1479-666X(26)00005-3","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Page i"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026276","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":"Diversity in core surgical training: Trends between 2012 and 2022","authors":"Matthew Newman,&nbsp;Neil Scott,&nbsp;Phyo Kyaw Myint,&nbsp;Ricky Ellis","doi":"10.1016/j.surge.2025.09.002","DOIUrl":"10.1016/j.surge.2025.09.002","url":null,"abstract":"<div><h3>Background and purpose</h3><div>A diverse healthcare workforce is an important goal in ensuring that services reflect and meet the needs of a diverse population. Core Surgical Training (CST) is the first stage of surgical training in the UK, but diversity trends at this level have not been previously described. We aim to describe trends in gender, ethnicity, disability, and sexuality among successful CST applicants between 2012 and 2022.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using anonymised data from the UK Medical Education Database (UKMED) for all successful CST applicants between 2012 and 2022. Chi-squared tests for trend were used to assess statistically significant changes in demographic characteristics over time. Data were categorised and missing data excluded as per pre-specified protocols.</div></div><div><h3>Results</h3><div>The proportion of Non-White CST entrants rose from 36.5 % in 2012 to 54.3 % in 2022 (X² = 124.421, p &lt; 0.001). Entrants declaring a disability increased from 4.8 % in 2016 to 10.4 % in 2019 (X² = 22.225, p = 0.014). No significant trends were observed for gender (X² = 15.338, p = 0.120) or sexuality (X² = 9.880, p = 0.451).</div></div><div><h3>Conclusions</h3><div>This study highlights positive trends in the ethnic and disability diversity of successful CST applicants over the past decade. However, gender and sexuality diversity showed no significant change. Further research is needed to explore barriers to entry and ensure continued progress towards an inclusive surgical workforce.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 1-7"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076477","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}